ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia

Torres A, Cilloniz C, Niederman MS et al (2021) Pneumonia. Nat Rev Dis Primers 7:25. https://doi.org/10.1038/s41572-021-00259-0 Ferrer M, Travierso C, Cilloniz C et al (2018) Severe community-acquired pneumonia: characteristics and prognostic factors in ventilated and non-ventilated patients. PLoS ONE 13:e0191721 Kolditz M, Ewig S, Klapdor B et al (2015) Community-acquired pneumonia as medical emergency: predictors of early deterioration. Thorax 70:551–558. https://doi.org/10.1136/thoraxjnl-2014-206744 Martin-Loeches I, Garduno A, Povoa P et al (2022) Choosing antibiotic therapy for severe community-acquired pneumonia. Curr Opin Infect Dis 35:133–139. https://doi.org/10.1097/QCO.0000000000000819 Simonetti AF, Garcia-Vidal C, Viasus D et al (2016) Declining mortality among hospitalized patients with community-acquired pneumonia. Clin Microbiol Infect 22(567):e1-567.e7. https://doi.org/10.1016/j.cmi.2016.03.015 Cavallazzi R, Furmanek S, Arnold FW et al (2020) The burden of community-acquired pneumonia requiring admission to ICU in the United States. Chest 158:1008–1016. https://doi.org/10.1016/j.chest.2020.03.051 Cilloniz C, Ferrer M, Liapikou A et al (2018) Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia. Eur Respir J 51:1702215. https://doi.org/10.1183/13993003.02215-2017 Jain S, Self WH, Wunderink RG et al (2015) Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med 373:415–427. https://doi.org/10.1056/NEJMoa1500245 Rouzé A, Martin-Loeches I, Povoa P et al (2021) Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med 47:188–198. https://doi.org/10.1007/s00134-020-06323-9 Metlay JP, Waterer GW, Long AC et al (2019) Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 200:e45–e67. https://doi.org/10.1164/rccm.201908-1581ST Menéndez R, Cilloniz C, España PP et al (2020) Neumonía adquirida en la comunidad. Normativa de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Actualización 2020. Arch Bronconeumol 56(1):1–10. https://doi.org/10.1016/j.arbres.2020.01.014 Mandell LA, Wunderink RG, Anzueto A et al (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44(Suppl. 2):S27–S72. https://doi.org/10.1086/511159 Ramirez JA, Musher DM, Evans SE et al (2020) Treatment of community-acquired pneumonia in immunocompromised adults. Chest 158:1896–1911. https://doi.org/10.1016/j.chest.2020.05.598 Brożek JL, Akl EA, Jaeschke R et al (2009) Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies. Allergy 64:1109–1116. https://doi.org/10.1111/j.1398-9995.2009.02083.x Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097 Nagavci B, Tonia T, Bush A, et al. (2021) ERS Handbook for Clinical Practice Guidelines: Methodological Guidance for Developing ERS Clinical Practice Guidelines [1.0]. Date last updated: November 2021. www.ersnet.org/science-and-research/development-programme/ers-clinical-practice-guidelines-statements-and-technical-standards/ Guyatt GH, Oxman AD, Kunz R et al (2011) GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 64:395–400. https://doi.org/10.1016/j.jclinepi.2010.09.012 Higgins JPT, Altman DG, Gotzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928 Deeks JJ, Higgins JPT, Altman DG (2021) Chapter 10: analysing data and undertaking meta-analyses. In: Higgins JPT, Thomas J, Chandler J et al (eds) Cochrane Handbook for Systematic reviews of interventions. Version 6.2, updated February 2021. Cochrane, 2021. www.training.cochrane.org/handbook Alonso-Coello P, Schünemann HJ, Moberg J et al (2016) GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ 353:i2016. https://doi.org/10.1136/bmj.i2016 Guyatt G, Oxman AD, Akl EA et al (2011) GRADE guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64:383–394. https://doi.org/10.1016/j.jclinepi.2010.04.026 Andrews J, Guyatt G, Oxman AD et al (2013) GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol 66:719–725. https://doi.org/10.1016/j.jclinepi.2012.03.013 Guyatt GH, Alonso-Coello P, Schünemann HJ et al (2016) Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group. J Clin Epidemiol 80:3–7. https://doi.org/10.1016/j.jclinepi.2016.07.006 Alimi Y, Lim WS, Lansbury L et al (2017) Systematic review of respiratory viral pathogens identified in adults with community-acquired pneumonia in Europe. J Clin Virol 95:26–35. https://doi.org/10.1016/j.jcv.2017.07.019 Brendish NJ, Malachira AK, Armstrong L et al (2017) Routine molecular point-of-care testing for respiratory viruses in adults presenting to hospital with acute respiratory illness (ResPOC): a pragmatic, open-label, randomised controlled trial. Lancet Respir Med 5:401–411. https://doi.org/10.1016/S2213-2600(17)30120-0 Webb BJ, Sorensen J, Mecham I et al (2019) Antibiotic use and outcomes after implementation of the drug resistance in pneumonia score in ED patients with community-onset pneumonia. Chest 156:843–851. https://doi.org/10.1016/j.chest.2019.04.093 Jones BE, Ying J, Stevens V et al (2020) Empirical anti-MRSA vs standard antibiotic therapy and risk of 30-day mortality in patients hospitalized for pneumonia. JAMA Intern Med 180:552–560. https://doi.org/10.1001/jamainternmed.2019.7495 Klein M, Bacher J, Barth S et al (2021) Multicenter evaluation of the Unyvero platform for testing bronchoalveolar lavage fluid. J Clin Microbiol 59:e02497-e2520. https://doi.org/10.1128/JCM.02497-20 Murphy CN, Fowler R, Balada-Llasat JM et al (2020) Multicenter evaluation of the BioFire FilmArray pneumonia/pneumonia plus panel for detection and quantification of agents of lower respiratory tract infection. J Clin Microbiol 58:e00128-e220. https://doi.org/10.1128/JCM.00128-20 Webb BJ, Sorensen J, Jephson A et al (2019) Broad-spectrum antibiotic use and poor outcomes in community-onset pneumonia: a cohort study. Eur Respir J 54:1900057. https://doi.org/10.1183/13993003.00057-2019 Mayer LM, Kahlert C, Rassouli F et al (2017) Impact of viral multiplex real-time PCR on management of respiratory tract infection: a retrospective cohort study. Pneumonia 9:4. https://doi.org/10.1186/s41479-017-0028-z Pickens C, Wunderink RG, Qi C et al (2020) A multiplex polymerase chain reaction assay for antibiotic stewardship in suspected pneumonia. Diagn Microbiol Infect Dis 98:115179. https://doi.org/10.1016/j.diagmicrobio.2020.115179 Buchan BW, Windham S, Balada-Llasat J-M et al (2020) Practical comparison of the BioFire FilmArray pneumonia panel to routine diagnostic methods and potential impact on antimicrobial stewardship in adult hospitalized patients with lower respiratory tract infections. J Clin Microbiol 58:e00135-e220. https://doi.org/10.1128/JCM.00135-20 Paonessa JR, Shah RD, Pickens CI et al (2019) Rapid detection of methicillin-resistant Staphylococcus aureus in BAL: a pilot randomized controlled trial. Chest 155:999–1007. https://doi.org/10.1016/j.chest.2019.02.007 Parke RL, McGuinness SP (2013) Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle. Respir Care 58:1621–1624. https://doi.org/10.4187/respcare.02358 Corley A, Caruana LR, Barnett AG et al (2011) Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth 107:998–1004. https://doi.org/10.1093/bja/aer265 Natalini D, Grieco DL, Santantonio MT et al (2019) Physiological effects of high-flow oxygen in tracheostomized patients. Ann Intensive Care 9:114. https://doi.org/10.1186/s13613-019-0591-y Möller W, Feng S, Domanski U et al (2017) Nasal high flow reduces dead space. J Appl Physiol 122:191–197. https://doi.org/10.1152/japplphysiol.00584.2016 Möller W, Celik G, Feng S et al (2015) Nasal high flow clears anatomical dead space in upper airway models. J Appl Physiol 118:1525–1532. https://doi.org/10.1152/japplphysiol.00934.2014 Schultz MJ, Roca O, Shrestha GS (2021) Global lessons learned from COVID-19 mass casualty incidents. Br J Anaesth 128:e97–e100. https://doi.org/10.1016/j.bja.2021.10.040 Sztrymf B, Messika J, Bertrand F et al (2011) Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med 37:1780–1786. https://doi.org/10.1007/s00134-011-2354-6 Parke RL, McGuinness SP, Eccleston ML (2011) A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients. Respir Care 56:265–270. https://doi.org/10.4187/respcare.00801 Sim MAB, Dean P, Kinsella J et al (2008) Performance of oxygen delivery devices when the breathing pattern of respiratory failure is simulated. Anaesthesia 63:938–940. https://doi.org/10.1111/j.1365-2044.2008.05536.x Tobin MJ, Laghi F, Jubran A (2020) P-SILI is not justification for intubation of COVID-19 patients. Ann Intensive Care 10:105. https://doi.org/10.1186/s13613-020-00724-1 Grieco DL, Menga LS, Raggi V et al (2020) Physiological comparison of high-flow nasal cannula and helmet noninvasive ventilation in acute hypoxemic respiratory failure. Am J Respir Crit Care Med 201:303–312. https://doi.org/10.1164/rccm.201904-0841OC Confalonieri M, Potena A, Carbone G et al (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. Am J Respir Crit Care Med 160:1585–1591. https://doi.org/10.1164/ajrccm.160.5.9903015 Hilbert G, Gruson D, Vargas F et al (2001) Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 344:481–487. https://doi.org/10.1056/NEJM200102153440703 Cosentini R, Brambilla AM, Aliberti S et al (2010) Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia. Chest 138:114–120. https://doi.org/10.1378/chest.09-2290 Brambilla AM, Aliberti S, Prina E et al (2014) Helmet CPAP vs oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Med 40:942–949. https://doi.org/10.1007/s00134-014-3325-5 Frat J-P, Thille AW, Mercat A et al (2015) High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 372:2185–2196. https://doi.org/10.1056/NEJMoa1503326 Lemiale V, Mokart D, Resche-Rigon M et al (2015) Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure. JAMA 314:1711–1719. https://doi.org/10.1001/jama.2015.12402 Martin-Loeches I, Arabi Y, Citerio G (2021) If not now, when? A clinical perspective on the unprecedented challenges facing ICUs during the COVID-19 pandemic. Intensive Care Med 47:588–590. https://doi.org/10.1007/s00134-021-06404-3 Gaillat J, Bru JP, Sedallian A (1994) Penicillin G/ofloxacin versus erythromycin/amoxicillin-clavulanate in the treatment of severe community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 13:639–644. https://doi.org/10.1007/BF01973989 Wilson BZ, Anzueto A, Restrepo MI et al (2012) Comparison of two guideline-concordant antimicrobial combinations in elderly patients hospitalized with severe community-acquired pneumonia. Crit Care Med 40:2310–2314. https://doi.org/10.1097/CCM.0b013e31825151a8 Mortensen EM, Restrepo MI, Anzueto A et al (2005) The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia. Crit Care 10:R8. https://doi.org/10.1186/cc3934 Martin-Loeches I, Lisboa T, Rodriguez A et al (2010) Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia. Intensive Care Med 36:612–620. https://doi.org/10.1007/s00134-009-1730-y Ceccato A, Cilloniz C, Ranzani OT et al (2017) Treatment with macrolides and glucocorticosteroids in severe community-acquired pneumonia: a post-hoc exploratory analysis of a randomized controlled trial. PLoS ONE 12:e0178022 Adrie C, Schwebel C, Garrouste-Orgeas M et al (2013) Initial use of one or two antibiotics for critically ill patients with community-acquired pneumonia: impact on survival and bacterial resistance. Crit Care 17:R265. https://doi.org/10.1186/cc13095 Hansen MP, Scott AM, McCullough A et al (2019) Adverse events in people taking macrolide antibiotics versus placebo for any indication. Cochrane Database Syst Rev 1:CD011825 Fish DN (2001) Fluoroquinolone adverse effects and drug interactions. Pharmacotherapy 21:253S-272S. https://doi.org/10.1592/phco.21.16.253S.33993 Martin-Loeches I, Dickson R, Torres A et al (2020) The importance of airway and lung microbiome in the critically ill. Crit Care 24:537. https://doi.org/10.1186/s13054-020-03219-4 Bratzler DW, Ma A, Nsa W (2008) Initial antibiotic selection and patient outcomes: observations from the National Pneumonia Project. Clin Infect Dis 47:S193–S201. https://doi.org/10.1086/591404 Frei CR, Restrepo MI, Mortensen EM et al (2006) Impact of guideline-concordant empiric antibiotic therapy in community-acquired pneumonia. Am J Med 119:865–871. https://doi.org/10.1016/j.amjmed.2006.02.014 Houck PM, MacLehose RF, Niederman MS et al (2001) Empiric antibiotic therapy and mortality among medicare pneumonia inpatients in 10 Western States. Chest 119:1420–1426. https://doi.org/10.1378/chest.119.5.1420 Karhu J, Ala-Kokko TI, Ohtonen P et al (2013) Severe community-acquired pneumonia treated with β-lactam-respiratory quinolone vs β-lactam-macrolide combination. Acta Anaesthesiol Scand 57:587–593. https://doi.org/10.1111/aas.12081 Mortensen EM, Halm EA, Pugh MJ et al (2014) Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. JAMA 311:2199–2208 Waterer GW, Somes GW, Wunderink RG (2001) Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med 161:1837–1842. https://doi.org/10.1001/archinte.161.15.1837 Naucler P, Darenberg J, Morfeldt E et al (2013) Contribution of host, bacterial factors and antibiotic treatment to mortality in adult patients with bacteraemic pneumococcal pneumonia. Thorax 68:571–579. https://doi.org/10.1136/thoraxjnl-2012-203106 Mongardon N, Max A, Bouglé A et al (2012) Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive care unit: a multicenter study. Crit Care 16:R155. https://doi.org/10.1186/cc11471 Schuetz P, Wirz Y, Sager R et al (2017) Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 10:CD007498 Schuetz P, Wirz Y, Sager R et al (2018) Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis 18:95–107. https://doi.org/10.1016/S1473-3099(17)30592-3 Nobre V, Harbarth S, Graf J-D et al (2008) Use of procalcitonin to shorten antibiotic treatment duration in septic patients. Am J Respir Crit Care Med 177:498–505. https://doi.org/10.1164/rccm.200708-1238OC Bouadma L, Luyt C-E, Tubach F et al (2010) Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 375:463–474. https://doi.org/10.1016/S0140-6736(09)61879-1 de Jong E, van Oers JA, Beishuizen A et al (2016) Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis 16:819–827. https://doi.org/10.1016/S1473-3099(16)00053-0 Rodríguez AH, Avilés-Jurado FX, Díaz E et al (2016) Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: a CHAID decision-tree analysis. J Infect 72:143–151. https://doi.org/10.1016/j.jinf.2015.11.007 Muthuri SG, Venkatesan S, Myles PR et al (2014) Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med 2:395–404. https://doi.org/10.1016/S2213-2600(14)70041-4 Ramirez J, Peyrani P, Wiemken T et al (2018) A randomized study evaluating the effectiveness of oseltamivir initiated at the time of hospital admission in adults hospitalized with influenza-associated lower respiratory tract infections. Clin Infect Dis 67:736–742. https://doi.org/10.1093/cid/ciy163 Jiang S, Liu T, Hu Y et al (2019) Efficacy and safety of glucocorticoids in the treatment of severe community-acquired pneumonia. Medicine 98:e16239. https://doi.org/10.1097/MD.0000000000016239 Meduri GU, Shih M-C, Bridges L et al (2022) Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med 48:1009–1023. https://doi.org/10.1007/s00134-022-06684-3 Sabry NA, Omar EE-D (2011) Corticosteroids and ICU course of community acquired pneumonia in Egyptian settings. Pharmacol Pharm 2:73–81 El-Ghamrawy AH, Shokeir MH, Esmat AA (2006) Effects of low-dose hydrocortisone in ICU patients with severe community-acquired pneumonia. Egypt J Chest 55:91–99 Confalonieri M, Urbino R, Potena A et al (2005) Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med 171:242–248. https://doi.org/10.1164/rccm.200406-808OC Marik P, Kraus P, Sribante J et al (1993) Hydrocortisone and tumor necrosis factor in severe community-acquired pneumonia. Chest 104:389–392. https://doi.org/10.1378/chest.104.2.389 VA Office of Research and Development (2020) Extended Steroid in Use in Community Acquired Pneumonia (CAP)(e) (ESCAPe). Date last updated: 8 October 2020. https://clinicaltrials.gov/ct2/show/NCT01283009. Torres A, Sibila O, Ferrer M et al (2015) Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA 313:677–686. https://doi.org/10.1001/jama.2015.88 Maruyama T, Fujisawa T, Ishida T et al (2019) A therapeutic strategy for all pneumonia patients: a 3-year prospective multicenter cohort study using risk factors for multidrug-resistant pathogens to select initial empiric therapy. Clin Infect Dis 68:1080–1088. https://doi.org/10.1093/cid/ciy631 Gil R, Webb BJ (2020) Strategies for prediction of drug-resistant pathogens and empiric antibiotic selection in community-acquired pneumonia. Curr Opin Pulm Med 26:249–259. https://doi.org/10.1097/MCP.0000000000000670 Niederman MS, Brito V (2007) Pneumonia in the older patient. Clin Chest Med 28:751–771. https://doi.org/10.1016/j.ccm.2007.08.004 Shorr AF, Zilberberg MD, Micek ST et al (2008) Prediction of infection due to antibiotic-resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med 168:2205. https://doi.org/10.1001/archinte.168.20.2205 Aliberti S, Di Pasquale M, Zanaboni AM et al (2012) Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis 54:470–478. https://doi.org/10.1093/cid/cir840 Shindo Y, Ito R, Kobayashi D et al (2013) Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med 188:985–995. https://doi.org/10.1164/rccm.201301-0079OC Shorr AF, Myers DE, Huang DB et al (2013) A risk score for identifying methicillin-resistant Staphylococcus aureus in patients presenting to the hospital with pneumonia. BMC Infect Dis 13:268. https://doi.org/10.1186/1471-2334-13-268 Prina E, Ranzani OT, Polverino E et al (2015) Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia. Ann Am Thorac Soc 12:153–160. https://doi.org/10.1513/AnnalsATS.201407-305OC Webb BJ, Dascomb K, Stenehjem E et al (2016) Derivation and multicenter validation of the drug resistance in pneumonia clinical prediction score. Antimicrob Agents Chemother 60:2652–2663. https://doi.org/10.1128/AAC.03071-15 Schreiber MP, Chan CM, Shorr AF (2010) Resistant pathogens in nonnosocomial pneumonia and respiratory failure. Chest 137:1283–1288. https://doi.org/10.1378/chest.09-2434 Martin-Loeches I, Levy MM, Artigas A (2015) Management of severe sepsis: advances, challenges, and current status. Drug Des Devel Ther 9:2079–2088. https://doi.org/10.2147/DDDT.S78757 Oi I, Ito I, Tanabe N et al (2020) Cefepime vs meropenem for moderate-to-severe pneumonia in patients at risk for aspiration: an open-label, randomized study. J Infect Chemother 26:181–187. https://doi.org/10.1016/j.jiac.2019.08.005 McCabe C (2009) Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia. Arch Intern Med 169:1525. https://doi.org/10.1001/archinternmed.2009.259 Rhodes A, Evans LE, Alhazzani W et al (2017) Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 43:304–377. https://doi.org/10.1007/s00134-017-4683-6 Jones BE, Brown KA, Jones MM et al (2017) Variation in empiric coverage versus detection of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa in hospitalizations for community-onset pneumonia across 128 US Veterans Affairs Medical Centers. Infect Control Hosp Epidemiol 38:937–944. https://doi.org/10.1017/ice.2017.98 Jones BE, Jones MM, Huttner B et al (2015) Trends in antibiotic use and nosocomial pathogens in hospitalized veterans with pneumonia at 128 medical centers, 2006–2010. Clin Infect Dis 61:1403–1410. https://doi.org/10.1093/cid/civ629 Restrepo MI, Babu BL, Reyes LF et al (2018) Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia: a multinational point prevalence study of hospitalised patients. Eur Respir J 52:1701190. https://doi.org/10.1183/13993003.01190-2017 Villafuerte D, Aliberti S, Soni NJ et al (2020) Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia. Respirology 25:543–551. https://doi.org/10.1111/resp.13663 Aliberti S, Reyes LF, Faverio P et al (2016) Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study. Lancet Infect Dis 16:1364–1376. https://doi.org/10.1016/S1473-3099(16)30267-5 Tillotson G, Lodise T, Classi P et al (2020) Antibiotic treatment failure and associated outcomes among adult patients with community-acquired pneumonia in the outpatient setting: a real-world US Insurance Claims Database Study. Open Forum Infect Dis 7:ofaa065. https://doi.org/10.1093/ofid/ofaa065 Mandell LA, Niederman MS (2019) Aspiration pneumonia. N Engl J Med 380:651–663. https://doi.org/10.1056/NEJMra1714562 Gupte T, Knack A, Cramer JD (2022) Mortality from aspiration pneumonia: incidence, trends, and risk factors. Dysphagia 37:1493–1500. https://doi.org/10.1007/s00455-022-10412-w Suzuki J, Ikeda R, Kato K et al (2021) Characteristics of aspiration pneumonia patients in acute care hospitals: a multicenter, retrospective survey in Northern Japan. PLoS ONE 16:e0254261 Bowerman TJ, Zhang J, Waite LM (2018) Antibacterial treatment of aspiration pneumonia in older people: a systematic review. Clin Interv Aging 13:2201–2213. https://doi.org/10.2147/CIA.S183344 El-Solh AA, Pietrantoni C, Bhat A et al (2003) Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med 167:1650–1654. https://doi.org/10.1164/rccm.200212-1543OC Levison ME (1983) Clindamycin compared with penicillin for the treatment of anaerobic lung abscess. Ann Intern Med 98:466. https://doi.org/10.7326/0003-4819-98-4-466 Kadowaki M (2005) Reappraisal of clindamycin IV monotherapy for treatment of mild-to-moderate aspiration pneumonia in elderly patients. Chest 127:1276–1282 Marumo S, Teranishi T, Higami Y et al (2014) Effectiveness of azithromycin in aspiration pneumonia: a prospective observational study. BMC Infect Dis 14:685. https://doi.org/10.1186/s12879-014-0685-y Hasegawa S, Shiraishi A, Yaegashi M et al (2019) Ceftriaxone versus ampicillin/sulbactam for the treatment of aspiration-associated pneumonia in adults. J Comp Eff Res 8:1275–1284. https://doi.org/10.2217/cer-2019-0041 Sun T, Sun L, Wang R et al (2014) Clinical efficacy and safety of moxifloxacin versus levofloxacin plus metronidazole for community-acquired pneumonia with aspiration factors. Chin Med J (Engl) 127:1201–1205