التهاب رئوي بالزائفة الزنجارية في الالتهاب الرئوي المكتسب من المجتمع غير الشديد مع استشفاء حديث وتعرض لمضادات حيوية وريدية

References

DOI: 10.1164/rccm.201908-1581ST

The major additional risk factors for MRSA and P. aeruginosa identified in the literature are hospitalization and parenteral antibiotic exposure in the last 90 days.

We recommend clinicians only cover empirically for MRSA or P. aeruginosa in adults with CAP if locally validated risk factors for either pathogen are present.

Obtain cultures but initiate coverage for P. aeruginosa only if culture results are positive.

combination therapy with a b-lactam (ampicillin-sulbactam, cefotaxime, ceftriaxone, or ceftaroline) and a macrolide (azithromycin or clarithromycin) (strong recommendation, high quality of evidence), or monotherapy with a respiratory fluoroquinolone (levofloxacin, moxifloxacin) (strong recommendation, high quality of evidence).

We recommend that the duration of antibiotic therapy should be guided by a validated measure of clinical stability (resolution of vital sign abnormalities [heart rate, respiratory rate, blood pressure, oxygen saturation, and temperature], ability to eat, and normal mentation), and antibiotic therapy should be continued until the patient achieves stability and for no less than a total of 5 days (strong recommendation, moderate quality of evidence).

Failure to achieve clinical stability within 5 days is associated with higher mortality and worse clinical outcomes.