ATS GUIDELINES Bundle

7 10. Suspected Aspiration ➤ We suggest NOT routinely adding anaerobic coverage for suspected aspiration pneumonia unless lung abscess or empyema is suspected (conditional recommendation, very low quality of evidence). 11. Extended-spectrum Antibiotics ➤ We recommend abandoning use of the prior categorization of healthcare-associated pneumonia (HCAP) to guide selection of extended antibiotic coverage in adults with CAP (strong recommendation, moderate quality of evidence). ➤ We recommend clinicians cover empirically only for MRSA or P. aeruginosa in adults with CAP if locally validated risk factors for either pathogen are present. (strong recommendation, moderate quality of evidence). Empiric treatment options for MRSA include vancomycin (15 mg/kg every 12 hours, adjust based on levels), or linezolid (600 mg every 12 hours). Empiric treatment options for P. aeruginosa include piperacillin-tazobactam (4.5 g every 6 hours), cefepime (2 g every 8 hours), ceftazidime (2 g every 8 hours), aztreonam (2 g every 8 hours), meropenem (1 g every 8 hours) or imipenem (500 mg every 6 hours). ➤ If clinicians are currently covering empirically for MRSA or P. aeruginosa in adults with CAP on the basis of published risk factors but do not have local etiological data, we recommend continuing empiric coverage while obtaining culture data to establish if these pathogens are present to justify continued treatment for these pathogens after the first few days of empiric treatment (strong recommendation, low quality of evidence). 12. Steroids ➤ We recommend NOT routinely using corticosteroids in adults with nonsevere CAP (strong recommendation, high quality of evidence). ➤ We suggest NOT routinely using corticosteroids in adults with severe CAP (conditional recommendation, moderate quality of evidence). ➤ We suggest NOT routinely using corticosteroids in adults with severe influenza pneumonia (conditional recommendation, low quality of evidence). ➤ We endorse the Surviving Sepsis Campaign recommendations on the use of corticosteroids in patients with CAP and refractory septic shock.

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