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• W1991474882 abstract "AbbreviationsATS American Thoracic SocietyCAP Community-acquired pneumoniaHCAP Health care-associated pneumoniaICU Intensive care unitIDSA Infectious Diseases Society of AmericaMDR Multidrug-resistantMRSA Methicillin-resistant Staphylococcus aureusPDR Potential drug-resistantPSI Pneumonia Severity IndexSCAP Severe community-acquired pneumoniaIn this issue of Internal and Emergency Medicine, Falconeet al. [1] validate the widely used predictive scoring sys-tems for assessing the severity of pneumonia. Theseinclude the Pneumonia Severity Index (PSI) [2], CURB-65(confusion, uremia, respiratory rate, low blood pressure,65 years of age or older) [3], and severe community-acquired pneumonia (SCAP) scores [4] for hospitalizedpatients with community-acquired pneumonia (CAP) andhealth care-associated pneumonia (HCAP) who wereenrolled in a prospective multicenter cohort study in Italy[5]. The authors find that PSI, CURB-65, and SCAP scoreshave a good performance for patients with CAP, but areless useful for patients with HCAP, particularly those cat-egorized as low risk. Furthermore, they describe thatinclusion in the severe classes of PSI, CURB-65, andSCAP scores and receiving an empirical treatment thatdoes not adhere to international guidelines, as documentedin the 2005 or 2007 American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) [6, 7],prove to be risk factors independently associated with in-hospital mortality or development of adverse events,including death, septic shock, and the need for a transfer toan intensive care unit (ICU).The PSI and CURB-65 scores were originally used aspredictive scoring systems to identify patients who couldreceive outpatient treatment, as low scores were associatedwith low mortality [2, 3]. However, the reported sensitivityand specificity of high scores for severe CAP, related tohigh mortality or adverse events, show that these systemsare not very useful [7]. Therefore, an alternative scoringsystem, SCAP scores, was designed to identify patientswith severe CAP [4]. The enrolled patients with CAP andHCAP in this Italian study required hospitalization [5].Therefore, it was suitable to assess patients with severepneumonia who were likely to have a fatal course, and notwho could receive outpatient treatment.When the PSI, CURB-65, and SCAP scores weredeveloped, the concept of HCAP was not widely used.Thus, a substantial number of HCAP patients were previ-ously defined as having CAP. A Japanese retrospectivestudy shows that areas under the receiver operating char-acteristic curves for the 30-day mortality in predictiverules, including those for CURB-65, are greater in patientswith newly defined CAP [7], in which HCAP is excluded,than in those with previously defined CAP [8]. This studyshows similar results; high proportions of mortality andadverse events among HCAP patients with low severity" @default.
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• W1991474882 date "2011-05-18" @default.
• W1991474882 modified "2023-09-28" @default.
• W1991474882 title "Emerging problems regarding severity assessment and treatment strategies for patients with pneumonia: controversies surrounding the HCAP concept" @default.
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• W1991474882 doi "https://doi.org/10.1007/s11739-011-0623-6" @default.
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