Intensive Care Medhttps::/dol.org/10.1007s00134-023-07033-8GUIDELINESERS/ESICM/ESCMID/ALAT guidelines for theCheck foupdatesmanagement of severe community-acquiredpneumoniaIgnacio Martin-Loeches234,Antoni Torres3,Blin Nagavci,Stefano Aliberti,Massimo AntonelliMatteo Bassetti,Lieuwe Bos10,James Chalmers11,Lennie Derde12,Jan de Waele13,Jose Garnacho-Montero14Marin Kollef5,Carlos Luna,Rosario Menendez,Michael Niederman7,Dimitry Ponomarev9Marcos Restrepo2,David Rigau21,Marcus Schultz2,Emmanuele Weiss24,Tobias Welte25and Richard Wunderink262023 This is a US.Government work and not under copyright protection in the US;foreign copyright protection may applyAbstractPurpose:Severe community-acquired pneumonia(sCAP)is associated with high morbidity and mortality,and whilstEuropean and non-European guidelines are available for community-acquired pneumonia,there are no specificguidelines for sCAPMethods:The European Respiratory Society (ERS),European Society of Intensive Care Medicine (ESICM),EuropeanSociety of Clinical Microbiology and Infectious Diseases(ESCMID),and Latin American Thoracic Association(ALAT)launched a task force to develop the first international guidelines for sCAP.The panel comprised a total of 18 Euro-pean and four non-European experts,as well as two methodologists.Eight clinical questions for sCAP diagnosisand treatment were chosen to be addressed.Systematic literature searches were performed in several databases.Meta-analyses were performed for evidence synthesis,whenever possible.The quality of evidence was assessed withGRADE (Grading of Recommendations,Assessment,Development and Evaluation).Evidence to Decision frameworkswere used to decide on the direction and strength of recommendations.Results:Recommendations issued were related to diagnosis,antibiotics,organ support,biomarkers and co-adjuvanttherapy.After considering the confidence in effect estimates,the importance of outcomes studied,desirable andundesirable consequences of treatment,cost,feasibility,acceptability of the intervention and implications to healthequity,recommendations were made for or against specific treatment interventions.Conclusions:In these international guidelines,ERS,ESICM,ESCMID,and ALAT provide evidence-based clinicalpractice recommendations for diagnosis,empirical treatment,and antibiotic therapy for sCAP,following the GRADEapproach.Furthermore,current knowledge gaps have been highlighted and recommendations for future researchhave been made'Correspondence:drmartinloeches@gmailcomThis article is being published concurrently in Intensive Care MedicineDepartment of Intensive Care Medicine,Multidisciplinary Intensive Care(https://doiorg/10.1007/s00134-023-07033-8)and the EuropeanResearch Organisation (MICRO),St James's Hospital Dublin,IrelandRespiratory Jour nal (https://doi.org/10.1183/13993003.00735-2022).TheFull author information is available at the end of the articlearticles are identical except for minor stylistic and spelling differences inkeeping wi
