Current Status Of Community-acquired Pneumonia Diagnosis And Treatment In Shanghai Revealed By A Questionnaire Analysis

ObjectiveCommunity acquired pneumonia(CAP)has a high morbidity and mortality worldwide and increases with age.In order to standardize the management of CAP diagnosis and treatment,Chinese Thoracic Society of Chinese Medical Association developed the guidelines of community-acquired pneumonia diagnosis and treatment in 2006.With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time,Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults.To survey the current status of community-acquired pneumonia(CAP)diagnosis and treatment among doctors in various hospitals across Shanghai for the purpose to promote the 2016 clinical practice guidelines for adults CAP of China.MethodsA questionnaire was designed to address the common questions in CAP management,including distribution characteristics and drug resistance of pathogens,diagnostic criteria and etiological diagnostic methods,judgment of severity and criteria for admission or intensive care unit,selection of empirical antibiotics and post-treatment evaluation,understanding and application of the new guidelines,etc.Before the promotion of the new guidelines,participants were informed to participate in the electronic questionnaire through the WeChat QR Code and summarize the analysis.ResultsA total of 1 254 valid questionnaires were received,46.1%(578)from tertiary,26.4%(331)from secondary and 27.5%(345)from primary care hospitals.Of these valid respondents,31.4%(394)are respiratory physicians and 68.6%(860)from non-respiratory medicine.When diagnosing CAP,78.1%(979/1254)of the doctors would use chest CT in more than 50% of the patients.Regarding the tools for evaluating the severity of CAP,60.3%(756/1254)of the respondents would prefer CURB-65.“Respiratory failure requiring mechanical ventilation and septic shock” are the most common criteria for admission to ICU.The results of this survey showed that the top 5 pathogenic microorganisms of CAP are Streptococcus pneumoniae,Mycoplasma pneumoniae,Klebsiella pneumoniae,Haemophilus influenzae and Chlamydia pneumoniae.The blood culture is not widely used in severe CAP no matter what level of the hospital(?2=1.211,P>0.05).For non-severe CAP patients,all the doctors tended to select monotherapy.The most frequently used antimicrobial regimen for severe CAP is third-or fourth-generation cephalosporins monotherapy.As for combination therapy,the most frequently used regimen in tertiary hospitals is “carbapenem plus vancomycin” while in primary and secondary hospitals is “?-lactams plus macrolides”.Regarding the criteria for switching antimicrobial therapy,76.6%(961/1254)of the respondents agreed that antimicrobial agents should be adjusted when new pulmonary opacity emerges in imaging examination.More doctors from primary hospitals and non-respiratory medicine would consider “complete resolution of pulmonary opacity” as the indication to discontinue antimicrobial therapy or to discharge patient,and “prolonged high fever”,“large area consolidation”,“multiple lobe-segment involvement” as the indication for corticosteroid therapy.Significantly lower proportion of doctors in secondary and tertiary hospitals would recommend patients to receive vaccination than in primary hospitals(P<0.05).ConclusionCurrently in the process of CAP diagnosis and treatment,there are still some problems such as excessive use of chest CT,low rate of blood culture in severe pneumonia and too broad application of glucocorticoids.Although Chinese Thoracic Society of Chinese Medical Association has issued its first guidelines for the diagnosis and treatment of CAP in adults in 2006,there are sill many gaps between the cognition and recommendations to the diagnosis and treatment of CAP in Shanghai.It is,therefore,especially important to promote the updated guidelines.Efforts should be made to popularize the 2016 CAP guideline in hospitals of any level of care,especially primary hospitals,for the purpose to further standardize CAP management in China.