PURPOSE: Severe community-acquired pneumonia (sCAP) is associated with high morbidity and mortality, and whilst European and non-European guidelines are available for community-acquired pneumonia, there are no specific guidelines for sCAP.

METHODS: The European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society 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 European and four non-European experts, as well as two methodologists. Eight clinical questions for sCAP diagnosis and 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 with GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Evidence to Decision frameworks were used to decide on the direction and strength of recommendations.

RESULTS: Recommendations issued were related to diagnosis, antibiotics, organ support, biomarkers and co-adjuvant therapy. After considering the confidence in effect estimates, the importance of outcomes studied, desirable and undesirable consequences of treatment, cost, feasibility, acceptability of the intervention and implications to health equity, recommendations were made for or against specific treatment interventions.

CONCLUSIONS: In these international guidelines, ERS, ESICM, ESCMID, and ALAT provide evidence-based clinical practice recommendations for diagnosis, empirical treatment, and antibiotic therapy for sCAP, following the GRADE approach. Furthermore, current knowledge gaps have been highlighted and recommendations for future research have been made.

目的：严重社区获得性肺炎（sCAP）与高发病率和死亡率相关，虽然欧洲和非欧洲指南可用于社区获得性肺炎，但没有针对sCAP的特定指南。

方法：欧洲呼吸学会（ERS）、欧洲重症监护医学会（ESICM）、欧洲临床微生物学和传染病协会（ESCMID）和拉丁美洲胸科协会（ALAT）成立了一个任务组，制定了第一份国际sCAP指南。该小组由18名欧洲专家和4名非欧洲专家以及两名方法论者组成。选择了8个有关sCAP诊断和治疗的临床问题进行讨论。在多个数据库中进行系统文献搜索。尽可能进行荟萃分析以综合证据。使用GRADE评估证据质量（推荐、评估、开发和评价）。使用“证据到决策”框架来确定建议的方向和强度。

结果：发布的建议涉及诊断、抗生素、器官支持、生物标志物和辅助治疗等方面。考虑到效应估计值的置信度、所研究结果的重要性、治疗的有益和不良后果、成本、可行性、干预措施的可接受性以及对健康公平的影响，针对特定治疗干预提出了建议或反对建议。

结论：在这些国际指南中，ERS、ESICM、ESCMID和ALAT根据GRADE方法为sCAP诊断、经验性治疗和抗生素治疗提供基于证据的临床实践建议。此外，还突出了当前知识空白，并提出了未来研究的建议。

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guidelines for the management of severe community-acquired pneumonia.