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2016 ; 8
(ä): 14
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The definition and classification of pneumonia
#MMPMID28702293
Mackenzie G
Pneumonia (Nathan)
2016[]; 8
(ä): 14
PMID28702293
show ga
Following the publication of a volume of Pneumonia focused on diagnosis, the
journal's Editorial Board members debated the definition and classification of
pneumonia and came to a consensus on the need to revise both of these. The
problem with our current approach to the classification of pneumonia is twofold:
(i) it results in widespread empirical, and often unnecessary, use of
antimicrobials that contributes to pathogen resistance; and (ii) it contributes
to heterogeneity among the groups of subjects compared in research, causing
misclassification bias and mixtures of effects that threaten internal validity.
After outlining the problem of classification, this commentary describes the
strengths and weaknesses of a range of systems for the classification of
pneumonia. The commentary then calls for debate to generate consensus
classifications in the field, proposing a working definition and way forward
focusing on the following three points: (i) pneumonia should be defined as an
acute infection of the lung parenchyma by various pathogens, excluding the
condition of bronchiolitis; (ii) defining pneumonia as a group of specific
(co)infections with different characteristics is an ideal that currently has
limited use, because the identification of aetiologic organisms in individuals is
often not possible (however, the benefits of classifying pneumonia into specific,
more homogenous phenotypes should be carefully considered when designing research
studies); and (iii) investigation of more homogenous pneumonia groupings is
achievable and is likely to yield more rapid advances in the field.