Community-acquired pneumonia.
Community-acquired pneumonia.
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DOI：
10.1016/s0140-6736(03)15021-0
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发表时间：
2003-12-13
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File TM
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本次研讨会回顾了社区获得性肺炎（CAP）的重要特征和管理问题，这些问题与免疫功能正常的成年人特别相关，并提供了有关病因、临床病程、诊断检测、治疗和预防的新信息。肺炎链球菌仍然是最重要的病原体;然而，这种微生物对抗菌药物的耐药性影响了CAP的经验性治疗。在几项前瞻性研究中，非典型病原体已被相当普遍地识别出来。这些病原体（军团菌属除外）的临床意义尚不清楚，部分原因是缺乏快速、标准化的检测。CAP的诊断评价对于适当评估疾病的严重程度和确定疾病的致病因子是重要的。在开发出更好的快速诊断方法之前，大多数患者将凭经验治疗。抗菌药物仍然是治疗的主要手段，关于特定药物的决定是由几个考虑因素指导的，包括活性谱、药代动力学和药效学原理。有几个因素已被证明与CAP患者的有益临床结局相关。这些因素包括及时给予抗菌药物、选择抗生素治疗和使用重症肺炎途径。应鼓励适当使用肺炎球菌病和流感疫苗。最近公布了若干关于联合呼吁程序管理的准则，并对其中的建议进行了审查。
This seminar reviews important features and management issues of community-acquired pneumonia (CAP) that are especially relevant to immunocompetent adults in light of new information about cause, clinical course, diagnostic testing, treatment, and prevention. Streptococcus pneumoniae remains the most important pathogen; however, emerging resistance of this organism to antimicrobial agents has affected empirical treatment of CAP. Atypical pathogens have been quite commonly identified in several prospective studies. The clinical significance of these pathogens (with the exception of Legionella spp) is not clear, partly because of the lack of rapid, standardised tests. Diagnostic evaluation of CAP is important for appropriate assessment of severity of illness and for establishment of the causative agent in the disease. Until better rapid diagnostic methods are developed, most patients will be treated empirically. Antimicrobials continue to be the mainstay of treatment, and decisions about specific agents are guided by several considerations that include spectrum of activity, and pharmacokinetic and pharmacodynamic principles. Several factors have been shown to be associated with a beneficial clinical outcome in patients with CAP. These factors include administration of antimicrobials in a timely manner, choice of antibiotic therapy, and the use of a critical pneumonia pathway. The appropriate use of vaccines against pneumococcal disease and influenza should be encouraged. Several guidelines for management of CAP have recently been published, the recommendations of which are reviewed.