Restrepo Marcos I, Anzueto Antonio
Division of Pulmonary and Crit Care Med, South Texas Veterans Healthcare System, Audie L. Murphy Division, University of Texas Health Science Center at San Antonio 78229, USA.
Curr Opin Infect Dis. 2006 Dec;19(6):557-64. doi: 10.1097/QCO.0b013e3280106b7f.
Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality and is the most common cause of death from infectious diseases. CAP patients requiring intensive care unit (ICU) admission carry the highest mortality rates. This paper aims to review the current literature regarding epidemiology, risk factors, severity criteria and reasons for admitting the hospitalized patient to the ICU, and the empiric and specific antibiotic therapeutic regimens employed.
Multiple sets of clinical practice guidelines have been published in the past few years addressing the treatment of CAP. The guidelines all agree that CAP patients admitted to the hospital represent a major concern, and appropriate empiric therapy should be instituted to improve clinical outcomes.
The cost, morbidity and mortality of CAP patients requiring ICU admission remain unacceptably high. These are heterogeneous groups of patients, so it is important to use risk-stratification based on clinical parameters and prediction tools. Appropriate antibiotic therapy is an important component in the management of both groups of patients. In particular, it is essential to administer an appropriate antimicrobial agent from the initiation of therapy, so that the risks of treatment failure and the morbidity of CAP may be minimized.
社区获得性肺炎（CAP）与显著的发病率和死亡率相关，是传染病死亡的最常见原因。需要入住重症监护病房（ICU）的CAP患者死亡率最高。本文旨在综述有关流行病学、危险因素、严重程度标准以及住院患者入住ICU的原因，以及所采用的经验性和特异性抗生素治疗方案的当前文献。
在过去几年中已经发布了多套针对CAP治疗的临床实践指南。这些指南都一致认为，入住医院的CAP患者是一个主要关注点，应采取适当的经验性治疗以改善临床结局。
需要入住ICU的CAP患者的成本、发病率和死亡率仍然高得令人无法接受。这些是异质性的患者群体，因此使用基于临床参数和预测工具的风险分层很重要。适当的抗生素治疗是这两组患者管理中的重要组成部分。特别是，从治疗开始就给予适当的抗菌药物至关重要，这样可以将治疗失败的风险和CAP的发病率降至最低。
