Niederman Michael S
Department of Medicine, Winthrop-University Hospital, 222 Station Plaza N, Suite 509, Mineola, NY 11501, USA.
Chest. 2007 Apr;131(4):1205-15. doi: 10.1378/chest.06-1994.
Community-acquired pneumonia (CAP) is a common illness, with the majority of patients treated out of the hospital, yet the greatest burden of the cost of care comes from inpatient management. In the past several years, the management of these patients has advanced, with new information about the natural history and prognosis of illness, the utility of serum markers to guide management, the use of appropriate clinical tools to guide the site-of-care decision, and the finding that guidelines can be developed in a way that improves patient outcome. The challenges to patient management include the emergence of new pathogens and the progression of antibiotic resistance in some of the common pathogens such as Streptococcus pneumoniae. Few new antimicrobial treatment options are available, and the utility of some new therapies has been limited by drug-related toxicity. Ancillary care for severe pneumonia with activated protein C and corticosteroids is being studied, but recently, inpatient care has been most affected by the development of evidence-based "core measures" for management that have been promoted by the Centers for Medicare and Medicaid Services, which form the basis for the public reporting of hospital performance in CAP care.
社区获得性肺炎（CAP）是一种常见疾病，大多数患者在院外接受治疗，但护理费用的最大负担却来自住院治疗管理。在过去几年中，这些患者的管理有了进展，出现了关于疾病自然史和预后的新信息、血清标志物指导管理的效用、使用适当临床工具指导护理地点决策，以及发现可以制定出改善患者预后的指南。患者管理面临的挑战包括新病原体的出现以及一些常见病原体（如肺炎链球菌）中抗生素耐药性的进展。几乎没有新的抗菌治疗选择，一些新疗法的效用也因药物相关毒性而受到限制。正在研究使用活化蛋白C和皮质类固醇对重症肺炎进行辅助治疗，但最近，住院治疗受医疗保险和医疗补助服务中心推行的基于证据的管理“核心措施”的影响最大，这些措施构成了医院在CAP护理方面公开报告绩效的基础。
