Carbonara Sergio, Monno Laura, Longo Benedetta, Angarano Gioacchino
Curr Opin Pulm Med. 2009 May;15(3):261-73. doi: 10.1097/MCP.0b013e3283287c3f.
Community-acquired pneumonia (CAP) is a major cause of morbidity, mortality and expenditure of resources. When followed, guidelines for CAP management have been demonstrated to improve clinical outcomes; however, several issues are still open. This review summarizes the recent advances in this field and the priority needs for future research.
Recently identified clinical and biochemical tools promise to improve the assessment of CAP severity; however, definition of the most accurate and feasible rule(s) for clinical practice is now necessary. Some empirical antimicrobial regimens are still being debated, such as the need for atypical pathogen coverage in home-treated and nonsevere hospitalized patients and the inclusion of respiratory fluoroquinolones among first-choice molecules. New drugs such as tigecycline and cethromycin appear promising. Pharmacokinetically enhanced amoxicillin/clavulanate is highly effective, even for treating CAP caused by multiple-drug-resistant Streptococcus pneumoniae. Other aspects recently clarified include the inappropriateness of rigid time-to-first-antibiotic-dose rules, the advantages of shorter antibiotic treatments for nonsevere patients and the need of special clinical attention for acute myocardial infarction among patients with severe CAP or clinical failure.
Recent developments have significantly contributed to refine the management of CAP patients. However, various hot topics remain undefined as yet and urgently require ad-hoc research in order to optimize the outcomes and the costs of this highly social-impacting disease.
社区获得性肺炎（CAP）是发病、死亡及资源消耗的主要原因。遵循CAP管理指南已被证明可改善临床结局；然而，仍有几个问题尚未解决。本综述总结了该领域的最新进展以及未来研究的优先需求。
最近确定的临床和生化工具有望改善CAP严重程度的评估；然而，现在需要为临床实践定义最准确和可行的规则。一些经验性抗菌方案仍在争论中，例如在家治疗的非重症住院患者是否需要覆盖非典型病原体以及首选药物中是否包括呼吸喹诺酮类药物。替加环素和西红霉素等新药似乎很有前景。药代动力学增强的阿莫西林/克拉维酸非常有效，即使用于治疗由多重耐药肺炎链球菌引起的CAP。最近澄清的其他方面包括严格的首次抗生素给药时间规则不合适、非重症患者较短疗程抗生素治疗的优势以及重症CAP或临床治疗失败患者中急性心肌梗死需要特别临床关注。
最近的进展对优化CAP患者的管理有显著贡献。然而，各种热点问题仍未明确，迫切需要进行专门研究，以优化这种对社会影响极大的疾病的治疗效果和成本。
