Pediatric Department, School of Medicine, DPMSC, University of Udine, Udine, Italy.
Acta Paediatr. 2010 Nov;99(11):1602-8. doi: 10.1111/j.1651-2227.2010.01924.x. Epub 2010 Jul 13.
Community-acquired pneumonia (CAP) still remains a significant cause for childhood morbidity worldwide. Streptococcus pneumoniae is the most important causative agent at all ages. Respiratory syncytial virus is common in young children, and Mycoplasma pneumoniae in schoolchildren. Paediatric CAP is universally treated with antibiotics; amoxicillin is the drug of choice for presumably pneumococcal and a macrolide for presumably atypical bacterial cases. Because of globally increased resistances, macrolides are not safety for pneumococcal CAP. At present, available prospective research data on the epidemiology of paediatric CAP in western countries are from 1970s to 1980s; correspondingly, data on bacterial aetiology are mainly from 1980s to 1990s. Current concepts on pneumococcal aetiology are mostly based on poorly validated antibody assays. Most data on clinical characteristics in children's CAP, as well as on antibiotic treatment come from developing countries, thus not being directly applicable in western communities. Recent viral studies have revealed the role of rhinoviruses, metapneumovirus and bocavirus in the aetiology of paediatric CAP. This review critically summarizes the available data on epidemiology, aetiology, clinical presentation, treatment and outcome of CAP in children, with special focus on the newest microbial findings, the age and applicability of the data and the need of new studies.
社区获得性肺炎（CAP）仍然是全球儿童发病率的重要原因。肺炎链球菌在所有年龄段都是最重要的病原体。呼吸道合胞病毒在幼儿中很常见，而肺炎支原体在学龄儿童中很常见。儿科 CAP 普遍采用抗生素治疗；阿莫西林是推测性肺炎链球菌感染的首选药物，大环内酯类药物是推测性非典型细菌感染的首选药物。由于全球耐药性增加，大环内酯类药物对肺炎链球菌 CAP 不再安全。目前，西方国家儿科 CAP 流行病学的现有前瞻性研究数据来自 20 世纪 70 年代至 80 年代；相应地，细菌病因学数据主要来自 20 世纪 80 年代至 90 年代。目前关于肺炎链球菌病因的概念主要基于验证不足的抗体检测。大多数关于儿童 CAP 临床特征以及抗生素治疗的数据都来自发展中国家，因此不能直接适用于西方国家。最近的病毒研究揭示了鼻病毒、副流感病毒和博卡病毒在儿童 CAP 病因学中的作用。本文批判性地总结了关于儿科 CAP 的流行病学、病因学、临床表现、治疗和结局的现有数据，特别关注最新的微生物发现、数据的年龄适用性以及新研究的必要性。
