Bantar Carlos, Curcio Daniel, Jasovich Abel, Bagnulo Homero, Arango Alvaro, Bavestrello Luis, Famiglietti Angela, García Patricia, Lopardo Gustavo, Losanovscky Miriam, Martínez Ernesto, Pedreira Walter, Piñeyro Luis, Remolif Christian, Rossi Flavia, Varón Fabio
Hospital San Martín, Paraná, Argentina.
Rev Chilena Infectol. 2010 Jun;27 Suppl 1:S9-S38. Epub 2010 Jul 26.
Community-acquired pneumonia (CAP) in adults is probably one of the infections affecting ambulatory patients for which the highest diversity of guidelines has been written worldwide. Most of them agree in that antimicrobial therapy should be initially tailored according to either the severity of the infection or the presence of comorbidities and the etiologic pathogen. Nevertheless, a great variability may be noted among the different countries in the selection of the primary choice in the antimicrobial agents, even for the cases considered as at a low-risk class. This fact may be due to the many microbial causes of CAP and specialties involved, as well as the different health-care systems effecting on the availability or cost of antibiotics. However, many countries or regions adopt some of the guidelines or design their own recommendations regardless of the local data, probably because of the scarcity of such data. This is the reason why we have developed a guideline for the initial treatment of CAP by 2002 upon the basis of several local evidences in South América (ConsenSur I). However, several issues deserve to be currently rediscussed as follows: certain clinical scores other than the Physiological Severity índex (PSI) have become more popular in clinical practice (i.e. CURB-65, CRB-65); some pathogens have emerged in the región, such as community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) and Legionella spp; new evidences on the performance of the rapid test for the etiologic diagnosis in CAP have been reported (eg. urinary Legionella andpneumococcus antigens); new therapeutic considerations needs to be approached (i.e. dosage reformulation, duration of treatment, emergence of novel antibiotics and clinical impact of combined therapy). Like in the first versión of the ConsenSur (ConsenSur I), the various current guidelines have helped to organize and stratify the present proposal, ConsenSur II.
成人社区获得性肺炎（CAP）可能是影响门诊患者的感染性疾病之一，全球针对该疾病撰写的指南种类最为繁多。大多数指南都认为，抗菌治疗应首先根据感染的严重程度、是否存在合并症以及病原体来进行调整。然而，即使在被认为是低风险类别的病例中，不同国家在选择抗菌药物的首选药物方面仍存在很大差异。这可能是由于CAP的微生物病因众多且涉及多个专业领域，以及不同的医疗保健系统对抗生素的可及性或成本产生影响。然而，许多国家或地区不顾当地数据而采用一些指南或制定自己的建议，这可能是因为此类数据稀缺。这就是我们在2002年根据南美洲的一些本地证据制定CAP初始治疗指南（共识I）的原因。然而，目前有几个问题值得重新讨论：除生理严重程度指数（PSI）外，某些临床评分在临床实践中变得更受欢迎（如CURB - 65、CRB - 65）；该地区出现了一些病原体，如社区获得性耐甲氧西林金黄色葡萄球菌（CA - MRSA）和军团菌属；有报道称CAP病因诊断快速检测的性能有了新证据（如尿军团菌和肺炎球菌抗原）；需要考虑新的治疗方法（如剂型改革、治疗持续时间、新型抗生素的出现以及联合治疗的临床影响）。与共识I的第一版一样，当前的各种指南有助于整理和分层本提案，即共识II。
