School of Medicine and Pharmacology, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia.
Curr Opin Infect Dis. 2011 Apr;24(2):137-41. doi: 10.1097/QCO.0b013e328343b70d.
We focus on a number of studies in the past 2 years that herald a dramatic shift in how we treat patients with not just community-acquired pneumonia (CAP), but potentially all sepsis.
Recent studies report that high bacterial load, and specifically pneumococcal load in CAP, appears to be significantly associated with worse outcomes. These findings change the sepsis paradigm. Bacterial load may identify potential candidates for adjunctive therapy, ICU admission and more aggressive management.
Whereas we all acknowledge the importance of the virulence of the pathogen in the outcome of CAP, microbiological tests currently play little role in management of patients. Whereas molecular tests such as polymerase chain reaction have promised to deliver accurate results in a clinically useful period of time, apart from a few niche situations they have yet to enter routine practice. In particular the ability to calculate the bacterial load in blood, and specifically pneumococcal load in CAP, appears to have significant clinical utility. Not only does bacterial load predict clinical outcome, the data so far available challenge some of our fundamental assumptions about optimal antibiotic therapy and the pathogenesis of severe sepsis.
我们重点关注了过去 2 年中的多项研究，这些研究预示着我们治疗不仅是社区获得性肺炎（CAP）患者，而且可能是所有脓毒症患者的方式将发生重大转变。
最近的研究报告表明，CAP 中的高细菌载量，特别是肺炎链球菌载量，与更差的结局明显相关。这些发现改变了脓毒症的范式。细菌载量可能可以识别出辅助治疗、入住 ICU 和更积极治疗的潜在候选者。
尽管我们都承认病原体毒力对 CAP 结局的重要性，但微生物学检测目前在患者管理中作用不大。聚合酶链反应等分子检测有望在临床有用的时间内提供准确的结果，但除了少数特定情况外，它们尚未进入常规实践。特别是计算血液细菌载量，特别是 CAP 中肺炎链球菌载量的能力，似乎具有重要的临床实用性。细菌载量不仅可以预测临床结局，而且到目前为止的数据还挑战了我们关于最佳抗生素治疗和严重脓毒症发病机制的一些基本假设。
