欧洲成人社区获得性肺炎的病因及抗生素治疗:文献综述
The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review.
作者信息
Torres A, Blasi F, Peetermans W E, Viegi G, Welte T
机构信息
Servei de Pneumologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBER de Enfermedades Respiratorias (CIBERes), University of Barcelona, Barcelona, Spain,
出版信息
Eur J Clin Microbiol Infect Dis. 2014 Jul;33(7):1065-79. doi: 10.1007/s10096-014-2067-1. Epub 2014 Feb 15.
The purpose of this paper was to generate up-to-date information on the aetiology of community-acquired pneumonia (CAP) and its antibiotic management in adults across Europe. Structured searches of PubMed identified information on the aetiology of CAP and its antibiotic management in individuals aged >15 years across Europe. We summarise the data from 33 studies published between January 2005 and July 2012 that reported on the pathogens identified in patients with CAP and antibiotic treatment in patients with CAP. Streptococcus pneumoniae was the most commonly isolated pathogen in patients with CAP and was identified in 12.0-85.0 % of patients. Other frequently identified pathogens found to cause CAP were Haemophilus influenzae, Gram-negative enteric bacilli, respiratory viruses and Mycoplasma pneumoniae. We found several age-related trends: S. pneumoniae, H. influenzae and respiratory viruses were more frequent in elderly patients aged ≥65 years, whereas M. pneumoniae was more frequent in those aged <65 years. Antibiotic monotherapy was more frequent than combination therapy, and beta-lactams were the most commonly prescribed antibiotics. Hospitalised patients were more likely than outpatients to receive combination antibiotic therapy. Limited data on antibiotic resistance were available in the studies. Penicillin resistance of S. pneumoniae was reported in 8.4-20.7 % of isolates and erythromycin resistance was reported in 14.7-17.1 % of isolates. Understanding the aetiology of CAP and the changing pattern of antibiotic resistance in Europe, together with an increased awareness of the risk factors for CAP, will help clinicians to identify those patients most at risk of developing CAP and provide guidance on the most appropriate treatment.
本文旨在获取欧洲成年人社区获得性肺炎(CAP)病因及其抗生素治疗的最新信息。通过对PubMed进行结构化检索,确定了欧洲15岁以上个体中CAP病因及其抗生素治疗的相关信息。我们总结了2005年1月至2012年7月间发表的33项研究的数据,这些研究报告了CAP患者中鉴定出的病原体以及CAP患者的抗生素治疗情况。肺炎链球菌是CAP患者中最常分离出的病原体,在12.0%至85.0%的患者中被鉴定出来。其他常见的导致CAP的病原体包括流感嗜血杆菌、革兰氏阴性肠道杆菌、呼吸道病毒和肺炎支原体。我们发现了一些与年龄相关的趋势:肺炎链球菌、流感嗜血杆菌和呼吸道病毒在≥65岁的老年患者中更为常见,而肺炎支原体在<65岁的患者中更为常见。抗生素单药治疗比联合治疗更为常见,β-内酰胺类是最常用的抗生素。住院患者比门诊患者更有可能接受联合抗生素治疗。研究中关于抗生素耐药性的数据有限。肺炎链球菌对青霉素的耐药率在分离株中为8.4%至20.7%,对红霉素的耐药率在分离株中为14.7%至17.1%。了解CAP的病因、欧洲抗生素耐药性的变化模式以及对CAP危险因素认识的提高,将有助于临床医生识别那些最易患CAP的患者,并为最合适的治疗提供指导。