Prina Elena, Ranzani Otavio T, Torres Antoni
Department of Pulmonology, Hospital Clinic of Barcelona, University of Barcelona, Institut D'investigacions August Pi I Sunyer (IDIBAPS), Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Respiratory Intensive Care Unit, Pulmonary Division, Heart Institute, Hospital das Clínicas, University of Sao Paulo, Sao Paulo, Brazil.
Lancet. 2015 Sep 12;386(9998):1097-108. doi: 10.1016/S0140-6736(15)60733-4. Epub 2015 Aug 12.
Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria. New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising. Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events. Studies are needed that focus on the long-term management of pneumonia.
社区获得性肺炎在全球范围内导致了极高的死亡率、发病率以及高昂的成本。经验性选择抗生素治疗是肺炎患者管理的基石。为减少抗生素的滥用、耐药性及副作用,需要一种经验性、有效且个体化的抗生素治疗方案。抗生素治疗开始后的随访也很重要,管理措施应包括尽早转换为口服抗生素、根据微生物学结果进行管理以及依据临床稳定性标准进行短疗程抗生素治疗。快速临床(肺部超声)和微生物学(分子生物学)诊断的新方法前景广阔。社区获得性肺炎与早期和晚期死亡率以及心血管事件发生率增加相关。需要开展聚焦于肺炎长期管理的研究。