Leoni Davide, Rello Jordi
aInfectious Disease Department, Tor Vergata University Hospital, University of 'La Sapienza', Rome, Italy bClinical Research & Innovation in Pneumonia & Sepsis (CRIPS) cCentro de Investigación Biomédica En Red - Enfermedades Respiratorias (CIBERES), Vall d'Hebron Institute of Research dUniversitat Autònoma de Barcelona, Barcelona, Spain.
Curr Opin Infect Dis. 2017 Apr;30(2):240-247. doi: 10.1097/QCO.0000000000000349.
Community-acquired pneumonia (CAP) is the leading cause of mortality among infectious diseases. Several efforts have been implemented to achieve better outcomes, but an important proportion of patients continue dying. This review focuses on the newest research on prognostic factors and diagnostics, opening new perspectives in the management of CAP.
CAP survival improved in recent years despite an increasing incidence of severe presentations. Appropriateness of antimicrobial choice, combination therapy and early administration of antibiotics has proved to be decisive. Novel biomarkers, as monocyte human leukocyte antigen-DR, presepsin and proadrenomedullin, have been explored for the prediction of severe CAP; moreover, the application of new techniques in metabolomics, genomics and microbiomics in the field of infections may contribute to predicting clinical instability and worse outcomes, showing that precise individual phenotypes are key factors for survival. CAP with unidentified organism is still an issue of concern, but new rapid molecular tests improve yield rates, revealing an unexpected high prevalence of viral detection and proving their usefulness also in the recognition of bacterial causes.
Precision medicine applied to risk stratification and diagnosis, together with rapid microbiologic molecular testing, may contribute to optimizing the management of CAP, with potential additional reduction of mortality rates.
社区获得性肺炎（CAP）是传染病死亡的主要原因。人们已经采取了多项措施以取得更好的治疗效果，但仍有相当一部分患者死亡。本综述聚焦于预后因素和诊断方面的最新研究，为CAP的管理开辟新视角。
尽管严重CAP的发病率有所上升，但近年来其生存率有所提高。抗菌药物选择的合理性、联合治疗以及抗生素的早期使用已被证明具有决定性作用。新型生物标志物，如单核细胞人类白细胞抗原-DR、可溶性髓系细胞触发受体-1和肾上腺髓质素原，已被用于预测严重CAP；此外，感染领域代谢组学、基因组学和微生物组学新技术的应用可能有助于预测临床不稳定和不良预后，表明精确的个体表型是生存的关键因素。病原体未明的CAP仍然是一个令人担忧的问题，但新的快速分子检测提高了检出率，显示出病毒检测意外的高流行率，并证明其在识别细菌病因方面也有用处。
应用于风险分层和诊断的精准医学，以及快速微生物分子检测，可能有助于优化CAP的管理，并有可能进一步降低死亡率。
