Mantero Marco, Tarsia Paolo, Gramegna Andrea, Henchi Sonia, Vanoni Nicolò, Di Pasquale Marta
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy.
Multidiscip Respir Med. 2017 Oct 5;12:26. doi: 10.1186/s40248-017-0106-3. eCollection 2017.
Community-acquired pneumonia is a common and serious disease, with high rates of morbidity and mortality. Management and treatment of community-acquired pneumonia are described in three main documents: the 2007 American Thoracic Society guidelines, the 2011 European Respiratory Society guidelines, and the 2009 British Thoracic Society guidelines, updated by the NICE in 2015. Despite the validity of current guidelines in improving prognosis and management of patients with community-acquired pneumonia, not all recommendations have high levels of evidence and there are still some controversial issues. In particular, there are some areas of low evidence such as the efficacy of an antibiotic molecule or scheme in patients with same risk factors; duration of antibiotic treatment, supportive therapy for acute respiratory failure and immunomodulation molecules. This review will summarize the main recommendations with high level of evidence and discuss the recommendations with lower evidence, analyzing the studies published after the guidelines' release.
社区获得性肺炎是一种常见且严重的疾病，发病率和死亡率很高。社区获得性肺炎的管理和治疗在三份主要文件中有描述：2007年美国胸科学会指南、2011年欧洲呼吸学会指南以及2009年英国胸科学会指南，后者于2015年由英国国家卫生与临床优化研究所（NICE）更新。尽管当前指南在改善社区获得性肺炎患者的预后和管理方面具有有效性，但并非所有建议都有高水平的证据支持，并且仍然存在一些有争议的问题。特别是，存在一些证据不足的领域，例如具有相同风险因素的患者中抗生素分子或方案的疗效；抗生素治疗的持续时间、急性呼吸衰竭的支持治疗以及免疫调节分子。本综述将总结具有高水平证据的主要建议，并讨论证据水平较低的建议，分析指南发布后发表的研究。
