Intensive Care Unit, Chest Department, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisbon.
Intensive Care Unit, Hospital Vila Franca de Xira, Vila Franca de Xira.
Curr Opin Infect Dis. 2018 Apr;31(2):170-176. doi: 10.1097/QCO.0000000000000435.
The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns.
New molecular biology methods have changed the etiologic perspective of CAP, especially the contribution of virus. Lung ultrasound and biomarkers might aid diagnosis and severity stratification in the outpatient setting. Antibiotic resistance is a growing problem that reinforces the importance of novel antibiotics. And finally, prevention and the use of anti-pneumococcal vaccine are instrumental in reducing the burden of disease.
Most of CAP cases are managed in the community; however, most research comes from hospitalized severe patients. New and awaited advances might contribute to aid diagnosis, cause and assessment of patients with CAP in the community. This knowledge might prove decisive in the execution of stewardship programmes that maintain current antibiotics, safeguard future ones and reinforce prevention.
1993 年首次发布了社区获得性肺炎（CAP）指南，但自那时以来，CAP 门诊管理仍存在诸多挑战。这些挑战包括难以确定初始临床诊断、风险分层（决定治疗场所）、经验性选择抗生素、新型抗生素相对稀缺以及了解当地微生物药敏模式的重要性。
新的分子生物学方法改变了 CAP 的病因学观点，尤其是病毒的作用。肺部超声和生物标志物可能有助于在门诊环境中进行诊断和严重程度分层。抗生素耐药性是一个日益严重的问题，这凸显了新型抗生素的重要性。最后，预防和使用肺炎球菌疫苗有助于减轻疾病负担。
大多数 CAP 病例在社区管理；然而，大多数研究来自住院的重症患者。新的和预期的进展可能有助于辅助社区中 CAP 患者的诊断、病因和评估。这些知识对于执行管理方案可能是决定性的，这些方案可以维持现有抗生素、保护未来抗生素并加强预防。
