Department of Pneumology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) Barcelona, Barcelona, Spain.
Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Curr Opin Crit Care. 2018 Dec;24(6):531-539. doi: 10.1097/MCC.0000000000000550.
Despite the improvements in its management, community-acquired pneumonia (CAP) still exhibits high global morbidity and mortality rates, especially in elderly patients. This review focuses on the most recent findings on the epidemiology, cause, diagnosis and management of CAP.
There is consistent evidence that the trend in CAP mortality has declined over time. However, the mortality of pneumococcal CAP has not changed in the last two decades, with an increase in the rate of hospitalization and more severe forms of CAP. Streptococcus pneumoniae remains the most frequent cause of CAP in all settings, age groups and regardless of comorbidities. However, the implementation of molecular diagnostic tests in the last years has identified respiratory viruses as a common cause of CAP too. The emergency of multidrug-resistance pathogens is a worldwide concern. An improvement in our ability to promptly identify the causative cause of CAP is required in order to provide pathogen-directed antibiotic therapy, improve antibiotic stewardship programs and implement appropriate vaccine strategies.
It is time to apply all the knowledge generated in the last decade in order to optimize the management of CAP.
尽管社区获得性肺炎(CAP)的管理已经有所改善,但它仍然在全球范围内表现出较高的发病率和死亡率,特别是在老年患者中。这篇综述重点介绍了 CAP 的流行病学、病因、诊断和治疗方面的最新发现。
有确凿的证据表明,CAP 的死亡率趋势随着时间的推移而下降。然而,在过去的二十年中,肺炎球菌性 CAP 的死亡率并没有改变,住院率上升,CAP 的严重程度增加。肺炎链球菌仍然是所有环境、年龄组和合并症患者中 CAP 的最常见原因。然而,近年来分子诊断检测的实施也发现了呼吸道病毒也是 CAP 的常见病因。多药耐药病原体的出现是一个全球性的问题。为了提供针对病原体的抗生素治疗、改善抗生素管理计划并实施适当的疫苗策略,我们需要提高及时识别 CAP 病因的能力。
现在是时候应用过去十年中所获得的所有知识来优化 CAP 的管理了。