Division of Pulmonary, Critical Care, and Sleep Medicine.
Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
Curr Opin Infect Dis. 2020 Apr;33(2):173-181. doi: 10.1097/QCO.0000000000000639.
The aim of this study was to discuss the literature on community-acquired pneumonia (CAP) in patients with chronic obstructive pulmonary disease (COPD).
Well designed studies show that COPD is the strongest risk factor for development of CAP. Lung microbiome, abnormal lung immunity and pathogen virulence are important components of the pathogenesis of CAP in COPD. The cause of CAP in patients with COPD is similar to that of non-COPD patients. However, patients with COPD are at an increased risk of infection by Gram-negative bacilli, including Pseudomonas aeruginosa. Empiric treatment regimens for CAP in COPD should contemplate the most common pathogens, and consideration should be given for the coverage of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus depending on the severity of CAP, severity of COPD or prior isolation of these pathogens. COPD has not been consistently shown to be an independent risk factor for worse short-term outcomes in patients with CAP. In a long-term study, COPD is associated with worse outcomes in these patients.
Research focused on lung microbiome and abnormal lug immunity in patients with COPD should be prioritized. Further clinical research should try to consolidate the role of additional treatment approaches such as immunomodulating medications in COPD patients with CAP.
本研究旨在讨论慢性阻塞性肺疾病（COPD）患者社区获得性肺炎（CAP）的相关文献。
精心设计的研究表明，COPD 是 CAP 发展的最强危险因素。肺部微生物组、异常肺部免疫和病原体毒力是 COPD 患者 CAP 发病机制的重要组成部分。COPD 患者 CAP 的病因与非 COPD 患者相似。然而，COPD 患者感染革兰氏阴性杆菌（包括铜绿假单胞菌）的风险增加。针对 COPD 患者 CAP 的经验性治疗方案应考虑最常见的病原体，并根据 CAP 的严重程度、COPD 的严重程度或这些病原体的既往分离情况，考虑覆盖铜绿假单胞菌和耐甲氧西林金黄色葡萄球菌。COPD 并未一致表明是 CAP 患者短期预后较差的独立危险因素。在一项长期研究中，COPD 与这些患者的不良结局相关。
应优先研究 COPD 患者肺部微生物组和异常肺部免疫。进一步的临床研究应尝试整合其他治疗方法（如免疫调节药物）在 COPD 合并 CAP 患者中的作用。
