Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Respiratory Unit, Rozzano, Italy.
Department of Internal Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Yale School of Medicine, New Haven, CT, USA.
Lancet. 2021 Sep 4;398(10303):906-919. doi: 10.1016/S0140-6736(21)00630-9.
Community-acquired pneumonia is not usually considered a high-priority problem by the public, although it is responsible for substantial mortality, with a third of patients dying within 1 year after being discharged from hospital for pneumoniae. Although up to 18% of patients with community-acquired pneumonia who were hospitalised (admitted to hospital and treated there) have at least one risk factor for immunosuppression worldwide, strong evidence on community-acquired pneumonia management in this population is scarce. Several features of clinical management for community-acquired pneumonia should be addressed to reduce mortality, morbidity, and complications related to community-acquired pneumonia in patients who are immunocompetent and patients who are immunocompromised. These features include rapid diagnosis, microbiological investigation, prevention and management of complications (eg, respiratory failure, sepsis, and multiorgan failure), empirical antibiotic therapy in accordance with patient's risk factors and local microbiological epidemiology, individualised antibiotic therapy according to microbiological data, appropriate outcomes for therapeutic switch from parenteral to oral antibiotics, discharge planning, and long-term follow-up. This Seminar offers an updated view on community-acquired pneumonia in adults, with suggestions for clinical and translational research.
社区获得性肺炎通常不会引起公众的高度重视，尽管它会导致大量患者死亡，三分之一的患者在因肺炎出院后 1 年内死亡。尽管在全球范围内，多达 18%的住院社区获得性肺炎患者至少存在一种免疫抑制的风险因素，但针对该人群的社区获得性肺炎管理方面的有力证据却很少。为了降低死亡率、发病率和与免疫功能正常和免疫功能低下患者的社区获得性肺炎相关的并发症，应解决社区获得性肺炎临床管理中的几个问题。这些特征包括快速诊断、微生物学调查、预防和处理并发症（例如呼吸衰竭、败血症和多器官衰竭）、根据患者的风险因素和当地微生物流行病学进行经验性抗生素治疗、根据微生物学数据进行个体化抗生素治疗、从静脉注射抗生素到口服抗生素的治疗转换的适当结果、出院计划和长期随访。本次研讨会提供了成人社区获得性肺炎的最新观点，并提出了临床和转化研究的建议。
