Garin Nicolas, Marti Christophe, Skali Lami Aicha, Prendki Virginie
Division of Internal Medicine, Riviera Chablais Hospital, 1847 Rennaz, Switzerland.
Division of General Internal Medicine, Geneva University Hospital, 1211 Geneva, Switzerland.
Microorganisms. 2022 Nov 24;10(12):2326. doi: 10.3390/microorganisms10122326.
Atypical pathogens are intracellular bacteria causing community-acquired pneumonia (CAP) in a significant minority of patients. spp., and , , and are commonly included in this category. is present in 5-8% of CAP, being the second most frequent pathogen after . is found in 3-5% of inpatients. spp. and are present in less than 1% of patients. is relatively frequent in New Zealand and Australia and might also be present in other parts of the world. Uncertainty remains on the prevalence of atypical pathogens, due to limitations in diagnostic means and methodological issues in epidemiological studies. Despite differences between CAP caused by typical and atypical pathogens, the clinical presentation alone does not allow accurate discrimination. Hence, antibiotics active against atypical pathogens (macrolides, tetracyclines and fluoroquinolones) should be included in the empiric antibiotic treatment of all patients with severe CAP. For patients with milder disease, evidence is lacking and recommendations differ between guidelines. Use of clinical prediction rules to identify patients most likely to be infected with atypical pathogens, and strategies of narrowing the antibiotic spectrum according to initial microbiologic investigations, should be the focus of future investigations.
非典型病原体是一类细胞内细菌，在少数社区获得性肺炎（CAP）患者中致病。嗜肺军团菌、肺炎支原体、肺炎衣原体和鹦鹉热衣原体通常属于这一类别。嗜肺军团菌在5%至8%的CAP患者中存在，是仅次于肺炎链球菌的第二常见病原体。肺炎支原体在3%至5%的住院患者中被发现。肺炎衣原体和鹦鹉热衣原体在不到1%的患者中存在。嗜肺军团菌在新西兰和澳大利亚相对常见，在世界其他地区也可能存在。由于诊断手段的限制和流行病学研究中的方法学问题，非典型病原体的患病率仍不确定。尽管典型病原体和非典型病原体引起的CAP存在差异，但仅凭临床表现无法准确区分。因此，在所有重症CAP患者的经验性抗生素治疗中，应包括对非典型病原体有效的抗生素（大环内酯类、四环素类和氟喹诺酮类）。对于病情较轻的患者，缺乏相关证据，不同指南的建议也有所不同。利用临床预测规则识别最有可能感染非典型病原体的患者，以及根据初始微生物学检查缩小抗生素谱的策略，应是未来研究的重点。
