Woodhead M
Department of Respiratory Medicine, Manchester Royal Infirmary, United Kingdom.
Semin Respir Infect. 1998 Mar;13(1):8-16.
Most patients with pneumonia never reach the hospital but are managed in the community. Unlike patients admitted to the hospital, in most, no investigations are performed and the diagnosis is based on clinical features. Less than half of those with clinical pneumonia have radiographic infiltrates and some of those with lower respiratory tract infection that is not considered to be pneumonia do. Few studies have investigated this condition, partly because of these diagnostic difficulties. The importance of distinction of these conditions is uncertain at present. The role of microbiological investigations in patients with pneumonia in the community requires clarification. For most patients it is unlikely that such tests will alter management, but it is not possible to predict those in whom such tests may help. What little is known about the microbial cause of pneumonia managed outside of the hospital is that the causative pathogens are similar to those found in studies of hospitalized patients, with the exception of pathogens usually associated with severe illness such as legionella and staphylococci, which are uncommon. Empirical antibiotic therapy can be predicted from the above findings, but much further research is required to fill in current gaps in our knowledge.
大多数肺炎患者从未住院，而是在社区接受治疗。与住院患者不同，大多数社区肺炎患者未进行任何检查，诊断基于临床特征。临床诊断为肺炎的患者中，不到一半有影像学浸润，而一些被认为不是肺炎的下呼吸道感染患者却有影像学浸润。很少有研究调查这种情况，部分原因是存在这些诊断困难。目前尚不确定区分这些情况的重要性。微生物学检查在社区肺炎患者中的作用需要阐明。对于大多数患者来说，此类检查不太可能改变治疗方案，但无法预测哪些患者可能会从中受益。关于院外治疗的肺炎的微生物病因，所知甚少的是，除了通常与重症相关的病原体（如军团菌和葡萄球菌，这些并不常见）外，致病病原体与住院患者研究中发现的病原体相似。从上述发现可以推断经验性抗生素治疗方案，但仍需要更多研究来填补我们目前知识上的空白。
