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在社区获得的肺炎:一篇综述

Valerie M Vaughn^1,2,3, Robert P Dickson^4,5,6, Jennifer K Horowitz³

¹Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.

|September 16, 2024

概括

在社区获得的肺炎 (CAP) 是每年影响数百万人的严重感染. 及时诊断和适当的抗生素治疗,如 ceftriaxone 和 azithromycin,对于有效的治疗和改善患者的结果至关重要.

科学领域:

肺病学
传染性疾病
危急护理医学

背景情况:

社区感染性肺炎 (CAP) 是美国的一个重大公共卫生问题,每年导致数百万例急诊,住院和死亡.
老年人和免疫系统受损或潜在肺部疾病的人面临更高的CAP风险及其严重并发症,包括败血症和急性呼吸困扰综合征.

研究的目的:

概述社区获得性肺炎的诊断标准.
根据疾病严重程度和潜在的病原体耐药性,讨论建议的经验性治疗策略.
强调检测流感和COVID-19等常见病毒病原体的重要性.

主要方法:

肺炎的诊断是基于临床迹象,症状和无其他解释的放射性证据.
在住院的CAP患者中,病原体的鉴定只能在38%的病例中实现,病毒和肺炎链球菌是常见的罪祸首.
经验性治疗决定考虑疾病的严重程度,细菌或耐药性感染的可能性,以及过度使用抗生素的潜在危害.

主要成果:

怀疑有细菌性CAP且没有耐药性细菌的风险因素的住院患者可以使用β-乳酸/ 巨组合治疗至少3天.
在社区流行率高的时期,建议所有CAP患者进行COVID-19和流感检测.
在严重的CAP病例中,当在症状出现后24小时内服用全身皮质类固醇时,可能会降低28天的死亡率.

结论:

社区获得性肺炎 (CAP) 需要及时诊断和治疗,并根据疾病严重程度和疑似病因量身定制治疗.
在没有耐药病原体的住院患者中,实验性抗生素治疗,如triaxone和azithromycin是一种常见的方法.
早期使用皮质类固醇可能会改善严重CAP的结果.

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