美国胸科学会CAP治疗.pdfVIP

Concise Clinical Review Management of Community-acquired Pneumonia in Adults 1,2 3 2 Grant W. Waterer , Jordi Rello , and Richard G. Wunderink 1University of Western Australia, Perth, Australia; 2Northwestern University Feinberg School of Medicine, Chicago, Illinois; and 3Critical Care Department, Vall d’Hebron University Hospital, Vall d’Hebron Institut Recerca, Barcelona, Spain Despite many advances in medical science, the mortality rate from Thoracic Society major and minor criteria (5), CURXO (6), community-acquired pneumonia (CAP) has changed little in the past SMART-COP (7), and CAP-PIRO (8). A significant volume of four decades. Death and adverse outcomes from CAP result from CAP research has been devoted to comparing the various a complex interplay between the pathogen and the host. Newer systems to try and identify which is the most reliable (9). information about the effect of pneumonia on comorbidity and Overall the results of comparisons of the different systems underlying diseases, especially long term, suggests this is an impor- depend on the use to which each is being put (e.g., determining tant additional axis that differs from the traditional triangular inpatient vs. outpatient treatment, need for intensive care, concept of pathogen, host defense, and antibiotic treatment. A predicting mortality, etc.), the particular hospital or health care number of clinical scoring systems have been developed to help system to which it is applied (reflecting differences in criteria for physicians identify patients with CAP at risk of adverse outcomes.