第八章 希氏内科学 肺炎.pdfVIP

Goldman: Cecil Medicine, 23rd ed. Copyright 2007 Saunders, An Imprint of Elsevier Chapter 97 OVERVIEW OF PNEUMONIA Andrew H. Limper It is a useful distinction to separate pneumonias, which are infections of the lung parenchyma and thus distinct from infections limited to the trachea or large bronchi ( Chapter 96 ), into those acquired in the community (community-acquired pneumonia) as opposed to those arising in institutional settings, with the second group being composed of hospital-acquired pneumonia, ventilator-associated pneumonia, and health care associated pneumonia. These two maj or pneumonia categories will be considered separately. Additional consideration should also be given to pneumonia caused by recurrent gross aspiration of oropharyngeal contents. The term pneumonia itself, however, includes other causes of inflammation of the lower respiratory air spaces, particularly the alveoli, such as acute or chronic eosinophilic pneumonia, bronchiolitis obliterans with organizing pneumonia, and usual interstitial pneumonia, all of which are presented in more detail elsew here ( Chapter 92 ). COMMUNITY-ACQUIRED PNEUMONIA Definition Community-acquired pneumonia includes cases of infectious pneumonia in patients living independently in the community. Patients who have been hospitalized for other reasons for less than 48 hours before the development of respiratory symptoms are also considered to have community-acquired pneumonia because it is likely that the inoculation had occurred before admission. However, patients who have previously been hospitalized for at least 2 days within the 90 days before infection, patients from nursing homes who received intravenous antibiotic therapy, chemotherapy, or wound care within the past 30 days, and patients from hemodialysis centers are considered to have health care associated pneumonia and are therefore excl