Abstract:
Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality worldwide, and since 1993, guidelines for management have been available. The process, which first began in the United States and Canada, has now been implemented in numerous countries throughout the world, and often each geographic region or country develops locally specific recommendations. It is interesting to realize that guidelines from different regions often interpret the same evidence base differently, and guidelines differ from one country to another, even though the bacteriology of CAP is often more similar than different from one region to another. One of the unique contributions of the 2007 US guidelines is the inclusion of quality and performance measures. In addition, US guidelines emphasize management principles that differ from some of the principles in European guidelines because of unique epidemiological considerations. In addition, certain therapy principles apply in the United States that differ from those in other regions, including the need for all patients to receive routine therapy for atypical pathogens, the emergence of community-acquired methicillin-resistant Staphylococcus aureus in some patients following influenza, and the need for all patients admitted to the intensive care unit to receive at least two antimicrobial agents. In the future, as guidelines evolve, there will be an important place for regional guidelines, particularly if these guidelines can recommend locally specific strategies to implement guidelines, which if successful, can lead to improved patient outcomes.
摘要:
社区获得性肺炎(CAP)是全球范围内常见的发病和死亡原因,自1993年以来,已经有了管理指南。过程,最早始于美国和加拿大,现在已经在世界许多国家实施,通常每个地理区域或国家都会制定针对当地的建议。有趣的是,来自不同地区的指南通常对相同的证据基础进行不同的解释,和指导方针因国家而异,尽管CAP的细菌学通常比不同地区更相似。2007年美国指南的独特贡献之一是纳入了质量和绩效指标。此外,由于独特的流行病学考虑,美国指南强调与欧洲指南中的某些原则不同的管理原则。此外,某些治疗原则适用于美国,与其他地区不同,包括所有患者都需要接受非典型病原体的常规治疗,一些流感患者出现社区获得性耐甲氧西林金黄色葡萄球菌,以及所有入住重症监护病房的患者需要接受至少两种抗微生物剂。在未来,随着指导方针的发展,区域指导方针将有一个重要的地方,特别是如果这些指南可以推荐当地特定的策略来实施指南,如果成功,可以改善患者的预后。