肺炎支原体感染是临床的常见病征，要做到恰当诊断、治疗和合理使用抗菌药物，迫切需要规范其检测方法并指导临床应用。遵照国家卫生计生委合理用药专家委员会的专项通知要求，儿科临床和检验学科专家基于实验室规范和临床实践这两个要素，博采各方观点、集思广益并参考相关文献编写成本共识，依据是检测方法的敏感性和特异性，经济实用性和可及性，共识还分层推荐了不同场景下肺炎支原体感染实验室诊断方法之选择。.

Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

For reasons of antibiotic resistance and side effects, macrolides should be prescribed with care in the pediatric population. We evaluated the adherence to Dutch guidelines of macrolide prescription in children and estimated the risk of Mycoplasma pneumoniae-associated pneumonia based on Fischer\'s decision tree. In this retrospective study, we included children aged 0-18 years who were treated with azithromycin or clarithromycin for pulmonary disease in four settings from general practice to hospital ward for (1) the prescriptions not in accordance with the guideline of the Dutch Association of Pediatrics and (2) the risk of M. pneumoniae in patients with community-acquired pneumonia (CAP) according to Fischer\'s decision tree. The latter suggests that children older than three years with a fever lasting more than two days are at high risk for M. pneumoniae and that it is therefore justified to treat them with macrolides. In total, 189 macrolide prescriptions from 2015 until 2017 were analyzed: 139 children used macrolides for a pulmonary indication (75%); 18% (n = 25) of the prescriptions were not in accordance with Dutch guidelines. Only 9.1% of patients with CAP were classified as having a high risk of M. pneumoniae according to Fischer\'s decision tree. A significant proportion of macrolide prescriptions for Dutch children with a pulmonary disease appears not to be in accordance with the guidelines. Most patients with CAP treated with a macrolide actually had a low risk of having M. pneumoniae according to Fischer\'s decision tree. Both observations suggest overuse of macrolides in children.

BACKGROUND: Very few data exist on the management of community-acquired pneumonia (CAP) in patients admitted to hospitals in the Gulf region. The objectives of this study were to describe treatment patterns for CAP in 38 hospitals in five Gulf countries (United Arab Emirates, Kuwait, Bahrain, Oman, and Qatar) and to compare the findings to the most recent Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guidelines.
METHODS: This was a prospective, observational study conducted between January 2009 and February 2011. Adult patients hospitalised (excluding intensive care units) for CAP and subsequently discharged were included. Data were collected retrospectively at hospital discharge, and prospectively during two follow-up visits. Data on medical history, mortality-risk scores, diagnostic criteria, antibiotic treatment, isolated pathogens and clinical and radiographic outcomes were collected. Care practices were compared to the IDSA/ATS guidelines.
RESULTS: A total of 684 patients were included. The majority (82.9 %) of patients were classified as low risk for mortality (pneumonia severity index II and III). The majority of patients fulfilled criteria for treatment success at discharge, although only 77.6 % presented a normalised leukocyte count. Overall, the management of CAP in Gulf countries is in line with the IDSA/ATS guidelines. This applied to the diagnosis of CAP, to the identification of high-risk CAP patients, to the identification of etiologic agent responsible for CAP and to the type of treatment despite the fact that combinations of antimicrobial agents were not consistent with the guidelines in 10 % of patients. In all patients, information about Gram\'s staining was not captured as recommended by the IDSA/ATS and in the majority of patients (>85 %) chest radiography was not systematically performed at the post-discharge follow-up visits.
CONCLUSIONS: The management of CAP in the Gulf region is globally in line with current IDSA/ATS guidelines, although rates of pathogen characterisation and post-discharge follow-up need to be improved.
CONCLUSIONS: Compliance with established guidelines should be encouraged in order to improve the management of the disease in this region.

OBJECTIVE: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Mycoplasma pneumoniae is one of the major causative pathogens of CAP. Early diagnosis of M. pneumoniae pneumonia is crucial for initiating appropriate antibiotic therapy. The aim of this study was to determine whether the Japanese Respiratory Society (JRS) guidelines on CAP are effective for diagnosing M. pneumoniae pneumonia.
METHODS: Between August 2008 and July 2009, adult outpatients with CAP were consecutively enrolled. The aetiology of CAP was determined by culture and real-time polymerase chain reaction (PCR) methods to detect M. pneumoniae, urine antigen tests to detect Streptococcus pneumoniae and Legionella pneumoniae, blood and sputum culture for bacteria and real-time PCR for eight common respiratory viruses. The predictive value of the JRS guidelines for differentiating M. pneumoniae pneumonia from typical bacterial and viral pneumonias was determined.
RESULTS: Data from 215 adult CAP outpatients was analyzed. An aetiological diagnosis was made for 105 patients (48.8%), including 62 patients with M. pneumoniae pneumonia, 17 patients with typical bacterial pneumonia and 23 patients with viral pneumonia. According to the JRS criteria for differential diagnosis of atypical pneumonia, 55 of 62 patients were correctly diagnosed with M. pneumoniae pneumonia (sensitivity 88.7%), and 31 of 40 patients with bacterial and viral pneumonia were correctly excluded (specificity 77.5%).
CONCLUSIONS: The JRS guidelines on CAP provide a useful tool for the identification of M. pneumoniae pneumonia cases and differentiating these from cases of typical bacterial or viral pneumonia.

Community-acquired pneumonia (CAP) is a major cause of death in developing countries and of morbidity in developed countries. The objective of the study was to define the causative agents among children hospitalized for CAP defined by WHO guidelines and to correlate etiology with clinical severity and surrogate markers. Investigations included an extensive etiological workup. A potential causative agent was detected in 86% of the 99 enrolled patients, with evidence of bacterial (53%), viral (67%), and mixed (33%) infections. Streptococcus pneumoniae was accounted for in 46% of CAP. Dehydration was the only clinical sign associated with bacterial pneumonia. CRP and PCT were significantly higher in bacterial infections. Increasing the number of diagnostic tests identifies potential causes of CAP in up to 86% of children, indicating a high prevalence of viruses and frequent co-infections. The high proportion of pneumococcal infections re-emphasizes the importance of pneumococcal immunization.

The Japanese Respiratory Society (JRS) published the guidelines for the management of community-acquired pneumonia in 2000. The guidelines set up nine parameters and criteria for the differential diagnosis of atypical pneumonia and bacterial pneumonia based on clinical symptoms, physical signs and laboratory data. To evaluate the performance of these guideline criteria, 91 cases of Chlamydia pneumoniae (53 cases were pure-C. pneumoniae and 38 cases were mixed-C. pneumoniae pneumonia), 103 cases of Mycoplasma pneumoniae (86 cases were pure-M. pneumoniae and 17 cases were mixed-M. pneumoniae pneumonia) and 144 cases of bacterial (Streptococcus pneumoniae and/or Haemophilus influenzae) pneumonia were analyzed. The accordance rate for a suspected atypical pneumonia with the guideline criteria was 84.8% for pure-M. pneumoniae pneumonia and 60.3% for pure-C. pneumoniae pneumonia, but only 9.0% for bacterial pneumonia, 12.1% for mixed-C. pneumoniae pneumonia and 16.6% for mixed-M. pneumoniae pneumonia. Overall, the sensitivity and specificity of the criteria in the JRS guidelines were 75.5% and 90.9%, respectively. Our results indicated that the differentiation of pneumonia in the JRS guidelines is useful for the diagnosis of M. pneumoniae pneumonia, but difficult to apply to the diagnosis of C. pneumoniae pneumonia.

To evaluate the usefulness of differentiation of atypical pneumonia and bacterial pneumonia in the community-acquired pneumonia guidelines of the Japanese Respiratory Society, we investigated 124 cases of three atypical pneumonias (Mycoplasma pneumonia, 62 cases; Chlamydia pneumoniae pneumonia, 46 cases; Chlamydia psittaci pneumonia, 13 cases) and 403 cases of bacterial pneumonia at our hospital over seven years. Overall, the sensitivity and specificity of the criteria in the guideline were 70.4% and 91.8%, respectively. High accordance was recognized in patients under 60 years old with atypical pneumonia. Items in the criteria that included subjective factors were considered inassessable. We found that the differentiation of pneumonias in the guideline is useful for the diagnosis of atypical pneumonia among younger patients, but it should be concise and objective. We therefore propose that the criteria would be more effective if they consisted of only 4 items: age under 60 years, no underlying disorders, presence of stubborn dry cough, and normal peripheral white blood cell count.

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