首页 中华急诊医学杂志 2025年34卷03期 急诊成人社区获得性肺炎临床实践指南（2024年版）
中华急诊医学杂志
期刊首页
过刊列表
高级检索
稿件发表
• 标准与指南 •
急诊成人社区获得性肺炎临床实践指南（2024年版）
中国医师协会急诊医师分会
中国急诊专科医联体
北京急诊医学学会
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1671-0282.2025.03.006
263
153
0
0
4
0
扫描转手机阅读
下载中华医学期刊APP阅读更流畅 体验更丰富
PDF下载
APP内阅读
摘要
社区获得性肺炎（community acquired pneumonia, CAP）是最常见的感染性疾病之一。调查显示，大部分CAP患者在急诊进行初始诊断和治疗。然而，各级医院急诊对于CAP的诊治能力差异较大，从而导致治疗效果存在较大差别。2015年中国医师协会急诊医师分会牵头制订了《中国急诊社区获得性肺炎临床实践指南》，对各级医院急诊CAP的诊治起到了较好的指导作用。近年来，国内外在CAP诊断、治疗等方面均有一定的进展，为更好地指导各地急诊CAP的诊治，本指南编写组在充分遵循《中国制订/修订临床诊疗指南的指导原则（2022版）》的基础上，对2015年指南进行更新和修订，形成新版急诊成人CAP临床实践指南。本指南适用于年龄18周岁及以上CAP患者，不包括2019冠状病毒病（COVID-19）相关肺炎及免疫抑制人群罹患的肺炎。证明与推荐等级说明见表1。
引用本文
中国医师协会急诊医师分会,中国急诊专科医联体,北京急诊医学学会. 急诊成人社区获得性肺炎临床实践指南（2024年版）[J]. 中华急诊医学杂志,2025,34(03)：300-317.
DOI:10.3760/cma.j.issn.1671-0282.2025.03.006PERMISSIONS
Request permissions for this article from CCC.
评价本文
*以上评分为匿名评价
本文评分
0分
[累计0个]
向我们报错
版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
社区获得性肺炎（community acquired pneumonia, CAP）是最常见的感染性疾病之一。调查显示，大部分CAP患者在急诊进行初始诊断和治疗。然而，各级医院急诊对于CAP的诊治能力差异较大，从而导致治疗效果存在较大差别。2015年中国医师协会急诊医师分会牵头制订了《中国急诊社区获得性肺炎临床实践指南》，对各级医院急诊CAP的诊治起到了较好的指导作用。近年来，国内外在CAP诊断、治疗等方面均有一定的进展，为更好地指导各地急诊CAP的诊治，本指南编写组在充分遵循《中国制订/修订临床诊疗指南的指导原则（2022版）》的基础上，对2015年指南进行更新和修订，形成新版急诊成人CAP临床实践指南。本指南适用于年龄18周岁及以上CAP患者，不包括2019冠状病毒病（COVID-19）相关肺炎及免疫抑制人群罹患的肺炎。证明与推荐等级说明见
表1
。
| 证据等级与推荐等级 | 说明 |
|---|---|
| 证据等级 | |
| 等级Ⅰ（高等级） | 高质量的随机对照临床研究（RCT）、权威指南以及高质量系统综述和Meta分析 |
| 等级Ⅱ（中等级） | 有一定研究局限性的RCT研究（如无隐藏分组、未设盲、未报告失访）、队列研究、病例系列研究及病例对照研究 |
| 等级Ⅲ（低等级） | 病例报道、专家意见 |
| 推荐等级 | |
| A（强推荐） | 该方案大多数患者、医生和政策制定者都会采纳 |
| B（中度推荐） | 该方案多数人会采纳，但仍有部分人不采纳，要结合患者具体情况作出体现其价值观和意愿的决定 |
| C（弱推荐） | 证据不足，需要患者、医生和政策制定者共同讨论决定 |
展开表格
证据等级与推荐等级说明
试读结束，您可以通过登录机构账户或个人账户后获取全文阅读权限。
已是订阅账户?
登录
参考文献
[1]
中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J]. 中华结核和呼吸杂志, 2016,39(4):253-279. DOI:
10.3760/cma.j.issn.1001-0939.2016.04.005
.
[2]
Sun YX , Li H , Pei ZC ,et al. Incidence of community-acquired pneumonia in urban China: a national population-based study[J]. Vaccine, 2020,38(52):8362-8370. DOI:
10.1016/j.vaccine.2020.11.004
.
[3]
Qin T , Zhou HJ , Ren HY ,et al. Incidence, etiology, and environmental risk factors of community-acquired pneumonia requiring hospitalization in China: a 3-year, prospective, age-stratified, multicenter case-control study[J]. Open Forum Infect Dis, 2021,8(11):ofab499. DOI:
10.1093/ofid/ofab499
.
[4]
Liu YN , Zhang YF , Xu Q ,et al. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study[J]. Lancet Microbe, 2023,4(5):e330-e339. DOI:
10.1016/S2666-5247(23)00031-9
.
[5]
Zhang LL , Xiao Y , Zhang GL ,et al. Identification of priority pathogens for aetiological diagnosis in adults with community-acquired pneumonia in China: a multicentre prospective study[J]. BMC Infect Dis, 2023,23(1):231. DOI:
10.1186/s12879-023-08166-3
.
[6]
Nie XM , Li YS , Yang ZW ,et al. Initial empiric antibiotic therapy for community-acquired pneumonia in Chinese hospitals[J]. Clin Microbiol Infect, 2018,24(6):658.e1-658658.e6. DOI:
10.1016/j.cmi.2017.09.014
.
[7]
Fan GH , Zhou YC , Zhou F ,et al. The mortality and years of life lost for community-acquired pneumonia before and during COVID-19 pandemic in China[J]. Lancet Reg Health West Pac, 2023,42:100968. DOI:
10.1016/j.lanwpc.2023.100968
.
[8]
Han XD , Zhou F , Li H ,et al. Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia[J]. BMC Infect Dis, 2018,18(1):192. DOI:
10.1186/s12879-018-3098-5
.
[9]
Song YS , Wang XC , Lang K ,et al. Development and validation of a nomogram for predicting 28-day mortality on admission in elderly patients with severe community-acquired pneumonia[J]. J Inflamm Res, 2022,15:4149-4158. DOI:
10.2147/JIR.S369319
.
[10]
Qu JM , Zhang J , Chen Y ,et al. Aetiology of severe community acquired pneumonia in adults identified by combined detection methods: a multi-centre prospective study in China[J]. Emerg Microbes Infect, 2022,11(1):556-566. DOI:
10.1080/22221751.2022.2035194
.
[11]
Kalil AC , Thomas PG . Influenza virus-related critical illness: pathophysiology and epidemiology[J]. Crit Care, 2019,23(1):258. DOI:
10.1186/s13054-019-2539-x
.
[12]
王玫,赵建玉,李雪,等. 2015至2019年北京某医院住院患者成人社区获得性肺炎病原学特点及防控研究[J]. 中华预防医学杂志, 2021,55(12)：1410-1418. DOI:
10.3760/cma.j.cn112150-20210706-00645
.
[13]
Zhou F , Wang YM , Liu YM ,et al. Disease severity and clinical outcomes of community-acquired pneumonia caused by non-influenza respiratory viruses in adults: a multicentre prospective registry study from the CAP-China Network[J]. Eur Respir J, 2019,54(2):1802406. DOI:
10.1183/13993003.02406-2018
.
[14]
Qu JX , Gu L , Pu ZH ,et al.
Viral etiology of community-acq
uired pneumonia among adolescents and adults with mild or moderate severity and its relation to age and severity
[J]. BMC Infect Dis, 2015,15:89. DOI:
10.1186/s12879-015-0808-0
.
[15]
Yin L , Zhang Y , Zheng YL ,et al.
Early detection of
Aspergillus
species in lower respiratory tract is associated with higher mortality in viral community-acquired pneumonia: a multicenter prospective cohort study in China
[J]. Lung, 2023,201(4):387-396. DOI:
10.1007/s00408-023-00638-2
.
[16]
Qin S , Zhang WZ , Chen F ,et al.
Antibodies against atypical pathogens and respiratory viruses detected by Pneumoslide IgM test in adults with community-acquired pn
eumonia in Guangzhou City
[J]. J Clin Lab Anal, 2020,34(9):e23419. DOI:
10.1002/jcla.23419
.
[17]
余小丽,俞婷,陈愉生,等. 80岁以上老年人社区获得性肺炎的临床特点及病原学分析[J]. 中国呼吸与危重监护杂志, 2022,21(2):90-95. DOI:
10.3969/j.issn.1002-1949.2020.03.018
.
[18]
Guo RN , Dan Z , Fan Z ,et al. Clinical characteristics and pathogen analysis of bronchoalveolar lavage fluid in elderly patients with community-acquired pneumonia[J]. Immun Inflamm Dis, 2023,11(4):e813. DOI:
10.1002/iid3.813
.
[19]
Reynolds D , Kollef M .
The epidemiology and pathogenesis and treatment of
Pseudomonas aeruginosa
infections: an update
[J]. Drugs, 2021,81(18):2117-2131. DOI:
10.1007/s40265-021-01635-6
.
[20]
Sun HY , Chai XL , Xu GX ,et al.
The formation and drug resistance mechanism of biofilm for
Streptococcus pneumoniae
infection in severe respiratory patients
[J]. Cell Mol Biol (Noisy-le-grand), 2023,69(1):75-80. DOI:
10.14715/cmb/2022.69.1.13
.
[21]
Zhou ML , Wang LL , Wang ZR ,et al.
Molecular characterization of penicillin-binding Protein2x, 2b and 1a of
Streptococcus pneumoniae
causing invasive pneumococcal diseases in China: a multicenter study
[J]. Front Microbiol, 2022,13:838790. DOI:
10.3389/fmicb.2022.838790
.
[22]
Li JL , Liu LS , Zhang H ,et al. Severe problem of macrolides resistance to common pathogens in China[J]. Front Cell Infect Microbiol, 2023,13:1181633. DOI:
10.3389/fcimb.2023.1181633
.
[23]
Cai FQ , Li JL , Liang WJ ,et al.
Effectiveness and safety of tetracyclines and quinolones in people
with
Mycoplasma pneumonia
: a systematic review and network meta-analysis
[J]. EClinicalMedicine, 2024,71:102589. DOI:
10.1016/j.eclinm.2024.102589
.
[24]
胡付品,丁丽,郭燕,等. CHINET 2023年细菌耐药监测结果[EB/OL].( 2024-03-05) [2024-06-30]. https://www.chinets.com/Content/File/CHINET 2023年细菌耐药监测结果.pdf.
[25]
Lv CX , Chen Y , Shi W ,et al. Comparison of different scoring systems for prediction of mortality and ICU admission in elderly CAP population[J]. Clin Interv Aging, 2021,16:1917-1929. DOI:
10.2147/CIA.S335315
.
[26]
Zhou HJ , Lan TF , Guo SB . Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: a single-center retrospective cohort study[J]. World J Emerg Med, 2020,11(4):206-215. DOI:
10.5847/wjem.j.1920-8642.2020.04.002
.
[27]
Le Bel J , Hausfater P , Chenevier-Gobeaux C ,et al. Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scan[J]. Crit Care, 2015,19:366. DOI:
10.1186/s13054-015-1083-6
.
[28]
<x>Son</x>
<x>g</x>
Y , Sun WX , Dai DY ,et al. Prediction value of procalcitonin combining CURB-65 for 90-day mortality in community-acquired pneumonia[J]. Expert Rev Respir Med, 2021,15(5):689-696. DOI:
10.1080/17476348.2021.1865810
.
[29]
Self WH , Balk RA , Grijalva CG ,et al. Procalcitonin as a marker of etiology in adults hospitalized with community-acquired pneumonia[J]. Clin Infect Dis, 2017,65(2):183-190. DOI:
10.1093/cid/cix317
.
[30]
Siljan WW , Holter JC , Nymo SH ,et al. Cytokine responses, microbial aetiology and short-term outcome in community-acquired pneumonia[J]. Eur J Clin Invest, 2018,48(1):e12865. DOI:
10.1111/eci.12865
.
[31]
Claessens YE , Debray MP , Tubach F ,et al. Early chest computed tomography scan to assist diagnosis and guide treatment decision for suspected community-acquired pneumonia[J]. Am J Respir Crit Care Med, 2015,192(8):974-982. DOI:
10.1164/rccm.201501-0017OC
.
[32]
Marti C , Garin N , Grosgurin O ,et al. Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis[J]. Crit Care, 2012,16(4):R141. DOI:
10.1186/cc11447
.
[33]
Charles PGP , Wolfe R , Whitby M ,et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia[J]. Clin Infect Dis, 2008,47(3):375-384. DOI:
10.1086/589754
.
[34]
Hu WP , Zhang FY , Zhang J ,et al. Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai[J]. J Thorac Dis, 2020,12(4):1417-1426. DOI:
10.21037/jtd.2020.03.02
.
[35]
Guo Q , Li HY , Song WD ,et al. qSOFA predicted pneumonia mortality better than minor criteria and worse than CURB-65 with robust elements and higher convergence[J]. Am J Emerg Med, 2022,52:1-7. DOI:
10.1016/j.ajem.2021.11.029
.
[36]
Kitsios GD , Nguyen VD , Sayed K ,et al. The upper and lower respiratory tract microbiome in severe aspiration pneumonia[J]. iScience, 2023,26(6):106832. DOI:
10.1016/j.isci.2023.106832
.
[37]
Zhu L , Hao YQ , Li W ,et al. Significance of pleural effusion detected by metagenomic next-generation sequencing in the diagnosis of aspiration pneumonia[J]. Front Cell Infect Microbiol, 2022,12:992352. DOI:
10.3389/fcimb.2022.992352
.
[38]
Gupta NM , Lindenauer PK , Yu PC ,et al. Association between alcohol use disorders and outcomes of patients hospitalized with community-acquired pneumonia[J]. JAMA Netw Open, 2019,2(6):e195172. DOI:
10.1001/jamanetworkopen.2019.5172
.
[39]
Grant LR , Meche A , McGrath L ,et al. Risk of pneumococcal disease in US adults by age and risk profile[J]. Open Forum Infect Dis, 2023,10(5):ofad192. DOI:
10.1093/ofid/ofad192
.
[40]
Aliberti S , Cook GS , Babu BL ,et al.
International prevalence and risk factors evaluation for drug-resistant
Streptococcus pneumoniae
pneumonia
[J]. J Infect, 2019,79(4):300-311. DOI:
10.1016/j.jinf.2019.07.004
.
[41]
Cilloniz C , Albert RK , Liapikou A ,et al.
The effect of macrolide resistance on the pres
entation and outcome of patients hospitalized for
Streptococcus pneumoniae
pneumonia
[J]. Am J Respir Crit Care Med, 2015,191(11):1265-1272. DOI:
10.1164/rccm.201502-0212OC
.
[42]
产超广谱β内酰胺酶肠杆菌感染急诊诊疗中国专家共识组. 产超广谱β内酰胺酶肠杆菌感染急诊诊疗中国专家共识[J]. 中华急诊医学杂志, 2020,29(12):1520-1526. DOI:
10.3760/cma.j.issn.1671-0282.2020.12.004
.
[43]
Quan JJ , Zhao DD , Liu LL ,et al.
High prevalence of ESBL-producing
Escherichia coli
and
Klebsiella pneumoniae
in community-onset bloodstream infections in China
[J]. J Antimicrob Chemother, 2017,72(1):273-280. DOI:
10.1093/jac/dkw372
.
[44]
Torres A , Chalmers JD , Dela Cruz CS ,et al. Challenges in severe community-acquired pneumonia: a point-of-view review[J]. Intensive Care Med, 2019,45(2):159-171. DOI:
10.1007/s00134-019-05519-y
.
[45]
中华医学会呼吸病学分会感染学组. 中国铜绿假单胞菌下呼吸道感染诊治专家共识(2022年版)[J]. 中华结核和呼吸杂志, 2022,45(8):739-752. DOI:
10.3760/cma.j.cn112147-20220407-00290
.
[46]
Restrepo MI , Babu BL , Reyes LF ,et al.
Burden a
nd risk factors for
Pseudomonas aeruginosa
community-acquired pneumonia: a multinational point prevalence study of hospitalised patients
[J]. Eur Respir J, 2018,52(2):1701190. DOI:
10.1183/13993003.01190-2017
.
[47]
Sando E , Suzuki M , Ishida M ,et al.
Definitive and indeterminate
Pseudomonas aeruginosa
infection in adults with community-acquired pneumonia: a prospective observational study
[J]. Ann Am Thorac Soc, 2021,18(9):1475-1481. DOI:
10.1513/AnnalsATS.201906-459OC
.
[48]
Aliberti S , Reyes LF , Faverio P ,et al.
Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIM
P): an international, observational cohort study
[J]. Lancet Infect Dis, 2016,16(12):1364-1376. DOI:
10.1016/S1473-3099(16)30267-5
.
[49]
Turner NA , Sharma-Kuinkel BK , Maskarinec SA ,et al.
Methicillin-resistant
Staphylococcus aureus
: an overview of basic and clinical research
[J]. Nat Rev Microbiol, 2019,17(4):203-218. DOI:
10.1038/s41579-018-0147-4
.
[50]
Popovich KJ , Aureden K , Cal Ham D ,et al.
SHEA/IDSA/APIC practice recommendation: strategies to prevent methicillin-resistant
Staphylococcus aureus
transmission and infection in acute-care hospitals: 2022 update
[J]. Infect Control Hosp Epidemiol, 2023,44(7):1039-1067. DOI:
10.1017/ice.2023.102
.
[51]
Metlay JP , Waterer GW , Long AC ,et al. Diagnosis and treatment of adults with community-acquired pneumonia. an official clinical practice guideline of the American thoracic society and infectious diseases society of America[J]. Am J Respir Crit Care Med, 2019,200(7):e45-e67. DOI:
10.1164/rccm.201908-1581ST
.
[52]
File TM Jr, Ramirez JA . Community-acquired pneumonia[J]. N Engl J Med, 2023,389(7):632-641. DOI:
10.1056/nejmcp2303286
.
[53]
北京医学会检验医学分会. 重症社区获得性肺炎病原微生物实验室诊断专家共识[J]. 中华医学杂志, 2020,100(19):1459-1464. DOI:
10.3760/cma.j.cn112137-20191108-02425
.
[54]
中华预防医学会医院感染控制分会. 临床微生物标本采集和送检指南[J]. 中华医院感染学杂志, 2018,28(20):3192-3200. DOI:
10.11816/cn.ni.2018-183362
.
[55]
中华医学会呼吸病学分会. 肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)[J]. 中华结核和呼吸杂志, 2017,40(8):578-583. DOI:
10.3760/cma.j.issn.1001-0939.2017.08.007
.
[56]
中华医学会呼吸病学分会. 下呼吸道感染宏基因组二代测序报告临床解读路径专家共识[J]. 中华结核和呼吸杂志, 2023,46(4):322-335. DOI:
10.3760/cma.j.cn112147-20220701-00553
.
[57]
宏基因组分析和诊断技术在急危重症感染应用专家共识组. 宏基因组分析和诊断技术在急危重症感染应用的专家共识[J]. 中华急诊医学杂志, 2019,28(2):151-155. DOI:
10.3760/cma.j.issn.1671-0282.2019.02.005
.
[58]
中国医药教育协会感染疾病专业委员会. 抗菌药物药代动力学/药效学理论临床应用专家共识[J]. 中华结核和呼吸杂志, 2018,41(6):409-446. DOI:
10.3760/cma.j.issn.1001-0939.2018.06.004
.
[59]
Lee JS , Giesler DL , Gellad WF ,et al. Antibiotic therapy for adults hospitalized with community-acquired pneumonia: a systematic review[J]. JAMA, 2016,315(6):593-602. DOI:
10.1001/jama.2016.0115
.
[60]
Falcone M , Russo A , Tiseo G ,et al.
Predictors of intensive care unit admission in patients with
Legionella pneumonia
: role of the time to appropriate antibiotic therapy
[J]. Infection, 2021,49(2):321-325. DOI:
10.1007/s15010-020-01565-7
.
[61]
Evans L , Rhodes A , Alhazzani W ,et al.
Surviving sepsis campaig
n: international guidelines for management of sepsis and septic shock 2021
[J]. Crit Care Med, 2021,49(11):e1063-e1143. DOI:
10.1097/CCM.0000000000005337
.
[62]
Li LF , Zhou JJ , Li MC ,et al.
Comparative genomic analysis of
Streptococcus pneumoniae
strains: penicillin non-susceptible multi-drug-resistant serotype 19A isolates
[J]. Curr Microbiol, 2022,79(2):49. DOI:
10.1007/s00284-021-02715-2
.
[63]
全球华人临床微生物暨感染学会,胡必杰,张文宏,等. 成人门急诊急性呼吸道感染诊治与防控专家共识[J]. 中华传染病杂志, 2024,42(6):321-337. DOI:
10.3760/cma.j.cn311365-20240705-00196
.
[64]
李耘,郑波,薛峰,等. 中国细菌耐药监测研究(CARST)2021—2022年革兰氏阳性菌监测报告[J]. 中国临床药理学杂志, 2023,39(23):3509-3524. DOI:
10.13699/j.cnki.1001-6821.2023.23.036
.
[65]
[66]
全国细菌耐药监测网. 全国细菌耐药监测网2014—2019年支气管肺泡灌洗液细菌耐药监测报告[J]. 中国感染控制杂志, 2021,20(1):60-68. DOI:
10.12138/j.issn.1671-9638.20216174
.
[67]
李刚,王文,贾伟,等. 2015—2021年CHINET链球菌属细菌耐药性监测[J]. 中国感染与化疗杂志, 2023,23(5):615-623. DOI:
10.16718/j.1009-7708.2023.05.013
.
[68]
Durães F , Sousa E . Omadacycline: a newly approved antibacterial from the class of tetracyclines[J]. Pharmaceuticals (Basel), 2019,12(2):63. DOI:
10.3390/ph12020063
.
[69]
国家呼吸内科医疗质量控制中心,中华医学会结核病学分会,中国防痨协会结核病控制专业分会,等. 综合医疗机构肺结核早期发现临床实践指南[J]. 中国防痨杂志, 2024,46(2):127-140. DOI:
10.19982/j.issn.1000-6621.20230428
.
[70]
Reijnders TDY , Saris A , Schultz MJ ,et al. Immunomodulation by macrolides: therapeutic potential for critical care[J]. Lancet Respir Med, 2020,8(6):619-630. DOI:
10.1016/S2213-2600(20)30080-1
.
[71]
Sligl WI , Asadi L , Eurich DT ,et al. Macrolides and mortality in critically ill patients with community-acquired pneumonia: a systematic review and meta-analysis[J]. Crit Care Med, 2014,42(2):420-432. DOI:
10.1097/CCM.0b013e3182a66b9b
.
[72]
Aliberti S , Dela Cruz CS , Amati F ,et al. Community-acquired pneumonia[J]. Lancet, 2021,398(10303):906-919. DOI:
10.1016/s0140-6736(21)00630-9
.
[73]
Zhang Y , Wang K , Yu H ,et al. Incidence and characteristics of aspiration pneumonia in adults in Beijing, China, 2011-2017[J]. Public Health, 2023,220:65-71. DOI:
10.1016/j.puhe.2023.04.021
.
[74]
戴维·吉尔伯特. 《桑福德抗微生物治疗指南》[M]. (新译 第53版),范洪伟,译. 北京:中国协和医科大学出版社, 2024:85-90.
[75]
Hale Thomas W. . Medications and Mothers’ Milk 2021: A Manual of Lactational Pharmacology[M]. Germany:Springer Publishing Company. 2020:102, 228, 491.
[76]
FDA. Pregnancy and lactation labeling rule[EB/OL]. ( 2014-12-04) [2015-01-10]. https://www.fda.gov/drugs/labeling-information-drug-products/pregnancy-and-lactation-labeling-drugs-final-rule.
[77]
Tansarli GS , Mylonakis E . Systematic review and meta-analysis of the efficacy of short-course antibiotic treatments for community-acquired pneumonia in adults[J]. Antimicrob Agents Chemother, 2018,62(9):e00635-18. DOI:
10.1128/AAC.00635-18
.
[78]
中国医药教育协会感染疾病专业委员会. 降钙素原指导抗菌药物临床合理应用专家共识[J]. 中华医学杂志, 2020,100(36):2813-2821. DOI:
10.3760/cma.j.cn112137-20200714-02112
.
[79]
Kuijpers SME , Buis DTP , Ziesemer KA ,et al. The evidence base for the optimal antibiotic treatment duration of upper and lower respiratory tract infections: an umbrella review[J]. Lancet Infect Dis, 2025,25(1):94-113. DOI:
10.1016/S1473-3099(24)00456-0
.
[80]
Gaudet A , Martin-Loeches I , Povoa P ,et al. Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia[J]. Ann Intensive Care, 2020,10(1):101. DOI:
10.1186/s13613-020-00721-4
.
[81]
中国医师协会急诊医师分会. 中国急诊重症肺炎临床实践专家共识[J]. 中国急救医学, 2016,36(2):97-107. DOI:
10.3969/j.issn.1002-1949.2016.02.001
.
[82]
Viasus D , Gaia V , Manzur-Barbur C ,et al.
Legionnaires
'
disease: update on diagnosis and treatment
[J]. Infect Dis Ther, 2022,11(3):973-986. DOI:
10.1007/s40121-022-00635-7
.
[83]
Chahin A , Opal SM .
Severe pneumonia caused by
Legionella
pneumophila: differential diagnosis and therapeutic considerations
[J]. Infect Dis Clin North Am, 2017,31(1):111-121. DOI:
10.1016/j.idc.2016.10.009
.
[84]
Zhang ZJ , Zhou H , Cao HE ,et al.
Human-to-human transmission of
Chlamydia psittaci
in China, 2020: an epidemiological and aetiological investigation
[J]. Lancet Microbe, 2022,3(7):e512-e520. DOI:
10.1016/S2666-5247(22)00064-7
.
[85]
Tang X , Wang N , Liu G ,et al. Psittacosis caused severe community-acquired pneumonia accompanied by acute hypoxic respiratory failure: a multicenter retrospective cohort study from China[J]. BMC Infect Dis, 2023,23(1):532. DOI:
10.1186/s12879-023-08283-z
.
[86]
赵晓东,吕传柱,于学忠,等. 喹诺酮类抗菌药物急诊临床应用指导意见[J]. 中国急救医学, 2020,40(11):1047-1056. DOI:
10.3969/j.issn.1002-1949.2020.11.004
.
[87]
Zhao B , Yu XX , Chen R ,et al. Efficacy and safety of nemonoxacin in outpatients with community-acquired pneumonia[J]. Infect Drug Resist, 2020,13:2099-2104. DOI:
10.2147/IDR.S248092
.
[88]
Cornely OA , Alastruey-Izquierdo A , Arenz D ,et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium[J]. Lancet Infect Dis, 2019,19(12):e405-e421. DOI:
10.1016/S1473-3099(19)30312-3
.
[89]
中国医药教育协会真菌病专业委员会,中国毛霉病专家共识工作组. 中国毛霉病临床诊疗专家共识(2022)[J]. 中华内科杂志, 2023,62(6):597-605. DOI:
10.3760/cma.j.cn112138-20220729-00557
.
[90]
中国微生物学会医学微生物学与免疫学专业委员会,重庆市微生物学会临床微生物专业委员会. 类鼻疽诊断与治疗专家共识[J]. 中华传染病杂志, 2022,40(10):577-583. DOI:
10.3760/cma.j.cn311365-20211113-00398
.
[91]
中华医学会感染病学分会艾滋病丙型肝炎学组. 艾滋病合并肺孢子菌肺炎诊疗专家共识(2024年版)[J]. 中华临床感染病杂志, 2024,17(2):81-92, 98. DOI:
10.3760/cma.j.issn.1674-2397.2024.02.001
.
[92]
中华医学会器官移植学分会. 中国肾脏移植术后耶氏肺孢子菌肺炎临床诊疗指南[J]. 器官移植, 2024,15(5):726-736. DOI:
10.3969/j.issn.1674-7445.2024168
.
[93]
Tamma PD , Heil EL , Justo JA ,et al. Infectious diseases society of America 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections[J]. Clin Infect Dis, 2024:ciae403. DOI:
10.1093/cid/ciae403
.
[94]
中华医学会急诊医学分会,中国老年社区获得性肺炎急诊诊疗专家共识组. 中国老年社区获得性肺炎急诊诊疗专家共识[J]. 中华急诊医学杂志, 2023,32(10):1319-1327. DOI:
10.3760/cma.j.issn.1671-0282.2023.10.005
.
[95]
中国老年医学学会,国家老年疾病临床医学研究中心(解放军总医院),解放军老年医学专业委员会. 感染诱发的老年多器官功能障碍综合征诊断与治疗中国指南2019[J]. 中华老年多器官疾病杂志, 2019,18(11):801-838. DOI:
10.11915/j.issn.1671-5403.2019.11.174
.
[96]
Cutuli SL , Grieco DL , Menga LS ,et al. Noninvasive ventilation and high-flow oxygen therapy for severe community-acquired pneumonia[J]. Curr Opin Infect Dis, 2021,34(2):142-150. DOI:
10.1097/QCO.0000000000000715
.
[97]
Roca O , Messika J , Caralt B ,et al.
Predicting success of high-flow nasal
Cannula
in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index
[J]. J Crit Care, 2016,35:200-205. DOI:
10.1016/j.jcrc.2016.05.022
.
[98]
Roca O , Caralt B , Messika J ,et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy[J]. Am J Respir Crit Care Med, 2019,199(11):1368-1376. DOI:
10.1164/rccm.201803-0589OC
.
[99]
Chen DY , Heunks L , Pan C ,et al.
A novel index to predict the failure of high-flow nasal
Cannula
in patients with acute hypoxemic respiratory failure: a pilot study
[J]. Am J Respir Crit Care Med, 2022,206(7):910-913. DOI:
10.1164/rccm.202203-0561LE
.
[100]
Brambilla AM , Aliberti S , Prina E ,et al.
Helmet CPAP
vs
. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia
[J]. Intensive Care Med, 2014,40(7):942-949. DOI:
10.1007/s00134-014-3325-5
.
[101]
Zhan QY , Sun B , Liang LR ,et al. Early use of noninvasive positive pressure ventilation for acute lung injury: a multicenter randomized controlled trial[J]. Crit Care Med, 2012,40(2):455-460. DOI:
10.1097/CCM.0b013e318232d75e
.
[102]
Antonelli M , Conti G , Moro ML ,et al.
Predictors of failure of noninvasive positive pres
sure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study
[J]. Intensive Care Med, 2001,27(11):1718-1728. DOI:
10.1007/s00134-001-1114-4
.
[103]
中国医师协会急诊医师分会,中国急性感染联盟. 2015年中国急诊社区获得性肺炎临床实践指南:疾病基础知识篇[J]. 中国急救医学, 2015,35(11):961-968. DOI:
10.3969/j.issn.1002-1949.2015.11.001
.
[104]
Jaswal DS , Leung JM , Sun JF ,et al. Tidal volume and plateau pressure use for acute lung injury from 2000 to present: a systematic literature review[J]. Crit Care Med, 2014,42(10):2278-2289. DOI:
10.1097/CCM.0000000000000504
.
[105]
Amato MBP , Meade MO , Slutsky AS ,et al. Driving pressure and survival in the acute respiratory distress syndrome[J]. N Engl J Med, 2015,372(8):747-755. DOI:
10.1056/NEJMsa1410639
.
[106]
吴峤微,方志宏,缪红军,等. 驱动压对急性呼吸窘迫综合征预后影响的系统评价与Meta分析[J]. 中华急诊医学杂志, 2022,31(9):1294-1298. DOI:
10.3760/cma.j.issn.1671-0282.2022.09.027
.
[107]
Guérin C , Reignier J , Richard JC ,et al. Prone positioning in severe acute respiratory distress syndrome[J]. N Engl J Med, 2013,368(23):2159-2168. DOI:
10.1056/NEJMoa1214103
.
[108]
Combes A , Hajage D , Capellier G ,et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome[J]. N Engl J Med, 2018,378(21):1965-1975. DOI:
10.1056/NEJMoa1800385
.
[109]
Dequin PF , Meziani F , Quenot JP ,et al. Hydrocortisone in severe community-acquired pneumonia[J]. N Engl J Med, 2023,388(21):1931-1941. DOI:
10.1056/NEJMoa2215145
.
[110]
Annane D , Renault A , Brun-Buisson C ,et al. Hydrocortisone plus fludrocortisone for adults with septic shock[J]. N Engl J Med, 2018,378(9):809-818. DOI:
10.1056/NEJMoa1705716
.
[111]
Wu JY , Tsai YW , Hsu WH ,et al. Efficacy and safety of adjunctive corticosteroids in the treatment of severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials[J]. Crit Care, 2023,27(1):274. DOI:
10.1186/s13054-023-04561-z
.
[112]
Pirracchio R , Venkatesh B , Legrand M . Low-dose corticosteroids for critically ill adults with severe pulmonary infections: a review[J]. JAMA, 2024,332(4):318-328. DOI:
10.1001/jama.2024.6096
.
[113]
National Heart L , Wiedemann HP , Wheeler AP ,et al. Comparison of two fluid-management strategies in acute lung injury[J]. N Engl J Med, 2006,354(24):2564-2575. DOI:
10.1056/NEJMoa062200
.
[114]
中华医学会呼吸病学分会,中国医师协会呼吸医师分会,王辰,等. 中国成人2019冠状病毒病的诊治与防控指南[J]. 中华医学杂志, 2021,101(18):1293-1356. DOI:
10.3760/cma.j.cn112137-20210112-00090
.
[115]
吴洲鹏,李凤贺,戴贻权,等. 老年人静脉血栓栓塞症防治中国专家共识[J]. 中国普外基础与临床杂志, 2023,30(10):1173-1187. DOI:
10.7507/1007-9424.202308048
.
[116]
Singer P , Blaser AR , Berger MM ,et al. ESPEN guideline on clinical nutrition in the intensive care unit[J]. Clin Nutr, 2019,38(1):48-79. DOI:
10.1016/j.clnu.2018.08.037
.
[117]
宋元林,张洪春,刘清泉,等. 重症社区获得性肺炎治疗的现状与展望[J]. 中华危重病急救医学, 2019,31(6):665-668. DOI:
10.3760/cma.j.issn.2095-4352.2019.06.001
.
[118]
余学庆,谢洋,李建生. 社区获得性肺炎中医诊疗指南(2018修订版)[J]. 中医杂志, 2019,60(4):350-360. DOI:
10.13288/j.11-2166/r.2019.04.019
.
[119]
Renner C , Jeitziner MM , Albert M ,et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome[J]. Crit Care, 2023,27(1):301. DOI:
10.1186/s13054-023-04569-5
.
[120]
Song YL , Yao C , Yao YM ,et al. XueBiJing injection versus placebo for critically ill patients with severe community-acquired pneumonia: a randomized controlled trial[J]. Crit Care Med, 2019,47(9):e735-e743. DOI:
10.1097/CCM.0000000000003842
.
[121]
吕青兰,赵雪峰,周璇. LAC及NLR和PCT预测重症社区获得性肺炎相关性脓毒症的价值[J]. 中华医院感染学杂志, 2022,32(18):2748-2751. DOI:
10.11816/cn.ni.2022-211707
.
[122]
Tosoni A , Paratore M , Piscitelli P ,et al. The use of procalcitonin for the management of sepsis in Internal Medicine wards: current evidence[J]. Panminerva Med, 2020,62(1):54-62. DOI:
10.23736/S0031-0808.19.03809-6
.
[123]
Munsell MK , Fadelu T , Stuver SO ,et al. The utility of procalcitonin for diagnosing bacteremia and bacterial pneumonia in hospitalized oncology patients[J]. J Cancer Res Clin Oncol, 2023,149(8):5193-5204. DOI:
10.1007/s00432-022-04419-x
.
[124]
Desai A , Aliberti S , Amati F ,et al. Cardiovascular complications in community-acquired pneumonia[J]. Microorganisms, 2022,10(11):2177. DOI:
10.3390/microorganisms10112177
.
[125]
Hollenberg SM , Singer M . Pathophysiology of sepsis-induced cardiomyopathy[J]. Nat Rev Cardiol, 2021,18(6):424-434. DOI:
10.1038/s41569-020-00492-2
.
[126]
Ammirati E , Moslehi JJ . Diagnosis and treatment of acute myocarditis: a review[J]. JAMA, 2023,329(13):1098-1113. DOI:
10.1001/jama.2023.3371
.
[127]
Younis H , Loh CC , Singh C ,et al. Acute myocardial infarction-related hospitalizations in non-elderly patients with pneumonia: a population-based study[J]. SN Compr Clin Med, 2023,5(1):160. DOI:
10.1007/s42399-023-01499-9
.
[128]
Chawla LS , Amdur RL , Faselis C ,et al. Impact of acute kidney injury in patients hospitalized with pneumonia[J]. Crit Care Med, 2017,45(4):600-606. DOI:
10.1097/CCM.0000000000002245
.
[129]
孙家艳,王兵侠,曹鹏,等. 质子泵抑制剂预防重症患者应激性溃疡获益与风险的队列研究:附1 972例病例分析[J]. 中华危重病急救医学, 2019,31(5):539-544. DOI:
10.3760/cma.j.issn.2095-4352.2019.05.004
.
[130]
Krag M , Marker S , Perner A ,et al. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU[J]. N Engl J Med, 2018,379(23):2199-2208. DOI:
10.1056/NEJMoa1714919
.
[131]
Ma GG , Shen YX , Wu L ,et al. Effect of liver injury on prognosis and treatment of hospitalized patients with COVID-19 pneumonia[J]. Ann Transl Med, 2021,9(1):10. DOI:
10.21037/atm-20-4850
.
[132]
Dinh A , Duran C , Ropers J ,et al. Factors associated with treatment failure in moderately severe community-acquired pneumonia: a secondary analysis of a randomized clinical trial[J]. JAMA Netw Open, 2021,4(10):e2129566. DOI:
10.1001/jamanetworkopen.2021.29566
.
[133]
Morley D , Torres A , Cillóniz C ,et al. Predictors of treatment failure and clinical stability in patients with community acquired pneumonia[J]. Ann Transl Med, 2017,5(22):443. DOI:
10.21037/atm.2017.06.54
.
[134]
[135]
张晓琳,任丽娜,徐健. 成人社区获得性肺炎为首诊断初治失败患者临床分析[J]. 中国实用医药, 2019,14(5):54-56. DOI:
10.14163/j.cnki.11-5547/r.2019.05.026
.
[136]
Eljaaly K , Alshehri S , Aljabri A ,et al. Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis[J]. BMC Infect Dis, 2017,17(1):385. DOI:
10.1186/s12879-017-2495-5
.
[137]
员笑笑,李淑芬,孙芳. 免疫功能正常成人腺病毒肺炎患者临床特征的meta分析[J]. 临床荟萃, 2024,39(4):293-303. DOI:
10.3969/j.issn.1004-583X.2024.04.001
.
[138]
Lee WC , Ho MC , Leu SW ,et al. The impacts of bacterial co-infections and secondary bacterial infections on patients with severe influenza pneumonitis admitted to the intensive care units[J]. J Crit Care, 2022,72:154164. DOI:
10.1016/j.jcrc.2022.154164
.
[139]
龙朋伟,刘肖,赵江云,等. 2015—2018年北京市成人流感病毒性肺炎共感染病原调查[J]. 国际药学研究杂志, 2020,47(3):206-210. DOI:
10.13220/j.cnki.jipr.2020.03.006
.
[140]
陈亮,韩秀迪,邢西迁,等. 甲型流感合并细菌性社区获得性肺炎患者的临床分析[J]. 国际流行病学传染病学杂志, 2018,45(2):75-79. DOI:
10.3760/cma.j.issn.1673-4149.2018.02.002
.
[141]
Kim K , Jung S , Kim M ,et al.
Global trends in the proportion of macrolide-resistant
Mycoplasma pneumoniae
infections: a systematic review and meta-analysis
[J]. JAMA Netw Open, 2022,5(7):e2220949. DOI:
10.1001/jamanetworkopen.2022.20949
.
[142]
Hogerwerf L , DE Gier B , Baan B ,et al.
Chlamydia psittaci
(psittacosis) as a cause of community-acquired pneumonia: a systematic review and meta-analysis
[J]. Epidemiol Infect, 2017,145(15):3096-3105. DOI:
10.1017/S0950268817002060
.
[143]
Wu XD , Li YY , Zhang M ,et al. Etiology of severe community-acquired pneumonia in adults based on metagenomic next-generation sequencing: a prospective multicenter study[J]. Infect Dis Ther, 2020,9(4):1003-1015. DOI:
10.1007/s40121-020-00353-y
.
[144]
沈凌,田贤江,梁荣章,等. 鹦鹉热衣原体肺炎48例临床特征分析[J]. 中华结核和呼吸杂志, 2021,44(10):886-891. DOI:
10.3760/cma.j.cn112147-20210127-00082
.
[145]
许容容,张蔷,韩淑华,等. 43例鹦鹉热衣原体肺炎临床特征[J]. 中国感染控制杂志, 2023,22(6):688-694. DOI:
10.12138/j.issn.1671-9638.20233462
.
[146]
Allgaier J , Lagu T , Haessler S ,et al.
Risk factors, management, and outcomes of
Legionella
pneumonia in a large, nationally representative sample
[J]. Chest, 2021,159(5):1782-1792. DOI:
10.1016/j.chest.2020.12.013
.
[147]
何蔡为,唐晓,孙兵,等. 重症军团菌肺炎合并急性呼吸衰竭34例临床特点及预后分析[J]. 中华结核和呼吸杂志, 2020,43(7):557-563. DOI:
10.3760/cma.j.cn112147-20200114-00023
.
[148]
Jouffroy R , Kedzierewicz R , Derkenne C ,et al. Hypoxemia index associated with prehospital intubation in COVID-19 patients[J]. J Clin Med, 2020,9(9):3025. DOI:
10.3390/jcm9093025
.
[149]
汪晖,
曾铁
英
,吴欣娟,等. 重型危重型新型冠状病毒肺炎患者整体护理专家共识[J]. 中华护理杂志, 2020,55(3):337-342. DOI:
10.3761/j.issn.0254-1769.2020.03.003
.
[150]
Broadhurst D , Cooke M , Sriram D ,et al. International consensus recommendation guidelines for subcutaneous infusions of hydration and medication in adults: an e-Delphi consensus study[J]. J Infus Nurs, 2023,46(4):199-209. DOI:
10.1097/NAN.0000000000000511
.
[151]
罗平,尹桃,刘韶,等. 中国医院质量安全管理: 《输液安全》团体标准的制定与实施评价[J]. 中国卫生质量管理, 2021,28(10):24-27. DOI:
10.13912/j.cnki.chqm.2021.28.10.07
.
[152]
中国研究型医院学会危重医学专业委员会,中国研究型医院学会危重医学专委会青年委员会. 重型和危重型新型冠状病毒肺炎诊断和治疗专家共识(修订版)[J]. 中华危重病急救医学, 2020,32(3):269-274. DOI:
10.3760/cma.j.cn121430-20200218-00188
.
[153]
Unoki T , Hayashida K , Kawai Y ,et al. Japanese clinical practice guidelines for rehabilitation in critically ill patients 2023 (J-ReCIP 2023)[J]. J Intensive Care, 2023,11(1):47. DOI:
10.1186/s40560-023-00697-w
.
[154]
Redondo E , Rivero-Calle I , Mascarós E ,et al. Vaccination against community-acquired pneumonia in Spanish adults: practical recommendations by the NeumoExperts prevention group[J]. Antibiotics (Basel), 2023,12(1):138. DOI:
10.3390/antibiotics12010138
.
[155]
中国疾病预防控制中心. 中国流感疫苗预防接种技术指南(2023—2024)[J]. 中国病毒病杂志, 2024,14(1):1-19. DOI:
10.16505/j.2095-0136.2024.1001
.
[156]
熊旭东,谢芳,何淼,等. 社区获得性肺炎中西医综合治疗指南(2015年上海市基层版)[J]. 上海中医药杂志, 2016,50(7):15-20. DOI:
10.16305/j.1007-1334.2016.07.004
.
备注信息
A
徐军，Email:
mocdef.6ab21eerfnujux；
B
曹钰，Email:
nc.defucabshcwuyoac；
C
朱华栋，Email:
mocdef.6ab210791gnodauhuhz；
D
赵晓东；Email:
mocdef.6ab2151736dxz；
E
于学忠，Email:
nc.defmoabc.liamdemzxy
F
PREPARE-2024CN330
G
所有作者声明无利益冲突
评论 （0条）
注册 登录
时间排序
- 时间排序
暂无评论，发表第一条评论抢沙发
最新推荐
更多
成人血液病患者接种新型冠状病毒疫苗中国专家共识（2022年版）
中国康复医学会血液病康复专业委员会 等 中华血液学杂志 2022,43(05)
中国成人急性淋巴细胞白血病诊断与治疗指南（2021年版）
中国抗癌协会血液肿瘤专业委员会 等 中华血液学杂志 2021,42(09)
中国2型糖尿病防治指南（2020年版）
中华医学会糖尿病学分会 中华糖尿病杂志 2021,13(04)
中国成人社区获得性肺炎诊断和治疗指南(2016年版)
中华医学会呼吸病学分会 中华结核和呼吸杂志 2016,39(04)
分享
详细信息
表
访问与引文
阅读权限
参考文献
访问与引用
访问数据
0
0
全部时间 最近30天 最近6个月 最近12个月
MedAI助手（体验版）
文档即答
智问智答
机器翻译
回答内容由人工智能生成，我社无法保证其准确性和完整性，该生成内容不代表我们的态度或观点，仅供参考。
生成快照
文献快照
文献快照
N/A
N/A
AI总结中
N/A
N/A
快照内容由人工智能生成，供您参考。
你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。
0/50
很抱歉，当前对话已达到其限制。
使用"新建对话"按钮开启更多对话。
停止回答
0/2000
信息反馈
中文(简体)
英文
翻译
机器翻译功能由科大讯飞提供技术支持
回答内容由人工智能生成，我社无法保证其准确性和完整性，该生成内容不代表我们的态度或观点，仅供参考。
你好！ 今天我能为您提供什么帮助？
0/30
of
很抱歉，当前对话已达到其限制。
使用"新建对话"按钮开启更多对话。
停止回答
扩写 缩写 改写 翻译
0/2000
信息反馈
历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号
小中大
翻译
润色
扩写
缩写
复制
引用
