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Pay attention to new evolution trends in the etiology of community-acquired pneumonia in adults

作　　者：何礼贤[1] He Lixian(Department of Respiratory and Critical Care Medicine of Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院呼吸和重症医学科,上海200032

出　　处：《中华结核和呼吸杂志》2024年第6期576-581,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：近二三十年来新发和再发感(传)染病频现、病原学分子检测技术进步、抗生素耐药、人群生活方式和免疫状态变化(包括疫苗接种)等原因,致CAP病原学发生新的演变。(1)肺炎链球菌虽然仍是CAP的常见病原体,但在中国和美国已不居首位。(2)病毒的挑战与困扰增加。(3)肺炎支原体在成人CAP的地位和经验性抗菌治疗常规覆盖的观点存在争议。(4)CAP多耐药菌特别多重耐药GNB感染受到关注。(5)共感染常见而报道混乱。由于CAP病原学演变呈现出多样化、地方化的趋势,给大国制订统一指南带来困难,本文对制订地方性CAP诊治指导意见提出建议。Over the past two to three decades,the emergence and re-emergence of new infectious diseases,advances in molecular detection techniques of pathogens,antibiotic resistance,changes in population lifestyle and immune status(including vaccination),and other factors have led to new evolutions in the etiology of community-acquired pneumonia(CAP).(1)Although Streptococcus pneumoniae remains a common pathogen of CAP,it is no longer the leading cause in China and the United States.According to the results of 2 multicenter studies in China in the early 21st century,Streptococcus pneumoniae accounted for 10.3%and 12.0%of adult CAP pathogens,respectively,ranking second.A study on key pathogens of adult CAP in nine cities in China's Mainland from 2014 to 2019 using real-time quantitative PCR and conventional culture on respiratory and blood specimens showed an overall prevalence of Streptococcus pneumoniae of 7.43%,ranking sixth.However,its ranking varied from third to seventh among the nine cities.(2)Challenges and concerns about viruses have increased.National surveillance of acute respiratory tract infections and epidemiology in China from 2009 to 2019 indicated that the positivity rates for viral infections in adult pneumonia was 20.5%.These rates were similar to the results of the CDC′s CAP pathogen study in the United States,although the rankings were different(viruses ranked second in China and first in the United States).Over the past 20 years,the emergence of new viral respiratory infections caused by mutant strains or zoonotic strains has significantly increased the challenges and threats posed by viral respiratory infections.(3)The role of Mycoplasma pneumoniae(M pneumoniae)in adult CAP and the need for routine empirical antibiotic coverage are controversial.In addition to the influence of epidemic cycles,the prevalence of M pneumoniae is influenced by factors such as age,season,study design,and detection methods,and geographical distribution is also an important influencing factor.Although M.pneumoniae ranks fir

关 键 词：疫苗接种 耐药菌 共感染 分子检测技术 肺炎链球菌 肺炎支原体 多重耐药 常见病原体 

分 类 号：R563.1[医药卫生—呼吸系统]