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1、STATEOFTHEARTREVIEWAdvancesinthecausesandmanagementofcommunityacquiredpneumoniainadults112RichardGWunderink,GrantWaterer1PulmonaryandCriticalCare,NorthwesternUniversityFeinbergABSTRACTSchoolofMedicine,Chicago,ILCommunityacquiredpneumoniaremainsacommoncauseofmorbi
2、dityand60611,USA2UniversityofWesternAustralia,mortality.Usually,thecausalorganismisnotidentifiedandtreatmentremainsPerth,Australiaempiric.RecentcomputedtomographyandmagneticresonanceimagingstudiesCorrespondenceto:RWunderinkr-wunderink@northwestern.eduhavechalleng
3、edtheaccuracyoftheclinicaldiagnosisofpneumonia,andCitethisas:BMJ2017;358:j2471doi:10.1136/bmj.j2471epidemiologicstudiesarechangingourperspectiveofwhatcausescommunityacquiredpneumonia,especiallytheroleofviralpathogensandthefrequentfindingSeriesexplanation:Stateoft
4、heArtReviewsarecommissionedofmultiplepathogens.ThepastdecadehasseenincreasingoveruseofempiriconthebasisoftheirrelevancetoacademicsandspecialistsintheUScoverageofmeticillinresistantStaphylococcusaureusandantibioticresistantGramandinternationally.Forthisreasontheya
5、rewrittenpredominantlybynegativepathogensowingtoinappropriateapplicationofguidelinesforhealthcareUSauthorsassociatedpneumonia.Optimaltreatmentremainsamatterfordebate,especiallyinverysickpatients,includingtheroleofcombinationantibiotictherapyandcorticosteroids.Pne
6、umoniacarebundlesarebeingdefinedtoimproveoutcomes.Increasedrecognitionofbothacuteandlongtermcardiaccomplicationsisshiftingourconceptofpneumoniafromanacutelungdiseasetoamultisystemproblemwithadversechronichealthconsequences.Introductionofthesepatientsaredisproport
7、ionatelypronetousual10Communityacquiredpneumonia(CAP)remainsamajorCAPpathogens.Forthisreview,wewillexcludethehealthconcernworldwidewithsubstantialmorbidityandmostseverelyimmunocompromisedpatients—those1‑3mortality.Theentirerangeofphysicians,fromprimarywithacutele
8、ukemiasandlymphomas,recentbonemar‑caretointensivistsandfromgeneraliststosubspecialists,roworsolidorgantransplantrecipients,thosereceiving4willencounterCAPinone
