呼吸臨床

【特集】「成人肺炎診療ガイドライン2017」を読み解く

企画：川名明彦


　肺炎は，今後も社会の高齢化を反映して増加し続けると予想されます。肺炎はありふれた疾患で，呼吸器科以外の医師も遭遇し得る一方，専門的な知識も求められ，適切な肺炎診療のあり方を示すガイドラインの必要性は高いといえます。このたび日本呼吸器学会の成人市中肺炎診療ガイドラインが10年ぶりに改定されました。新ガイドラインは，真の意味でのevidence based medicineを実践し，「Minds診療ガイドライン作成の手引き」に準拠するなど新しい考え方が導入されています。それと同時に冊子のページ数は旧版のほぼ倍に増え，短時間でその内容を掴むにはややハードルが高くなったようにも見えます。本特集では，この新ガイドラインのポリシーと内容をコンパクトに解説いただくことを企図し，作成に関わった先生方にご執筆をお願いしました。

市中肺炎

宮下修行*

*川崎医科大学総合内科学1（〒700-8505　岡山県岡山市北区中山下2-6-1）


Community-acquired pneumonia

Naoyuki Miyashita*
*Department of Internal Medicine 1, Kawasaki Medical School, Okayama


Keywords：市中肺炎，細菌性肺炎，非定型肺炎，quick SOFA，A-DROPシステム/community-acquired pneumonia, bacterial pneumonia, atypical pneumonia, quick SOFA, A-DROP system


呼吸臨床 2017年1巻1号　論文No.e00006
Jpn Open J Respir Med 2017 Vol. 1 No. 1 Article No.e00006

DOI: 10.24557/kokyurinsho.1.e00006


掲載日：2017年10月21日


©️Naoyuki Miyashita. 本論文の複製権，翻訳権，上映権，譲渡権，貸与権，公衆送信権（送信可能化権を含む）は弊社に帰属し，それらの利用ならびに許諾等の管理は弊社が行います。


要旨

　市中肺炎が院内肺炎や医療・介護関連肺炎と大きく異なる点は，宿主の状態と原因微生物の違いで，市中肺炎では誤嚥性肺炎が少なく非定型病原体が関与する。市中発症型肺炎を見た場合，まず医療・介護関連肺炎の除外を行い，次いで治療場所の決定を行う。この場合，敗血症の有無をquick SOFAで判定し，重症度をA-DROPシステムで判定する。同時に迅速診断法で原因菌検索を行い，原因菌が判明しない場合は細菌性肺炎と非定型肺炎の鑑別をし，治療方針を決定する。


文献

  1. 日本呼吸器学会成人肺炎診療ガイドライン2017作成委員会．成人肺炎診療ガイドライン2017．
  2. Miyashita N, et al. Clinical features and the role of atypical pathogens in nursing and healthcare-associated pneumonia (NHCAP): differences between teaching university hospital and community hospital. Intern Med. 2012; 51: 585-94.
  3. Ishida T, et al. Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia. Intern Med. 2012; 51: 2537-44.
  4. Fukuyama H, et al. A prospective comparison of nursing-and healthcare-associated pneumonia (NHCAP) with community-acquired pneumonia (CAP). J Infect Chemother. 2013; 19: 719-26.
  5. Oshitani Y, et al. Reevaluation of the Japanese guideline for healthcare-associated pneumonia in a medium-size community hospital in Japan. J Infect Chemother. 2013; 19: 579-87.
  6. Nakagawa N, et al. Comparison of clinical profile in elderly patients with nursing and healthcare-associated pneumonia, and those with community-acquired pneumonia. Geriatr Gerontol Int. 2014; 14: 362-71.
  7. Sakoda Y, et al. Retrospective analysis of nursing and healthcare-associated pneumonia: analysis of adverse prognostic factors and validity of the selection criteria. Respir Invest. 2014; 52: 114-20.
  8. Maruyama T, et al. A new strategy for healthcare-associated pneumonia: a 2-year prospective multicenter cohort study using risk factors for multidrug-resistant pathogens to select initial empiric therapy. Clin Infect Dis 2013; 57: 1373-83.
  9. Kato T, Miyashita N, et al. Changes in physical function after hospitalization in patients with nursing and healthcare-associated pneumonia. J Infect Chemother. 2016; 22: 662-6.
  10. Chalmers JD, et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med. 2011; 37: 1409-20. 
  11. Jones BE, et al. Validating hospital admission criteria for decision support in pneumonia. BMC Pulm Med. 2014; 14: 149.
  12. Singer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315: 801-10.
  13. Schuetz P, et al. Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective. Clin Chem Lab Med. 2015; 53: 583-92.
  14. Yamasaki K, et al. Significance of anaerobes and oral bacteria in community-acquired pneumonia. PLOS ONE. 2013; 8: e63103.
  15. Miyashita N, et al. Diagnostic sensitivity of a rapid antigen test for the detection of Mycoplasma pneumoniae: comparison with real-time PCR. J Infect Chemother. 2015; 21: 473-5.
  16. Miyashita N, et al. Rapid diagnostic method for the identification of Mycoplasma pneumoniae respiratory tract infection. J Infect Chemother. 2016; 22: 327-30. 
  17. Miyashita N, et al. Antibody responses of Chlamydophila pneumoniae pneumonia: why is the diagnosis of C. pneumoniae pneumonia difficult? J Infect Chemother. 2015; 21: 497-501. 
  18. Miyashita N, et al. Rapid and simple diagnosis of Chlamydophila pneumoniae pneumonia using an immunochromatographic test for the detection of immunoglobulin M antibodies. Clin Vaccine Immunol. 2008; 15: 1128-31.
  19. Miyashita N, et al. Influence of age in the clinical differentiation of atypical pneumonia in adults. Respirology. 2012; 17: 1073-9. 
  20. Miyashita N, et al. Clinical features of severe Mycoplasma pneumoniae in adults admitted to an intensive care unit. J Med Microbiol. 2007; 56: 1625-9. 
  21. Miyashita N, et al. Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults. J Infect Chemother. 2015; 21: 153-60.
  22. Miyashita N, et al. Radiographic features of Mycoplasma pneumoniae pneumonia: differential diagnosis and performance timing. BMC Med Imaging. 2009; 9: 7.
  23. Ito I, et al. Differentiation of bacterial and non-bacterial community-acquired pneumonia by thin-section computed tomography. Eur J Radiol. 2009; 72: 388-95.
  24. Horita N, et al. Beta-lactam plus macrolides or beta-lactam alone for community-acquired pneumonia: systematic review and meta-analysis. Respirology. 2016; 21: 1193-200. 
  25. Horita N, et al. Adjunctive systemic corticosteroids for hospitalized community-acquired pneumonia: systematic review and meta-Analysis 2015 Update. Sci Rep. 2015; 5: 14061. 


続きを見る

ログイン

新規登録

会員登録





※ご登録の前に個人情報保護方針をご一読ください。

登録

パスワードを忘れた方


送信