社区获得性肺炎（非 COVID-19）

通常并发重度 CAP。患者出现发热、白细胞增多、呼吸急促和心动过速。可能迅速进展至多器官衰竭和休克。对于所有疑似脓毒症或存在风险的患者，需遵循当地常规，给予检查和治疗。立即开始治疗。根据感染的可能性和疾病严重程度，或根据当地常规，确定治疗紧迫性。[70]Academy of Medical Royal Colleges. Statement on the initial antimicrobial treatment of sepsis V2.0. Oct 2022 [internet publication]. https://www.aomrc.org.uk/reports-guidance/statement-on-the-initial-antimicrobial-treatment-of-sepsis-v2-0 ​[81]Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com

成人脓毒症

肺炎可能会并发急性呼吸窘迫综合征 (ARDS)，这种情况下会出现非心源性肺水肿和重度肺部炎症。

其死亡率为 30% 至 50%，可使用低潮气量通气平台压力限制性机械通气予以治疗。[6]Torres A, Peetermans WE, Viegi G, et al. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013 Nov;68(11):1057-65. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812874 http://www.ncbi.nlm.nih.gov/pubmed/24130229?tool=bestpractice.com

急性呼吸窘迫综合征

发病原因可能是使用抗生素后干扰了正常肠道菌群。患者通常出现腹泻、腹痛和白细胞增多。可利用艰难梭菌酶的粪便免疫检测结果进行诊断。理想情况下，应停用致病抗生素，以口服甲硝唑、万古霉素或 fidaxomicin 进行治疗。

艰难梭菌相关性疾病

一项研究指出，罹患 CAP 的住院患者中，心力衰竭的发病率为 14.1%。[163]Corrales-Medina VF, Suh KN, Rose G, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. 2011 Jun;8(6):e1001048. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125176 http://www.ncbi.nlm.nih.gov/pubmed/21738449?tool=bestpractice.com 有关 CAP 患者出现心脏并发症的危险因素的信息很少。对于住院治疗的患者而言，高龄、既往患有充血性心力衰竭、CAP 严重程度以及通过葡萄糖滑尺注射胰岛素都是可能的危险因素。[164]Becker T, Moldoveanu A, Cukierman T, et al. Clinical outcomes associated with the use of subcutaneous insulin-by-glucose sliding scales to manage hyperglycemia in hospitalized patients with pneumonia. Diabetes Res Clin Pract. 2007 Dec;78(3):392-7. http://www.ncbi.nlm.nih.gov/pubmed/17597248?tool=bestpractice.com [165]Ramirez J, Aliberti S, Mirsaeidi M, et al. Acute myocardial infarction in hospitalized patients with community-acquired pneumonia. Clin Infect Dis. 2008 Jul 15;47(2):182-7. https://academic.oup.com/cid/article/47/2/182/357199 http://www.ncbi.nlm.nih.gov/pubmed/18533841?tool=bestpractice.com [166]Corrales-Medina VF, Serpa J, Rueda AM, et al. Acute bacterial pneumonia is associated with the occurrence of acute coronary syndromes. Medicine (Baltimore). 2009 May;88(3):154-9. http://www.ncbi.nlm.nih.gov/pubmed/19440118?tool=bestpractice.com 对于已知患有心血管病的患者，接种肺炎球菌疫苗和流感疫苗可以降低发病率和死亡率。

一项研究指出，罹患 CAP 的住院患者中，急性冠脉综合征的发病率为 5.3%。[163]Corrales-Medina VF, Suh KN, Rose G, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. 2011 Jun;8(6):e1001048. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125176 http://www.ncbi.nlm.nih.gov/pubmed/21738449?tool=bestpractice.com

急性冠脉综合征概述

一项研究指出，罹患 CAP 的住院患者中，心律失常的发病率为 4.7%。[163]Corrales-Medina VF, Suh KN, Rose G, et al. Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies. PLoS Med. 2011 Jun;8(6):e1001048. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125176 http://www.ncbi.nlm.nih.gov/pubmed/21738449?tool=bestpractice.com

心律失常概述（心脏）

被认为是成人 CAP 患者的罕见并发症。与各种致病菌相关，例如金黄色葡萄球菌、化脓性链球菌、诺卡氏菌属、肺炎克雷伯菌以及肺炎链球菌。

吸烟、酗酒、高龄、糖尿病、慢性肺病或肝病都是与坏死性肺炎相关的危险因素。[170]Tsai YF, Ku YH. Necrotizing pneumonia: a rare complication of pneumonia requiring special consideration. Curr Opin Pulm Med. 2012 May;18(3):246-52. http://www.ncbi.nlm.nih.gov/pubmed/22388585?tool=bestpractice.com

住院治疗的肺炎患者罹患此症的发生率可高达 57%。[167]Light RW, Girard WM, Jenkinson SG, et al. Parapneumonic effusions. Am J Med. 1980 Oct;69(4):507-12. http://www.ncbi.nlm.nih.gov/pubmed/7424940?tool=bestpractice.com [168]Taryle DA, Potts DE, Sahn SA. The incidence and clinical correlates of parapneumonic effusions in pneumococcal pneumonia. Chest. 1978 Aug;74(2):170-3. http://www.ncbi.nlm.nih.gov/pubmed/679746?tool=bestpractice.com 伴有胸膜腔积液的 CAP 病例中，约 1% 至 2% 的病例会并发脓胸。

应将胸腔积液考虑为诊断肺炎严重程度的指标，胸腔积液与治疗失败风险增高显著相关。[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55. https://thorax.bmj.com/content/64/Suppl_3/iii1.long http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com [169]Menéndez R, Torres A, Zalacaín R, et al. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome. Thorax. 2004 Nov;59(11):960-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746855 http://www.ncbi.nlm.nih.gov/pubmed/15516472?tool=bestpractice.com

胸膜腔积液

一种罕见的并发症，经常需要长期抗生素治疗，在某些情况下还需要进行手术引流。

肺脓肿

成人 CAP 患者的罕见并发症。气胸与葡萄球菌、链球菌和其他类型细菌所导致的可能造成肺部塌陷的细菌性肺炎相关。

气胸