2025年社区获得性肺炎诊疗指南更新解读
该综述汇总美国胸科学会2025年社区获得性肺炎（CAP）指南更新，重点涉及影像诊断、抗生素疗程及糖皮质激素使用，并强调对急诊诊疗的影响。指南支持经验丰富的临床医生使用肺超声诊断CAP，对病毒检测阳性且健康的患者基于极低质量证据建议不常规使用抗生素。
要点
- 经验丰富的临床医生可用肺超声诊断CAP。
- 病毒检测阳性且健康的CAP患者，基于极低质量证据建议不处方抗生素。
- 非重症CAP达临床稳定后抗生素疗程可少于5天（最短3天）。
核心结论
- 2025年ATS指南更新了CAP影像诊断、抗生素治疗及糖皮质激素使用推荐，并强调对急诊医学的影响。
研究设计与样本
- 该文为综述，汇总美国胸科学会2025年发布的CAP指南更新内容，重点讨论其对急诊诊疗的影响。
主要发现
- 指南支持由经验丰富的临床医生使用肺超声诊断CAP。
- 对病毒检测阳性且其他方面健康的CAP患者，2025年指南基于极低质量证据建议不处方抗生素，但需考虑影像学表现等因素。
- 对有合并症或住院患者，以及影像学符合肺炎者，应给予抗生素。
关键数值与推荐
- 门诊及住院的非重症CAP患者达到临床稳定后，推荐抗生素疗程少于5天（最短3天），而非≥5天。
- 住院重症CAP患者推荐抗生素疗程5天或以上。
- 重症CAP患者可使用糖皮质激素，但非重症肺炎不建议使用。
临床怎么用
- 急诊评估CAP时可考虑由经验丰富的临床医生使用肺超声辅助诊断。
- 病毒检测阳性且健康的患者需结合影像学等因素决策是否使用抗生素。
- 非重症CAP达临床稳定后可缩短抗生素疗程至少于5天（最短3天）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Am J Emerg Med. 2026 Sep;107:16-20. doi: 10.1016/j.ajem.2026.05.020. Epub 2026 May 14. ABSTRACT Community-acquired pneumonia (CAP) is a common condition evaluated and managed in the emergency department (ED) setting. Guidelines published in 2007 and 2019 from the American Thoracic Society (ATS) and Infectious Diseases Society of America provide recommendations for CAP, but there are a variety of studies that have been published since the release of these guidelines. The ATS published updated guidelines in 2025, which discuss imaging, antibiotic therapy, and corticosteroids. The updated guidelines support the use of lung ultrasound for diagnosis of CAP when used by experienced clinicians. For patients with CAP and positive viral testing who are otherwise healthy, the 2025 guidelines suggest not prescribing antibiotics based on very low-quality evidence, though there are several factors that should be considered (e.g., imaging findings). Antibiotics should be administered in those with comorbidities or admitted patients, as well as those with imaging findings consistent with pneumonia. Duration of antibiotic therapy less than 5 days (minimum 3 days) in outpatients and admitted patients with nonsevere CAP who reach clinical stability is recommended, rather than ≥5 days of therapy. In patients admitted with severe CAP, the guideline recommend 5 or more days of antibiotics. Corticosteroids may be used in patients with severe CAP, but the guidelines recommend against their use in nonsevere pneumonia. This review summarizes the 2025 guideline recommendations with an emphasis on their impact on emergency medicine. PMID: 42127879 | DOI: 10.1016/j.ajem.2026.05.020
引用
- 指南共识 · 肺炎：2025 guideline updates for community-acquired pneumonia diagnosis and management
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。