| Abstract | Izvanbolničke pneumonije sve su one pneumonije koje su stečene u općoj populaciji. Uzrokovane su širokim spektrom mikroorganizama među kojima je i dalje najčešći Streptococcus pneumoniae. Sve se veća važnost pridaje i atipičnim uzročnicima, osobito respiratornim virusima. SARS-Cov-2 relativno je novi uzročnik izrazitog globalnog značenja. Starija životna dob, muški spol, nizak socioekonomski status, navike poput pušenja i konzumacije alkohola te komorbidne kronične bolesti imaju značajan učinak na razvoj, tijek i ishode bolesti. Postavljanje dijagnoze sastoji se od uzimanja anamneze koja obavezno mora uključivati epidemiološke podatke i rizične faktore te kliničkog pregleda koji uvelike može potvrditi sumnju na dijagnozu pneumonije. Konačna se dijagnoza postavlja radiološkim metodama, a laboratorijski su parametri izrazito važni za uvid u opće stanje bolesnika i težinu njegove bolesti. Mikrobiološke metode provode se u bolničkim uvjetima ili kada prethodne pretrage ne upućuju na jasnu dijagnozu. Na temelju kliničkog pregleda, laboratorijske i radiološke obrade odlučuje se o načinu zbrinjavanja bolesnika. Razvijeni su sustavi bodovanja u svrhu svrstavanja bolesnika u određenu kategoriju težine bolesti. Bolesnici s lakšim oblicima pneumonije mogu se zbrinuti ambulantno, dok oni s težim oblicima zahtijevaju hospitalizaciju ili prijem u jedinicu intenzivnog liječenja. Temelj liječenja izvanbolničkih pneumonija jest antibiotska terapija koja se započinje empirijski. Odluka o uvođenju određenog antibiotika temelji se na kliničkoj slici, težini bolesti i komorbiditetima bolesnika, trenutnoj epidemiološkoj situaciji te podacima o lokalnoj rezistenciji uzročnika na antibiotike. Ishod bolesti također ovisi o njenoj težini i udruženim kroničnim bolestima, o pravovremeno postavljenoj dijagnozi i ranom uvođenju adekvatne antibiotske terapije. Osim kratkoročnog mortaliteta, pokazalo se da izvanbolničke pneumonije utječu i na dugoročne ishode bolesnika u smislu povećanog morbiditeta i godinama nakon preboljele pneumonije. |
| Abstract (english) | Community-acquired pneumonia is pneumonia acquired in the general population. It is caused by a wide variety of microorganisms, the most common of which remains the Streptococcus pneumoniae. However, atypical pathogens, particularly respiratory viruses, have also gained significance. SARS-Cov-2 is a relatively recent pathogen of global importance. Advanced age, male sex, low socioeconomic status, lifestyle habits such as smoking and alcohol consumption, and comorbid chronic illnesses all have a significant effect on the development, course and outcomes of the disease. The path towards establishing a diagnosis consists of taking a thorough history, which should include epidemiological information and risk factors, and a physical exam, which can be of great help in confirming or removing suspicion of pneumonia. The diagnosis is confirmed by radiology, and laboratory findings are essential for evaluating the patient’s general health, as well as the severity of the disease. Microbiological investigations are performed in the hospital setting or if the results of previous investigations don’t support a clear diagnosis. The findings of the physical exam, laboratory workup, and radiology determine the site of care. Different scoring systems have been developed for the purpose of sorting the patient into a certain category of disease severity. Milder cases of community-acquired pneumonia may be managed in the outpatient setting, whereas severe cases require hospitalisation or admission to the intensive care unit. Empirical antibiotics are the mainstay of treatment for community-acquired pneumonia. The choice of antibiotic is guided by clinical presentation, disease severity and the patient’s comorbidities, but also by the current epidemiological situation and data on local levels of antimicrobial resistance. Outcomes of the disease depend on its severity and comorbid chronic conditions, but they are also dependent on a timely diagnosis and early introduction of adequate antibiotic therapy. Aside from short-term mortality, studies have shown that community-acquired pneumonia affects long-term outcomes as well, increasing the patients’ morbidity for years following recovery. |
