The 10 Most Common Questions about Nonresolving Pneumonia

摘要

Pneumonia continues to be one of the most important health care problems in the United States. When pneumonia fails to resolve in the expected manner, the medical, social, and economic consequences can be considerable. Although much remains unknown about the spectrum of normal resolution of pneumonia, the natural history of pneumococcal pneumonia often serves as a yardstick against which to measure the resolution of other pneumonias. Pneumonias that do not resolve as expected fall into one of four categories: 1) slow but progressive resolution, 2) nonresolution, 3) progression, and 4) recurrence. Often, when a pneumonia fails to resolve as expected, the reason is that the cause of the lung infiltrates either is not actually pneumonia but is a noninfectious process that mimics pneumonia or is an infection with an unusual pathogen not susceptible to standard antimicrobial therapy. Delayed resolution also has been linked to a number of risk factors. Factors associated with aging may change the natural history of pneumonia to the extent that prolonged resolution may be the norm in the elderly. Pneumonia in mechanically ventilated patients poses particularly difficult problems in diagnosis and treatment, especially in those with acute respiratory distress syndrome, because worsening infiltrates may not be caused by pneumonia, and the impact of antibiotics is uncertain. Although nosocomial pneumonia should usually be evaluated on an emergent basis because of the critical condition of most patients, as a general rule patients with community-acquired pneumonia may be observed for 4 to 8 weeks before further intervention need be considered.