切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 76 -83. doi: 10.3877/cma.j.issn.1674-1358.2026.02.002

专家共识

获得性免疫缺陷综合征合并细菌性肺炎诊治专家共识
国家传染病医学中心   
  • 收稿日期:2026-02-26 出版日期:2026-04-15
  • 基金资助:
    国家重点研发计划(2023YFC2308800)

Expert consensus on diagnosis and treatment of aquired immunodeficiency syndrome complicated with bacterial pneumonia

National Center for Infectious Diseases   

  • Received:2026-02-26 Published:2026-04-15
引用本文:

国家传染病医学中心. 获得性免疫缺陷综合征合并细菌性肺炎诊治专家共识[J/OL]. 中华实验和临床感染病杂志(电子版), 2026, 20(02): 76-83.

National Center for Infectious Diseases. Expert consensus on diagnosis and treatment of aquired immunodeficiency syndrome complicated with bacterial pneumonia[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2026, 20(02): 76-83.

获得性免疫缺陷综合征(AIDS)病原体为人类免疫缺陷病毒(HIV)。HIV感染导致机体免疫功能受到抑制,更易并发各种机会性感染。其中,细菌性肺炎是AIDS患者最常见的并发症之一,反复发生的细菌性肺炎往往提示临床医生警惕AIDS可能,若不及时规范治疗甚至可能危及生命。迄今为止,我国尚无针对AIDS合并细菌性肺炎诊断和治疗的指南或专家共识出台。因此,国家传染病医学中心和首都医科大学附属北京地坛医院联合我国行业领域内知名专家,参考国内外相关文献制定了本共识,旨在提高临床医务工作者对AIDS合并细菌性肺炎的综合诊治能力。

Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV). Due to HIV-mediated immunosuppression, infected individuals are more prone to frequent and severe opportunistic infections. Bacterial pneumonia is one of the most common complications among HIV-infected individuals. Recurrent bacterial pneumonia warrants vigilance for AIDS in clinical practice, which may even be life-threatening if it is not treated promptly and standardly. Currently, no guideline or expert consensus on the diagnosis and treatment of bacterial pneumonia in patients with AIDS have been issued in China. Therefore, this consensus was developed by the National Center for Infectious Diseases and Beijing Ditan Hospital, Capital Medical University, in combination with well-known domestic experts in relevant fields with reference to literature at home and abroad, aiming to improve the comprehensive diagnosis and treatment capabilities of clinical healthcare workers for AIDS complicated with bacterial pneumonia.

表1 共识推荐意见证据质量与推荐等级
图1 AIDS合并细菌性肺炎诊疗流程图 注:ART为抗反转录病毒疗法
共识推荐意见汇总
推荐意见 推荐等级 证据等级
反复发生的细菌性肺炎(1年内发作两次或多次)为AIDS定义性疾病之一,应视为可能提示HIV感染的指标之一,并依照《中国人类免疫缺陷病毒感染/获得性免疫缺陷综合征诊断与治疗指南(2024年版)》进行HIV检测。AIDS患者住院期间出现肺炎症状时,除肺炎链球菌等常见病原体外,需高度警惕革兰阴性杆菌(如肺炎克雷伯菌、铜绿假单胞菌)感染的可能,尤其是在CD4+ T淋巴细胞计数低下、有反复住院史或近期使用过抗菌药物的患者中。 1 A
呼吸急促和动脉血氧饱和度降低提示肺炎已发展至中重度阶段,心动过速和(或)低血压提示败血症或感染性休克,AIDS患者发生细菌性肺炎合并败血症的概率较非HIV感染者高。应快速评估AIDS患者病情严重程度,决定是否住院或收入ICU。CURB-65评分系统简便易行,适用于快速评估。 1 A
对于感染HIV且患有细菌性肺炎、病情较轻可门诊治疗的患者,用于确定细菌性病因的常规诊断性检查为可选项目,尤其当微生物学检查无法及时进行时。 1 B
对于因细菌性肺炎住院的AIDS患者,建议对痰液进行革兰染色检查并做进行次血培养,尤其是患有重症肺炎、未接受ART的患者或住院前CD4+ T淋巴细胞<350个/μl(尤其<100个/μl)的患者。理想情况下,标本应在开始使用抗菌药物之前采集,或在开始使用抗菌药物后12~18 h内采集。 1 A
建议对住院患者,特别是重症细菌性肺炎患者,进行嗜肺军团菌和肺炎链球菌的尿抗原检测。此外,对于患有重症细菌性肺炎的成人患者,应将下呼吸道分泌物在选择性培养基上进行军团菌培养,或进行军团菌核酸检测。当存在流行病学因素提示时,如与军团菌暴发有关联或近期有旅行史,感染HIV但非重症细菌性肺炎的患者也应进行军团菌检测。 1 B
如条件允许,应对AIDS合并细菌性肺炎患者进行快速耐甲氧西林金黄色葡萄球菌(MRSA)鼻腔检测,特别是对有MRSA感染风险因素的患者或在MRSA高流行环境中的患者,以指导抗菌药物选择。 2 C
在明确肺炎诊断并进行了合理的病原学检查后,AIDS合并细菌性肺炎患者需结合病原体类型、患者免疫状态(如CD4+ T淋巴细胞计数)及感染严重程度,制定个体化方案,同时需兼顾ART的启动与调整。区分社区获得性肺炎和医院获得性肺炎,及时进行初始经验性抗感染治疗,无需等待诊断检测结果。 1 A
对于疑似结核病但未同时接受标准四联抗结核治疗的患者,应谨慎使用喹诺酮类单药治疗。 1 B
尚未接受ART的细菌性肺炎患者应在肺炎治疗2周内启动。 1 A
如临床症状尚未消失,长期吸烟或年龄超过50岁并患有细菌性肺炎的AIDS患者应随访胸部CT检查。 2 C
建议根据国家社区获得性肺炎指南为AIDS患者提供肺炎球菌疫苗接种。 1 B
建议向患有细菌性肺炎且尚未戒烟的AIDS患者提供戒烟干预。 1 B
[1]
Sogaard OS, Lohse N, Gerstoft J, et al. Hospitalization for pneumonia among individuals with and without HIV infection, 1995-2007: a Danish population-based, nationwide cohort study[J]. Clin Infect Dis,2008,47(10):1345-1353.
[2]
Aston SJ, Ho A, Jary H, et al. Etiology and risk factors for mortality in an adult community-acquired pneumonia cohort in Malawi[J]. Am J Respir Crit Care Med,2019,200(3):359-369.
[3]
Gaskell KM, Feasey NA, Heyderman RS. Management of severe non-TB bacterial infection in HIV-infected adults[J]. Expert Rev Anti Infect Ther,2015,13(2):183-195.
[4]
Burke RM, Sabet N, Ellis J, et al. Causes of hospitalisation among people living with HIV worldwide, 2014-23: a systematic review and meta-analysis[J]. Lancet HIV,2025,12(5):e355-e366.
[5]
Ford N, Shubber Z, Meintjes G, et al. Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis[J]. Lancet HIV,2015,2(10):e438-e444.
[6]
Acquired Immunodeficiency Syndrome Professional Group SoIDCMA, Chinese Center for Disease C, Prevention. Chinese guidelines for the diagnosis and treatment of human immunodeficiency virus infection/acquired immunodeficiency syndrome (2024 edition)[J]. Chin Med J (Engl),2024,137(22):2654-2680.
[7]
Hirschtick RE, Glassroth J, Jordan MC, et al. Bacterial pneumonia in persons infected with the human immunodeficiency virus. Pulmonary Complications of HIV Infection Study Group[J]. N Engl J Med,1995, 333(13):845-851.
[8]
O'Connor J, Vjecha MJ, Phillips AN, et al. Effect of immediate initiation of antiretroviral therapy on risk of severe bacterial infections in HIV-positive people with CD4 cell counts of more than 500 cells per muL: secondary outcome results from a randomised controlled trial[J]. Lancet HIV,2017,4(3):e105-e112.
[9]
Crothers K, Huang L, Goulet JL, et al. HIV infection and risk for incident pulmonary diseases in the combination antiretroviral therapy era[J]. Am J Respir Crit Care Med,2011,183(3):388-395.
[10]
Gingo MR, Balasubramani GK, Kingsley L, et al. The impact of HAART on the respiratory complications of HIV infection: longitudinal trends in the MACS and WIHS cohorts[J]. PLoS One,2013,8(3):e58812.
[11]
Damery S, Nichols L, Holder R, et al. Assessing the predictive value of HIV indicator conditions in general practice: a case-control study using the THIN database[J]. Br J Gen Pract,2013,63(611):e370-e377.
[12]
National Center for Infectious Diseases Division of HIV/AIDS. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults[J]. MMWR Recomm Rep,1992,41(RR-17):1-19.
[13]
Kohli R, Lo Y, Homel P, et al. Bacterial pneumonia, HIV therapy, and disease progression among HIV-infected women in the HIV epidemiologic research (HER) study[J]. Clin Infect Dis,2006, 43(1):90-98.
[14]
Miller RF, Foley NM, Kessel D, et al. Community acquired lobar pneumonia in patients with HIV infection and AIDS[J]. Thorax,1994,49(4):367-368.
[15]
Cilloniz C, Torres A, Polverino E, et al. Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome[J]. Eur Respir J,2014,43(6):1698-1708.
[16]
Benito N, Moreno A, Miro JM, et al. Pulmonary infections in HIV-infected patients: an update in the 21st century[J]. Eur Respir J,2012,39(3):730-745.
[17]
Seybold U, Kourbatova EV, Johnson JG, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections[J]. Clin Infect Dis,2006,42(5):647-656.
[18]
Diep BA, Chambers HF, Graber CJ, et al. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men[J]. Ann Intern Med,2008,148(4):249-257.
[19]
Park DR, Sherbin VL, Goodman MS, et al. The etiology of community-acquired pneumonia at an urban public hospital: influence of human immunodeficiency virus infection and initial severity of illness[J]. J Infect Dis,2001,184(3):268-277.
[20]
Mundy LM, Auwaerter PG, Oldach D, et al. Community-acquired pneumonia: impact of immune status[J]. Am J Respir Crit Care Med,1995,152(4 Pt 1):1309-1315.
[21]
Tarp B, Jensen JS, Ostergaard L, et al. Search for agents causing atypical pneumonia in HIV-positive patients by inhibitor-controlled PCR assays[J]. Eur Respir J,1999,13(1):175-179.
[22]
Sogaard OS, Reekie J, Ristola M, et al. Severe bacterial non-aids infections in HIV-positive persons: incidence rates and risk factors[J]. J Infect,2013,66(5):439-446.
[23]
Gordin FM, Roediger MP, Girard PM, et al. Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption[J]. Am J Respir Crit Care Med,2008,178(6):630-636.
[24]
Pett SL, Carey C, Lin E, et al. Predictors of bacterial pneumonia in Evaluation of Subcutaneous Interleukin-2 in a Randomized International Trial (ESPRIT)[J]. HIV Med,2011,12(4):219-227.
[25]
Jambo KC, Banda DH, Kankwatira AM, et al. Small alveolar macrophages are infected preferentially by HIV and exhibit impaired phagocytic function[J]. Mucosal Immunol,2014,7(5):1116-1126.
[26]
Charles TP, Shellito JE. Human immunodeficiency virus infection and host defense in the lungs[J]. Semin Respir Crit Care Med,2016,37(2):147-156.
[27]
Mussini C, Galli L, Lepri AC, et al. Incidence, timing, and determinants of bacterial pneumonia among HIV-infected patients: data from the ICONA Foundation Cohort[J]. J Acquir Immune Defic Syndr,2013,63(3):339-345.
[28]
Lamas CC, Coelho LE, Grinsztejn BJ, et al. Community-acquired lower respiratory tract infections in HIV-infected patients on antiretroviral therapy: predictors in a contemporary cohort study[J]. Infection,2017,45(6):801-809.
[29]
Edelman EJ, Gordon KS, Crothers K, et al. Association of prescribed opioids with increased risk of community-acquired pneumonia among patients with and without HIV[J]. JAMA Intern Med,2019,179(3):297-304.
[30]
Attia EF, McGinnis KA, Feemster LC, et al. Association of COPD with risk for pulmonary infections requiring hospitalization in HIV-infected veterans[J]. J Acquir Immune Defic Syndr,2015,70(3):280-288.
[31]
Almeida A, Almeida AR, Castelo Branco S, et al. CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients[J]. Int J STD AIDS,2016,27(11):998-1004.
[32]
Curran A, Falco V, Crespo M, et al. Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome[J]. HIV Med,2008,9(8):609-615.
[33]
Cilloniz C, Torres A, Manzardo C, et al. Community-acquired pneumococcal pneumonia in virologically suppressed HIV-infected adult patients: A matched case-control study[J]. Chest,2017,152(2):295-303.
[34]
Feldman C, Klugman KP, Yu VL, et al. Bacteraemic pneumococcal pneumonia: impact of HIV on clinical presentation and outcome[J]. J Infect,2007,55(2):125-135.
[35]
Sage EK, Noursadeghi M, Evans HE, et al. Prognostic value of C-reactive protein in HIV-infected patients with Pneumocystis jirovecii pneumonia[J]. Int J STD AIDS,2010,21(4):288-292.
[36]
Mendelson F, Griesel R, Tiffin N, et al. C-reactive protein and procalcitonin to discriminate between tuberculosis, Pneumocystis jirovecii pneumonia, and bacterial pneumonia in HIV-infected inpatients meeting WHO criteria for seriously ill: a prospective cohort study[J]. BMC Infect Dis,2018,18(1):399.
[37]
Schleicher GK, Herbert V, Brink A, et al. Procalcitonin and C-reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia[J]. Eur Respir J,2005,25(4):688-692.
[38]
Evans SE, Jennerich AL, Azar MM, et al. Nucleic acid-based testing for noninfluenza viral pathogens in adults with suspected community-acquired pneumonia. An Official American Thoracic Society Clinical Practice Guideline[J]. Am J Respir Crit Care Med,2021,203(9):1070-1087.
[39]
Garcia Garrido HM, Mak AMR, Wit F, et al. Incidence and risk factors for invasive pneumococcal disease and community-acquired pneumonia in human immunodeficiency virus-infected individuals in a high-income setting[J]. Clin Infect Dis,2020,71(1):41-50.
[40]
Grau I, Pallares R, Tubau F, et al. Epidemiologic changes in bacteremic pneumococcal disease in patients with human immunodeficiency virus in the era of highly active antiretroviral therapy[J]. Arch Intern Med,2005,165(13):1533-1540.
[41]
中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J]. 中华结核和呼吸杂志,2016,39(4):253-279.
[42]
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America[J]. Am J Respir Crit Care Med,2019,200(7):e45-e67.
[43]
Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009[J]. Thorax,2009,64(Suppl 3):iii1-iii55.
[44]
National Institute for Health and Care Excellence. Pneumonia: diagnosis and management[EB/OL]. 2025.
[45]
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021[J]. Crit Care Med,2021,49(11):e1063-e1143.
[46]
Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV[EB/OL]. 2023-09-07.
[47]
Zou X, He J, Zheng J, et al. Evaluation of effectiveness, safety and cost-benefit of the 23- valent pneumococcal capsular polysaccharide vaccine for HIV-Infected patients[J]. Vaccine,2022,40(1):37-42.
[48]
Benard A, Mercie P, Alioum A, et al. Bacterial pneumonia among HIV-infected patients: decreased risk after tobacco smoking cessation. ANRS CO3 Aquitaine Cohort, 2000-2007[J]. PLoS One,2010,5(1):e8896.
[1] 朱东熙, 李锴文, 何旺. 广东省医学会泌尿外科疑难病例多学科会诊(第29期)——膀胱癌保膀胱综合治疗后进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(03): 352-357.
[2] 张俊峰, 牛越, 陈鹏. 局部进展期肾细胞癌新辅助和辅助治疗策略的现实挑战与未来发展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(03): 248-254.
[3] 许颜浩, 邓正根, 张晓坡, 甘卫东, 郭宏骞. 基于CT角度界面和溢啤酒征对乏脂性肾血管平滑肌脂肪瘤与肾透明细胞癌的鉴别[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(03): 273-278.
[4] 陈海珊, 李琨. 前列腺癌接受雄激素剥夺治疗患者及其配偶二元应对与心理困扰的主客体效应分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(03): 323-329.
[5] 李钰, 叶璟威, 戚维天, 叶云林, 李向东, 李志勇, 刘卓炜. 广东省医学会泌尿外科疑难病例多学科会诊(第30期)——严重泌尿系感染伴淋巴结肿大[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(03): 358-362.
[6] 曾桂能, 杨鹏辉, 刘荣. 表达IL-21的重组溶瘤流感病毒在胰腺癌中的抗肿瘤及免疫激活作用研究[J/OL]. 中华细胞与干细胞杂志(电子版), 2026, 16(03): 129-139.
[7] 叶林森, 杨扬. 进展期肝癌治疗困境与探索:综述与展望[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 290-298.
[8] 陈丽君, 黎建绪, 梁世雄, 向邦德. 原发性肝癌放疗策略与应用展望[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 299-306.
[9] 周正, 胡帅, 谢茂云, 郑希彦, 刘婷, 林志群, 陈贤清, 杜飞, 史宪杰. 可切除肝癌围手术期辅助治疗研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 317-325.
[10] 贾生雄, 徐岩, 贺小军, 谭凯, 杜锡林. CD47-SIRPα轴调控及CD47靶向治疗:破解胰腺癌免疫治疗耐药新策略[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 337-345.
[11] 黄思捷, 张惠勇, 郭小辉, 徐成润. 全身炎症反应指数对晚期肝癌患者TACE联合靶向免疫治疗预后的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 355-361.
[12] 蒋泉, 刘康寿, 王梓霖, 程勇, 刘玉龙, 叶艳彬, 孙健, 曹明溶, 谌小龙. 肝脏恶性肿瘤钇-90微球选择性内放射治疗全程管理模式构建[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 362-371.
[13] 洪士皓, 杨昕. 个性化骨科手术中3D打印技术的临床应用与展望[J/OL]. 中华临床医师杂志(电子版), 2026, 20(04): 249-255.
[14] 席雅楠, 姚国栋, 郭秀珍, 高斌礼, 赵渊, 李婷, 钟李岩, 李梦倩. IDEAS模式对机器人辅助结直肠癌根治术患者康复结局的影响[J/OL]. 中华临床医师杂志(电子版), 2026, 20(04): 285-291.
[15] 齐洪武, 徐泽雨. 脑脓肿的临床诊治进展[J/OL]. 中华临床医师杂志(电子版), 2026, 20(04): 327-331.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?