The microbiology of severe community acquired pneumonia (SCAP) has implications on management, clinical outcomes and public health policy. Therefore, knowledge of the etiologies of SCAP and methods to identify these microorganisms is key. Bacteria including Streptococcus pneumoniae, Staphylococcus aureus and Enterobacteriaceae continue to be important causes of SCAP. Viruses remain the most commonly identified etiology of SCAP. Atypical organisms are also important etiologies of SCAP and are critical to identify for public health. With the increased number of immunocompromised individuals, less common pathogens may also be found as the causative agent of SCAP. Traditional diagnostic tests, including semi-quantitative respiratory cultures, blood cultures and urinary antigens continue to hold an important role in the evaluation of patients with SCAP. Many of the limitations of the aforementioned tests are addressed by rapid, molecular diagnostic tests. Molecular diagnostics utilize culture-independent technology to identify species-specific genetic sequences. These tests are often semi-automated and provide results within hours, which provides an opportunity for expedient antibiotic stewardship. The existing literature suggests molecular diagnostic techniques may improve antibiotic stewardship in CAP, and future research should investigate optimal methods for implementation of these assays into clinical practice.

严重社区获得性肺炎 (SCAP) 的微生物学对治疗、临床结果和公共卫生政策具有影响。因此，了解 SCAP 的病因和识别这些微生物的方法是关键。肺炎链球菌、金黄色葡萄球菌和肠杆菌科细菌等细菌仍然是 SCAP 的重要病因。病毒仍然是 SCAP 最常见的病因。非典型微生物也是 SCAP 的重要病因，对于公共卫生的识别至关重要。随着免疫功能低下个体数量的增加，不太常见的病原体也可能被发现是 SCAP 的病原体。传统的诊断测试，包括半定量呼吸道培养、血培养和尿抗原，在 SCAP 患者的评估中仍然发挥着重要作用。上述测试的许多局限性可以通过快速分子诊断测试来解决。分子诊断利用独立于培养的技术来识别物种特异性基因序列。这些测试通常是半自动化的，并在数小时内提供结果，这为便捷的抗生素管理提供了机会。现有文献表明分子诊断技术可以改善 CAP 中的抗生素管理，未来的研究应该调查将这些检测方法应用到临床实践的最佳方法。