Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

Abstract

Background. The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia.Methods. We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor.Results. At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001).Conclusions. Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses.

An international perspective on hospitalized patients with viral community-acquired pneumonia

“…In the current study, we found that patients were more likely to undergo testing for viruses if they had more severe CAP, had prior respiratory comorbidities, were obese, or were immunocompromised due to malignancy, transplant history, or previous chemotherapy. Our group recently studied the etiology of CAP in immunocompromised patients and found that the prevalence of Influenza virus was similar in immunocompromised and immunocompetent patients [32]. Based on this epidemiological background, immunocompromised patients with CAP should be tested for other viruses, avoiding the underestimation of the risk of other pathogens.…”

Diagnosis of severe respiratory infections in immunocompromised patients

“…All types of immunosuppression are risk factors for classic bacterial pneumonia, and 1 out of 5 patients hospitalized for community-acquired pneumonia (CAP) is immunocompromised [21]. Long-term steroid therapy (> 10 mg/day of prednisone-equivalent for ≥ 3 months) is the main cause of immunosuppression.…”

“…Humoral immunosuppression and hypogammaglobulinemia are risk factors for bacterial pneumonia, especially with Streptococcus pneumoniae and Haemophilus influenzae [24]. In addition to immunosuppression, patients may have other factors associated with both bacterial pneumonia and Pseudomonas pneumonia, such as structural lung disease [chronic obstructive pulmonary disease (COPD) or bronchiectasis], diabetes mellitus, smoking, and alcohol abuse [21]. Specific risk factors have been reported for pneumonia due to Nocardia, Neisseria, Rhodococcus, and Q fever (Coxiella burnetii).…”

“…Streptococcus pneumoniae, Klebsiella pneumoniae, and Haemophilus spp. are the most frequently identified causative pathogens [21]. Pseudomonas spp., enteric Gram-negative bacilli, Stenotrophomonas spp., and methicillin-resistant Staphylococcus aureus should be considered [32].…”

More targeted use of oseltamivir and in-hospital isolation facilities after implementation of a multifaceted strategy including a rapid molecular diagnostic panel for respiratory viruses in immunocompromised adult patients

“…Moreover, the number of immunocompromised patients is increasing due to ageing of the population, increased prevalence of chronic diseases as well as treatment with immunosuppressive agents [4,5]. Although immunocompromised patients have similar etiologies of acute RTI when compared to immunocompetent patients [6], they more often have a complicated course of the disease leading to high healthcare burden, especially in secondary and tertiary care settings [7,8]. Within the respiratory viral season, in-hospital isolation facilities are often falling short due to the high number of patients with suspected https://doi.org/10.1016/j.jcv.2019.04.003 Received 2 January 2019; Received in revised form 4 April 2019; Accepted 6 April 2019 viral infections and immunocompromised patients with prolonged viral shedding [9,10].…”