Treatment of Community-Acquired Pneumonia in Immunocompromised Adults

Abstract

BACKGROUND: Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. RESEARCH QUESTION: There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP. STUDY DESIGN AND METHODS: This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. RESULTS: The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens. INTERPRETATION: This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.

Metagenomic Next-Generation Sequencing for Pathogenic Diagnosis and Antibiotic Management of Severe Community-Acquired Pneumonia in Immunocompromised Adults

“…Though the clinicians have gradually realized the particularity of immunocompromised SCAP patients, the optimized antibiotic strategy for them remains uncertain. The excessive antibiotic use can lead to resistance and medical resources waste ( Webb et al., 2015 ; Metlay et al., 2019 ; Ramirez et al., 2020 ). Zhang et al.…”

“…SCAP was defined in patients with either one major criterion or at least three minor criteria of the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) criteria ( Metlay et al., 2019 ). Immunosuppression was defined according to the previous article ( Ramirez et al., 2020 ): primary immune deficiency disease; active malignancy; receiving cancer chemotherapy; HIV infection with a CD4 T-lymphocyte count <200 cells/μL or percentage <14%; solid organ transplantation; hematopoietic stem cell transplantation; receiving corticosteroid therapy with a dose 20 mg prednisone or equivalent daily for ≧14 days or a cumulative dose >700 mg of prednisone; receiving biologic immune modulators; receiving disease-modifying anti-rheumatic or other immunosuppressive drugs. Patients were excluded if they had been discharged before mNGS results were obtained, if they combine with hospital acquired pneumonia (HAP) or if the acquisition time of BALF was more than 72 hours after ICU admission.…”

“…The inability to obtain a precisely and timely pathogen diagnosis might lead to excessive antibiotic treatment and unnecessary healthcare costs. However, pathogenic diagnosis and adequate empirical treatment in immunocompromised patients is challenging because they are susceptible to common pathogens and numerous opportunistic pathogens ( Ramirez et al., 2020 ). The low detection rate and time-consuming process for conventional pathogen tests ( Jain et al., 2015 ) make these challenges bigger, and which is a key problem faced by clinicians.…”

Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie – Update 2021

“…auch zur NHAP verhält sich die ambulant erworbene Pneumonie des ▶ Tab. 3 Auswahl typischer Konditionen mit schwerer Immunsuppression [6].…”

The severity and risk factors for mortality in immunocompromised adult patients hospitalized with influenza-related pneumonia

“…Patients with Flu-p were de ned as individuals for whom polymerase chain reaction (PCR) analyses of respiratory specimens (including sputum, nasal/nasopharyngeal swabs, bronchial aspirates, and bronchoalveolar lavage uid) were positive for in uenza viral RNA, and for whom respiratory symptoms and chest radiographic ndings were consistent with newly emergent chest in ltrates. IC patients included primary immune de ciency diseases, active malignancy, HIV infection with a CD4 T-lymphocyte count < 200 cells/mL or percentage < 14%, immunosuppressive therapy (Supplementary Material 2), solid organ transplantation, hematopoietic stem cell transplantation, splenectomy [12]. Patients who had early neuraminidase inhibitor (NAI) therapy were those who had been administered NAI agents within two days of symptom onset [13].…”