1. Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients.
- Author
-
Di Pasquale MF, Sotgiu G, Gramegna A, Radovanovic D, Terraneo S, Reyes LF, Rupp J, González Del Castillo J, Blasi F, Aliberti S, and Restrepo MI
- Subjects
- Acquired Immunodeficiency Syndrome complications, Acquired Immunodeficiency Syndrome immunology, Acquired Immunodeficiency Syndrome microbiology, Africa epidemiology, Aged, Aged, 80 and over, Americas epidemiology, Anemia, Aplastic complications, Anemia, Aplastic immunology, Anemia, Aplastic microbiology, Asia epidemiology, Australia epidemiology, Community-Acquired Infections, Europe epidemiology, Female, Hematologic Neoplasms complications, Hematologic Neoplasms immunology, Hematologic Neoplasms microbiology, Humans, Lung Transplantation, Male, Middle Aged, Mycoses etiology, Mycoses immunology, Mycoses microbiology, Neutropenia complications, Neutropenia immunology, Neutropenia microbiology, Pneumonia, Bacterial etiology, Pneumonia, Bacterial immunology, Pneumonia, Bacterial microbiology, Prevalence, Risk Factors, Acquired Immunodeficiency Syndrome epidemiology, Anemia, Aplastic epidemiology, Hematologic Neoplasms epidemiology, Immunocompromised Host, Mycoses epidemiology, Neutropenia epidemiology, Pneumonia, Bacterial epidemiology
- 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., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Published
- 2019
- Full Text
- View/download PDF