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Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2019 Apr 24; Vol. 68 (9), pp. 1482-1493. - Publication Year :
- 2019
-
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.<br />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.<br />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).<br />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.<br /> (© 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.)
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 68
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 31222287
- Full Text :
- https://doi.org/10.1093/cid/ciy723