Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients.

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2019-04

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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.

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GLIMP Investigators, Humans, Pneumonia, Bacterial, Community-Acquired Infections, Mycoses, Acquired Immunodeficiency Syndrome, Hematologic Neoplasms, Anemia, Aplastic, Neutropenia, Lung Transplantation, Prevalence, Risk Factors, Immunocompromised Host, Aged, Aged, 80 and over, Middle Aged, Africa, Americas, Asia, Australia, Europe, Female, Male

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https://hdl.handle.net/10161/29844

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https://creativecommons.org/licenses/by-nc/4.0

Published Version (Please cite this version)

10.1093/cid/ciy723

Publication Info

Di Pasquale, Marta Francesca, Giovanni Sotgiu, Andrea Gramegna, Andrea Gramegna, Dejan Radovanovic, Silvia Terraneo, Luis F Reyes, Jan Rupp, et al. (2019). Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 68(9). pp. 1482–1493. 10.1093/cid/ciy723 Retrieved from https://hdl.handle.net/10161/29844.

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