TY - JOUR
T1 - Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients
AU - GLIMP Investigators
AU - Di Pasquale, Marta Francesca
AU - Sotgiu, Giovanni
AU - Gramegna, Andrea
AU - Radovanovic, Dejan
AU - Terraneo, Silvia
AU - Reyes, Luis F.
AU - Rupp, Jan
AU - del Castillo, Juan Gonzalez
AU - Blasi, Francesco
AU - Aliberti, Stefano
AU - Restrepo, Marcos I.
AU - Aruj, Patricia Karina
AU - Attorri, Silvia
AU - Barimboim, Enrique
AU - Caeiro, Juan Pablo
AU - Garzon, Maria I.
AU - Cambursano, Victor Hugo
AU - Cazaux, A.
AU - Ceccato, Adrian
AU - Chertcoff, Julio
AU - Lascar, Florencia
AU - Di Tulio, Fernando
AU - Diaz, Ariel Cordon
AU - de Vedia, Lautaro
AU - Ganaha, Maria Cristina
AU - Lambert, Sandra
AU - Luna, Carlos M.
AU - Malberti, Alessio Gerardo
AU - Morcillo, Nora
AU - Tartara, Silvina
AU - Cetrangolo, Antonio A.
AU - Pensotti, Claudia
AU - Monte, Privada
AU - Pereyra, Betiana
AU - Scapellato, Pablo Gustavo
AU - Stagnaro, Juan Pablo
AU - Shah, Sonali
AU - Lotsch, Felix
AU - Thalhammer, Florian
AU - Anseeuw, Kurt
AU - Francois, Camille A.
AU - Van Braeckel, Eva
AU - Vincent, Jean Louis
AU - Djimon, Marcel Zannou
AU - Bashi, Jules
AU - Dodo, Roger
AU - Xu, Jin-fu
AU - Rusu, Doina
AU - Toma, Cristina
AU - van Boven, Job F. M.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - 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.
AB - 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.
KW - pneumonia
KW - multidrug-resistant pathogens
KW - microbiology
KW - MRSA
KW - immunocompromise
KW - BLOOD-STREAM INFECTIONS
KW - MULTIDRUG-RESISTANT PATHOGENS
KW - RESPIRATORY-TRACT INFECTIONS
KW - RISK-FACTORS
KW - PNEUMOCYSTIS PNEUMONIA
KW - TRANSPLANT RECIPIENTS
KW - HOSPITALIZED-PATIENTS
KW - BACTERIAL PNEUMONIA
KW - DISEASES-SOCIETY
KW - MANAGEMENT
U2 - 10.1093/cid/ciy723
DO - 10.1093/cid/ciy723
M3 - Article
SN - 1058-4838
VL - 68
SP - 1482
EP - 1493
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 9
ER -