Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Apr 24;68(9):1482-1493.
doi: 10.1093/cid/ciy723.

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

Marta Francesca Di Pasquale  1 , Giovanni Sotgiu  2 , Andrea Gramegna  1 , Dejan Radovanovic  3 , Silvia Terraneo  4 , Luis F Reyes  5 , Jan Rupp  6 , Juan González Del Castillo  7   8 , Francesco Blasi  1 , Stefano Aliberti  1 , Marcos I Restrepo  9 ; GLIMP Investigators
Collaborators, Affiliations
Observational Study

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

Marta Francesca Di Pasquale et al. Clin Infect Dis. .

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.

Keywords: MRSA; immunocompromise; microbiology; multidrug-resistant pathogens; pneumonia.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Distribution of prevalence of immunocompromise among the different countries participating in the study, categorized as no data, <5%, 5%–10%, 11%–20%, 21%–30%, or >30% of total cases.
Figure 2.
Figure 2.
Prevalence of each single risk factor for immunocompromise.
Figure 3.
Figure 3.
Prevalence of the number of risk factors present simultaneously in a single patient.
Figure 4.
Figure 4.
Network analysis between risk factors for immunocompromise.
See this image and copyright information in PMC

References

    1. Aliberti S, Di Pasquale M, Zanaboni AM, et al. . Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis 2012; 54:470–8. - PubMed
    1. Aliberti S, Cilloniz C, Chalmers JD, et al. . Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European perspective. Thorax 2013; 68:997–9. - PubMed
    1. Shindo Y, Ito R, Kobayashi D, et al. . Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med 2013; 188:985–95. - PubMed
    1. Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med 2014; 371:1619–28. - PubMed
    1. Mandell LA, Wunderink RG, Anzueto A, et al. ; Infectious Diseases Society of America; American Thoracic Society Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(suppl 2):S27–72. - PMC - PubMed

Publication types

MeSH terms