Treatment of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies

Julio A Ramirez¹, Daniel M Musher², Scott E Evans³, Charles Dela Cruz⁴, Kristina A Crothers⁵, Chadi A Hage⁶, Stefano Aliberti⁷, Antonio Anzueto⁸, Francisco Arancibia⁹, Forest Arnold¹⁰, Elie Azoulay¹¹, Francesco Blasi⁷, Jose Bordon¹², Steven Burdette¹³, Bin Cao¹⁴, Rodrigo Cavallazzi¹⁵, James Chalmers¹⁶, Patrick Charles¹⁷, Jean Chastre¹⁸, Yann-Erick Claessens¹⁹, Nathan Dean²⁰, Xavier Duval²¹, Muriel Fartoukh²², Charles Feldman²³, Thomas File²⁴, Filipe Froes²⁵, Stephen Furmanek¹⁰, Martin Gnoni¹⁰, Gustavo Lopardo²⁶, Carlos Luna²⁷, Takaya Maruyama²⁸, Rosario Menendez²⁹, Mark Metersky³⁰, Donna Mildvan³¹, Eric Mortensen³², Michael S Niederman³³, Mathias Pletz³⁴, Jordi Rello³⁵, Marcos I Restrepo⁸, Yuichiro Shindo³⁶, Antoni Torres³⁷, Grant Waterer³⁸, Brandon Webb³⁹, Tobias Welte⁴⁰, Martin Witzenrath⁴¹, Richard Wunderink⁴²

Affiliations

¹ Division of Infectious Diseases, University of Louisville, Louisville, KY. Electronic address: j.ramirez@louisville.edu.
² Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX.
³ Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
⁴ Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT.
⁵ Veterans Puget Sound Health Care System, University of Washington, Seattle WA.
⁶ Thoracic Transplant Program, Indiana University, Indianapolis, IN.
⁷ Department of Pathophysiology and Transplantation, University of Milan, and Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.
⁸ South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital, and University of Texas Health, San Antonio, TX.
⁹ Pneumology Service, Instituto Nacional del Tórax and Clínica Santa María, Santiago de Chile, Chile.
¹⁰ Division of Infectious Diseases, University of Louisville, Louisville, KY.
¹¹ Medical ICU, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
¹² Section of Infectious Diseases, Providence Health Center, Washington, DC.
¹³ Wright State University Boonshoft School of Medicine, Dayton, OH.
¹⁴ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
¹⁵ Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, Louisville, KY.
¹⁶ Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK.
¹⁷ Department of Infectious Diseases, Austin Health and Department of Medicine, University of Melbourne, Australia.
¹⁸ Service de Médecine Intensive-Réanimation, Hôpital La Pitié-Salpêtrière, Sorbonne Université, APHP, Paris, France.
¹⁹ Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Monaco.
²⁰ Intermountain Medical Center and the University of Utah, Salt Lake City, UT.
²¹ UMR 1137, IAME, INSERM, and CIC 1425, Hôpital Bichat-Claude Bernard, APHP, Paris, France.
²² Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, and APHP, Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France.
²³ Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
²⁴ Infectious Disease Section, Northeast Ohio Medical University and Infectious Disease Division, Summa Health, Akron, OH.
²⁵ ICU, Chest Department, Hospital Pulido Valente-Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
²⁶ Fundación del Centro de Estudios Infectológicos, Buenos Aires, Argentina.
²⁷ Pulmonary Diseases Division, Universidad de Buenos Aires, Buenos Aires, Argentina.
²⁸ Department of Respiratory Medicine, National Hospital Organization Mie National Hospital, Tsu, Japan.
²⁹ Pneumology Department, La Fe University and Polytechnic Hospital, La Fe Health Research Institute, Valencia, Spain.
³⁰ Division of Pulmonary, Critical Care and Sleep Medicine and Center for Bronchiectasis Care, University of Connecticut Health, Farmington, CT.
³¹ Icahn School of Medicine at Mount Sinai, New York, NY.
³² Department of Medicine, University of Connecticut Health Center, Farmington, CT.
³³ Pulmonary and Critical Care, New York Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, New York, NY.
³⁴ Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
³⁵ Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, and Infections Area, Vall d'Hebron Institute of Research, Barcelona, Spain.
³⁶ Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
³⁷ Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona. Barcelona, CIBERES, Spain.
³⁸ School of Medicine, University of Western Australia, Perth, Australia.
³⁹ Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT and Division of Infectious Diseases and Geographic Medicine, Stanford Medicine, Palo Alto, CA.
⁴⁰ German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Clinic of Pneumology, Hannover Medical School, Hannover, Germany.
⁴¹ Division of Pulmonary Inflammation and Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
⁴² Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL.

PMID: 32561442
PMCID: PMC7297164
DOI: 10.1016/j.chest.2020.05.598

Review

Treatment of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies

Julio A Ramirez et al. Chest. 2020 Nov.

. 2020 Nov;158(5):1896-1911.

doi: 10.1016/j.chest.2020.05.598. Epub 2020 Jun 16.

Authors

Affiliations

¹ Division of Infectious Diseases, University of Louisville, Louisville, KY. Electronic address: j.ramirez@louisville.edu.
² Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston, TX.
³ Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX.
⁴ Pulmonary, Critical Care and Sleep Medicine, Yale University, New Haven, CT.
⁵ Veterans Puget Sound Health Care System, University of Washington, Seattle WA.
⁶ Thoracic Transplant Program, Indiana University, Indianapolis, IN.
⁷ Department of Pathophysiology and Transplantation, University of Milan, and Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.
⁸ South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital, and University of Texas Health, San Antonio, TX.
⁹ Pneumology Service, Instituto Nacional del Tórax and Clínica Santa María, Santiago de Chile, Chile.
¹⁰ Division of Infectious Diseases, University of Louisville, Louisville, KY.
¹¹ Medical ICU, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
¹² Section of Infectious Diseases, Providence Health Center, Washington, DC.
¹³ Wright State University Boonshoft School of Medicine, Dayton, OH.
¹⁴ Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
¹⁵ Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville, Louisville, KY.
¹⁶ Scottish Centre for Respiratory Research, School of Medicine, Ninewells Hospital and Medical School, Dundee, UK.
¹⁷ Department of Infectious Diseases, Austin Health and Department of Medicine, University of Melbourne, Australia.
¹⁸ Service de Médecine Intensive-Réanimation, Hôpital La Pitié-Salpêtrière, Sorbonne Université, APHP, Paris, France.
¹⁹ Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Monaco.
²⁰ Intermountain Medical Center and the University of Utah, Salt Lake City, UT.
²¹ UMR 1137, IAME, INSERM, and CIC 1425, Hôpital Bichat-Claude Bernard, APHP, Paris, France.
²² Service de Médecine Intensive Réanimation, Hôpital Tenon, APHP, and APHP, Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France.
²³ Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
²⁴ Infectious Disease Section, Northeast Ohio Medical University and Infectious Disease Division, Summa Health, Akron, OH.
²⁵ ICU, Chest Department, Hospital Pulido Valente-Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
²⁶ Fundación del Centro de Estudios Infectológicos, Buenos Aires, Argentina.
²⁷ Pulmonary Diseases Division, Universidad de Buenos Aires, Buenos Aires, Argentina.
²⁸ Department of Respiratory Medicine, National Hospital Organization Mie National Hospital, Tsu, Japan.
²⁹ Pneumology Department, La Fe University and Polytechnic Hospital, La Fe Health Research Institute, Valencia, Spain.
³⁰ Division of Pulmonary, Critical Care and Sleep Medicine and Center for Bronchiectasis Care, University of Connecticut Health, Farmington, CT.
³¹ Icahn School of Medicine at Mount Sinai, New York, NY.
³² Department of Medicine, University of Connecticut Health Center, Farmington, CT.
³³ Pulmonary and Critical Care, New York Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, New York, NY.
³⁴ Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
³⁵ Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, and Infections Area, Vall d'Hebron Institute of Research, Barcelona, Spain.
³⁶ Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
³⁷ Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona. Barcelona, CIBERES, Spain.
³⁸ School of Medicine, University of Western Australia, Perth, Australia.
³⁹ Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT and Division of Infectious Diseases and Geographic Medicine, Stanford Medicine, Palo Alto, CA.
⁴⁰ German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) Clinic of Pneumology, Hannover Medical School, Hannover, Germany.
⁴¹ Division of Pulmonary Inflammation and Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
⁴² Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL.

PMID: 32561442
PMCID: PMC7297164
DOI: 10.1016/j.chest.2020.05.598

Abstract

Background: Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients.

Research question: There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP.

Study design and methods: This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus.

Results: The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens.

Interpretation: This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.

Keywords: community-acquired pneumonia; immunocompromised; pneumonia.

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Comment in

Management of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies.
Hill AT. Hill AT. Chest. 2020 Nov;158(5):1802-1803. doi: 10.1016/j.chest.2020.08.003. Chest. 2020. PMID: 33160518 No abstract available.
Community-Acquired Pneumonia in Immunocompromised Adults: Solid Tumors Might Not Be Regarded as Independent Risk Factors for Opportunistic Pathogens.
Kolditz M, Ewig S. Kolditz M, et al. Chest. 2020 Dec;158(6):2702-2703. doi: 10.1016/j.chest.2020.06.083. Chest. 2020. PMID: 33280756 No abstract available.
Response.
Ramirez JA, Musher DM, Evans SE. Ramirez JA, et al. Chest. 2020 Dec;158(6):2703-2704. doi: 10.1016/j.chest.2020.07.034. Chest. 2020. PMID: 33280758 No abstract available.

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Treatment of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies

Affiliations

Treatment of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies

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Affiliations

Abstract

Comment in

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Medical

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