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
. 2023 Nov 22;10(11):ofad565.
doi: 10.1093/ofid/ofad565. eCollection 2023 Nov.

Community-Acquired Pneumonia in the Immunocompromised Host: Epidemiology and Outcomes

Julio A Ramirez  1   2 , Thomas R Chandler  1 , Stephen P Furmanek  1 , Ruth Carrico  1 , Ashley M Wilde  1 , Daniya Sheikh  2 , Raghava Ambadapoodi  2 , Vidyulata Salunkhe  2 , Mohammad Tahboub  2 , Forest W Arnold  2 , Jose Bordon  3 , Rodrigo Cavallazzi  4 ; Louisville CAP in the Immunocompromised Study Group
Collaborators, Affiliations

Community-Acquired Pneumonia in the Immunocompromised Host: Epidemiology and Outcomes

Julio A Ramirez et al. Open Forum Infect Dis. .

Abstract

Background: The epidemiology and outcomes of community-acquired pneumonia (CAP) in immunocompromised hosts (ICHs) are not well defined. The objective of this study was to define the epidemiology and outcomes of CAP in ICHs as compared with non-ICHs.

Methods: This ancillary study included a prospective cohort of hospitalized adult Louisville residents with CAP from 1 June 2014 to 31 May 2016. An ICH was defined per the criteria of the Centers for Disease Control and Prevention. Geospatial epidemiology explored associations between ICHs hospitalized with CAP and income level, race, and age. Mortality for ICHs and non-ICHs was evaluated during hospitalization and 30 days, 6 months, and 1 year after hospitalization.

Results: A total of 761 (10%) ICHs were identified among 7449 patients hospitalized with CAP. The most common immunocompromising medical conditions or treatments were advanced-stage cancer (53%), cancer chemotherapy (23%), and corticosteroid use (20%). Clusters of ICHs hospitalized with CAP were found in areas associated with low-income and Black or African American populations. Mortality by time point for ICHs vs non-ICHs was as follows: hospitalization, 9% vs 5%; 30 days, 24% vs 11%; 6 months, 44% vs 21%; and 1 year, 53% vs 27%, respectively.

Conclusions: Approximately 1 in 10 hospitalized patients with CAP is immunocompromised, with advanced-stage cancer being the most frequent immunocompromising condition, as seen in half of all patients who are immunocompromised. Risk for hospitalization may be influenced by socioeconomic disparities and/or race. ICHs have a 2-fold increase in mortality as compared with non-ICHs.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Distribution of immunocompromising medical conditions and treatments. Conditions and treatments are not mutually exclusive; percentages add to >100%. DMARD, disease-modifying antirheumatic drug.
Figure 2.
Figure 2.
Distribution of patients hospitalized with community-acquired pneumonia by immune function.
Figure 3.
Figure 3.
Distribution of immunocompromised hosts in Louisville, Kentucky, vs poverty, race, and age. A, Hospitalized cases of immunocompromised hosts with community-acquired pneumonia in Jefferson County, Kentucky, with an area of an increased risk of hospitalization outlined by dotted line. Publicly available census data collected from the same area and year quantifying the number individuals (B) at or below the national poverty level, (C) of Black or African American race, and (D) of advanced age. Area of relative risk was identified through the Kulldorff spatial scan statistic.13,14
Figure 4.
Figure 4.
Time to event outcomes between ICHs and non-ICHs. A, Kaplan-Meier estimation and corresponding survival curves for time to clinical stability between ICHs and non-ICHs. Day 0 represents the first day of hospitalization, when all patients were clinically unstable. B, Kaplan-Meier estimation and corresponding survival curve for time to hospital discharge between ICHs and non-ICHs. Day 0 represents the first day of hospitalization, when all patients were still hospitalized. ICH, immunocompromised host.
Figure 5.
Figure 5.
Time to mortality up to 1 year following hospital discharge. A, Time to mortality for ICHs and non-ICHs. B, Time to mortality for patients hospitalized with community-acquired pneumonia classified according to function of the immune system. ICH, immunocompromised host.
See this image and copyright information in PMC

References

    1. Harpaz R, Dahl RM, Dooling KL. Prevalence of immunosuppression among US adults, 2013. JAMA 2016; 316:2547–8. - PubMed
    1. Jenkinson PW, Plevris N, Siakavellas S, et al. Temporal trends in surgical resection rates and biologic prescribing in Crohn’s disease: a population-based cohort study. J Crohns Colitis 2020; 14:1241–7. - PubMed
    1. Organ Procurement and Transplantation Network . National data: transplants in the US by region. Available at: https://optn.transplant.hrsa.gov/data/view-datareports/national-data/#. Accessed 7 July 2023.
    1. Xu J, Murphy SL, Kochanek KD, Bastian BA. Deaths: final data for 2013. Natl Vital Stat Rep 2016; 64:1–119. - PubMed
    1. Pfuntner A, Wier LM, Stocks C. Most Frequent Conditions in US Hospitals, 2011. Rockville: Agency for Healthcare Research and Quality, 2013. Healthcare Cost and Utilization Project statistical brief 162.