Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients
Authors: Di Pasquale Marta Francesca , Sotgiu Giovanni , Gramegna Andrea , Radovanovic Dejan , Terraneo Silvia , Reyes Luis F , Rupp Jan , González del Castillo Juan , Blasi Francesco , Aliberti Stefano , Restrepo Marcos I ,   GLIMP Investigators, Aruj Patricia Karina , Attorri Silvia , Barimboim Enrique , Caeiro Juan Pablo , Garzón María I , Cambursano Victor Hugo , Cazaux A , Ceccato Adrian , Chertcoff Julio , Lascar Florencia , Tulio Fernando Di , Díaz Ariel Cordon , de Vedia Lautaro , Ganaha Maria Cristina , Lambert Sandra , Lopardo Gustavo , Luna Carlos M , Malberti Alessio Gerardo , Morcillo Nora , Tartara Silvina , Cetrangolo Antonio A , Pensotti Claudia , Pereyra Betiana , Scapellato Pablo Gustavo , Stagnaro Juan Pablo , Shah Sonali , Lötsch Felix , Thalhammer Florian , Anseeuw Kurt , Francois Camille A , Van Braeckel Eva , Vincent Jean Louis , Djimon Marcel Zannou , Bashi Jules , Dodo Roger , Nouér Simone Aranha , Chipev Peter , Encheva Milena , Miteva Darina , Petkova Diana , Balkissou Adamou Dodo , Yone Eric Walter Pefura , Ngahane Bertrand Hugo Mbatchou , Shen Ning , Xu Jin-fu , Rico Carlos Andres Bustamante , Buitrago Ricardo , Paternina Fernando Jose Pereira , Ntumba Jean-Marie Kayembe , Carevic Vesna Vladic , Jakopovic Marko , Jankovic Mateja , Matkovic Zinka , Mitrecic Ivan , Jacobsson Marie-Laure Bouchy , Christensen Anette Bro , Bødtger Uffe Christian Heitmann , Meyer Christian Niels , Jensen Andreas Vestergaard , Baunbæk-Knudsen Gertrud , Petersen Pelle Trier , Andersen Stine , El-Wahhab Ibrahim El-Said Abd , Morsy Nesreen Elsayed , Shafiek Hanaa , Sobh Eman , Abdulsemed Kedir Abdella , Bertrand Fabrice , Brun-Buisson Christian , de Montmollin Etienne , Fartoukh Muriel , Messika Jonathan , Tattevin Pierre , Khoury Abdo , Ebruke Bernard , Dreher Michael , Kolditz Martin , Meisinger Matthias , Niederlausitz Klinikum , Pletz Mathias W , Hagel Stefan , Rupp Jan , Schaberg Tom , Spielmanns Marc , Creutz Petra , Suttorp Norton , Siaw-Lartey Beatrice , Dimakou Katerina , Papapetrou Dimosthenis , Tsigou Evdoxia , Ampazis Dimitrios , Kaimakamis Evangelos , Bhatia Mohit , Dhar Raja , D’Souza George , Garg Rajiv , Koul Parvaiz A , Mahesh P A , Jayaraj B S , Narayan Kiran Vishnu , Udnur Hirennappa B , Krishnamurthy Shashi Bhaskara , Kant Surya , Swarnakar Rajesh , Limaye Sneha , Salvi Sundeep , Golshani Keihan , Keatings Vera M , Martin-Loeches Ignacio , Maor Yasmin , Strahilevitz Jacob , Battaglia Salvatore , Carrabba Maria , Ceriana Piero , Confalonieri Marco , Monforte Antonella d’Arminio , Prato Bruno Del , Rosa Marino De , Fantini Riccardo , Fiorentino Giuseppe , Gammino Maria Antonia , Menzella Francesco , Milani Giuseppe , Nava Stefano , Palmiero Gerardo , Petrino Roberta , Gabrielli Barbra , Rossi Paolo , Sorino Claudio , Steinhilber Gundi , Zanforlin Alessandro , Franzetti Fabio , Carugati Manuela , Morosi Manuela , Monge Elisa , Carone Mauro , Patella Vincenzo , Scarlata Simone , Comel Andrea , Kurahashi Kiyoyasu , Bacha Zeina Aoun , Ugalde Daniel Barajas , Zuñiga Omar Ceballos , Villegas José F , Medenica Milic , van de Garde E M W , Mihsra Deebya Raj , Shrestha Poojan , Ridgeon Elliott , Awokola Babatunde Ishola , Nwankwo Ogonna N O , Olufunlola Adefuye Bolanle , Olumide Segaolu , Ukwaja Kingsley N , Irfan Muhammad , Minarowski Lukasz , Szymon Skoczyński , Froes Felipe , Leuschner Pedro , Meireles Mariana , Ferrão Cláudia , Leuschner Pedro , Neves João , Ravara Sofia B , Brocovschii Victoria , Ion Chesov , Rusu Doina , Toma Cristina , Chirita Daniela , Dorobat Carmen Mihaela , Birkun Alexei , Kaluzhenina Anna , Almotairi Abdullah , Bukhary Zakeya Abdulbaqi Ali , Edathodu Jameela , Fathy Amal , Enani Abdullah Mushira Abdulaziz , Mohamed Nazik Eltayeb , Memon Jawed Ulhadi , Bella Abdelhaleem , Bogdanović Nada , Milenkovic Branislava , Pesut Dragica , Borderìas Luis , Garcia Noel Manuel Bordon , Alarcón Hugo Cabello , Cilloniz Catia , Torres Antoni , Diaz-Brito Vicens , Casas Xavier , González Alicia Encabo , Fernández-Almira Maria Luisa , Gallego Miguel , Gaspar-GarcÍa Inmaculada , del Castillo Juan González , Victoria Patricia Javaloyes , Martínez Elena Laserna , de Molina Rosa Malo , Marcos Pedro J , Menéndez Rosario , Pando-Sandoval Ana , Aymerich Cristina Prat , de la Torre Alicia Lacoma , García-Olivé Ignasi , Rello Jordi , Moyano Silvia , Sanz Francisco , Sibila Oriol , Rodrigo-Troyano Ana , Solé-Violán Jordi , Uranga Ane , van Boven Job F M , Torra Ester Vendrell , Pujol Jordi Almirall , Feldman Charles , Yum Ho Kee , Fiogbe Arnauld Attannon , Yangui Ferdaous , Bilaceroglu Semra , Dalar Levent , Yilmaz Ufuk , Bogomolov Artemii , Elahi Naheed , Dhasmana Devesh J , Feneley Andrew , Ions Rhiannon , Skeemer Julie , Woltmann Gerrit , Hancock Carole , Hill Adam T , Rudran Banu , Ruiz-Buitrago Silvia , Campbell Marion , Whitaker Paul , Youzguin Alexander , Singanayagam Anika , Allen Karen S , Brito Veronica , Dietz Jessica , Dysart Claire E , Kellie Susan M , Franco-Sadud Ricardo A , Meier Garnet , Gaga Mina , Holland Thomas L , Bergin Stephen P , Kheir Fayez , Landmeier Mark , Lois Manuel , Nair Girish B , Patel Hemali , Reyes Katherine , Rodriguez-Cintron William , Saito Shigeki , Soni Nilam J , Noda Julio , Hinojosa Cecilia I , Levine Stephanie M , Angel Luis F , Anzueto Antonio , Whitlow K Scott , Hipskind John , Sukhija Kunal , Totten Vicken , Wunderink Richard G , Shah Ray D , Mateyo Kondwelani John , Noriega Lorena , Alvarado Ezequiel , Aman Mohamed , Labra Lucía 
Published: August 2018

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 &lt; .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.