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.
| Originalsprache | Englisch |
|---|---|
| Zeitschrift | Clinical Infectious Diseases |
| Jahrgang | 68 |
| Ausgabenummer | 9 |
| Seiten (von - bis) | 1482-1493 |
| Seitenumfang | 12 |
| ISSN | 1058-4838 |
| DOIs | |
| Publikationsstatus | Veröffentlicht - 24.04.2019 |
Fördermittel
1Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, University of Milan, 2Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 3Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Pulmonary Unit, Ospedale L. Sacco, ASST Fatebenfratelli-Sacco, and 4Respiratory Unit, San Paolo Hospital, Department of Medical Sciences, University of Milan, Italy; 5Microbiology Department, Universidad de La Sabana, Chia, Colombia; 6Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus Lübeck, Germany; 7Emergency Department, Hospital Clínico San Carlos, Universidad Complutense, and 8Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, IdISSC, Madrid, Spain; and 9Division of Pulmonary Diseases and Critical Care Medicine, The University of Texas Health Science Center at San Antonio Acknowledgments. We thank the Asociacion Latinoamericana de Torax, European Respiratory Society, World Federation of Societies of Intensive and Critical Care Medicine, and American College of Chest Physicians for their support of this project. We also thank the following study contributors for their valuable collaboration. Argentina: Patricia Karina Aruj (Department of Internal Medicine, University Hospital Alfredo Lanari, Buenos Aires), Silvia Attorri (Hospital Luis Lago Maggiore, Mendoza), Enrique Barimboim (Hospital Central de Mendoza), Juan Pablo Caeiro and María I. Garzón (Hospital Privado Universitario, Córdoba), Victor Hugo Cambursano, A. Cazaux (Servicio de Neumologia, Hospital Rawson, Córdoba), Adrian Ceccato (Hospital Nacional Prof Alejandro Posadas), Julio Chertcoff, Florencia Lascar, and Fernando Di Tulio (Critical Care Unit and Respiratory Medicine, Buenos Aires British Hospital), Ariel Cordon Díaz (Hospital General Alvear, Ciudad, Mendoza), Medical Center); Gambia: Bernard Ebruke (Medical Research Council Unit, Fajara, Gambia); Germany: Michael Dreher (Department of Cardiology, Pneumology, Vascular Medicine and Intensive Care Medicine, University Hospital Aachen), Martin Kolditz (Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden), Matthias Meisinger, Klinikum Niederlausitz, Klinik für Innere Medizin und Intensivmedizin, Senftenberg), Mathias W. Pletz and Stefan Hagel (Center for Infectious Diseases and Infection Control, Jena University Hospital), Jan Rupp (Department of Infectious Diseases and Microbiology, University of Lübeck), Tom Schaberg (Zentrum für Pneumologie, Agaplesion Diakonieklinikum Rotenburg), Marc Spielmanns (Internal Medicine Department, Pulmonary Rehabilitation and Department of Health, School of Medicine, University Witten-Herdecke, St Remigius Hospital, Leverkusen) Petra Creutz and Norton Suttorp (Department of Infectious Disease and Respiratory Medicine, Charité–University Medicine, Berlin); Ghana: Beatrice Siaw-Lartey (Komfo-Anokye Teaching Hospital, Kumasi); Greece: Katerina Dimakou (5th Respiratory Medicine Department, SOTIRIA Chest Hospital, Athens), Dimosthenis Papapetrou (Medical Group of Athens, Paleo Faliro Clinic, Athens), Evdoxia Tsigou and Dimitrios Ampazis (Agioi Anargiroi Hospital, Kifissia, Athens), Evangelos Kaimakamis (Intensive Care Unit, G. Papanikolaou General Hospital of Thessaloniki); India: Mohit Bhatia (S. S. Hospital IMS BHU Varanasi), Raja Dhar (Fortis Hospitals, Kolkata), George D’Souza (Department of Pulmonary Medicine, St John’s Medical College Hospital, Bangalore), Rajiv Garg (Department of Respiratory Medicine, King George’s Medical University UP, Lucknow), Parvaiz A. Koul (Department of Internal and Pulmonary Medicine, SheriKashmir Institute of Medical Sciences, Srinagar), P. A. Mahesh and B. S. Jayaraj (Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore), Kiran Vishnu Narayan (Pulmonary Medicine, Government Medical College Kozhikode, Kerala), Hirennappa B. Udnur and Shashi Bhaskara Krishnamurthy (Columbia Asia Hospital, Hebbal, Bengaluru, Karnataka), Surya Kant (Department of Respiratory Medicine, King George’s Medical University, Chowk, Lucknow, Uttar Pradesh), Rajesh Swarnakar (Getwell Hospital and Research Institute, Dhantoli, Nagpur), Sneha Limaye and Sundeep Salvi (on behalf of the Respiratory Research Network of India from the Chest Research Foundation in Pune); Iran: Keihan Golshani (Isfahan University of Medical Sciences); Ireland: Vera M. Keatings (Letterkenny General Hospital, County Donegal), Ignacio Martin-Loeches (Multidisciplinary Intensive Care Research Organization, St James’s University Hospital, Trinity Centre for Health Sciences Dublin); Israel: Yasmin Maor (Infectious Disease Unit, affiliated with Tel Aviv University, Wolfson Medical Center, Holon), Jacob Strahilevitz (Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University, Jerusalem); Italy: Salvatore Battaglia, University of Palermo, Pneumologia DiBiMIS, Palermo), Maria Carrabba (Internal Medicine Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milano), Piero Ceriana (Pulmonary Rehabilitation, IRCCS Fondazione Maugeri, Pavia), Marco Confalonieri (Department of Pulmunology, University Hospital, Trieste), Antonella d’Ar-minio Monforte (Department of Health Sciences, Clinic of Infectious Disease, San Paolo Hospital, University of Milan), Bruno Del Prato (Interventional Pneumology, Hospital Antonio Cardarelli, Naples), Marino De Rosa (Unità Operativa Complessa [UOC] Pneumologia PO San Filippo Neri Azienda Sanitaria Locale Roma E Roma), Riccardo Fantini (Respiratory Diseases Clinic, Policlinico di Modena, Modena), Giuseppe Fiorentino (UOC Fisiopatologia e Riabilitazione Respiratoria Azienda Ospedaliera Ospedali dei Colli PO Monaldi), Maria Antonia Gammino (Pulmonary Medicine Unit, San Martino Hospital, Sardegna), Francesco Menzella (Department of Cardiac-Thoracic-Vascular and Intensive Care Medicine, Pneumology Unit, IRCCS–Arcispedale Santa Maria Nuova, Reggio Emilia), Giuseppe Milani (Azienda Ospedaliera Sant Anna di Como, Presidio Ospedale S. Anna Nuovo, Unità Operativa di Pneumologia, Como), Stefano Nava (Alma Mater University of Bologna, DIMES, Respiratory and Critical Care Unit Sant’Orsola Malpighi Hospital), Gerardo Palmiero (Respiratory Unit, Versilia Hospital, Lido di Camaiore, Lucca), Roberta Petrino and Barbra Gabrielli (Emergency Medicine Unit, S. Andrea Hospital, Vercelli), Paolo Rossi (Internal Medicine Department, Azienda Ospedaliero–Universitaria S. Maria della Misericordia, Udine), Claudio Sorino, Pulmonology Unit, A. O. Sant’Anna di Como), Gundi Garcia (Barcelona Policlínic and Moises Broggi Hospital at Sant Joan Despí), Hugo Cabello Alarcón (Sant Hospital Seu de Urgell, Catalonia), Catia Cilloniz and Antoni Torres (Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona), Vicens Diaz-Brito and Xavier Casas (Infectious Diseases Unit and Pneumology Service, Parc Sanitari Sant Joan de Deu, Sant Boi, Barcelona), Alicia Encabo González (Hospital Complex of Pontevedra), Maria Luisa Fernández-Almira (Medicina Interna, Hospital Universitario Central de Asturias), Miguel Gallego (Department of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, and CIBER de Enfermedades Respiratorias, CIBERES, Bunyola), Inmaculada Gaspar-GarcÍa (Department of Respiratory Medicine, Hospital Costa del Sol, Marbella, Málaga), Juan González del Castillo (Emergency Department, Hospital Universitario Clínico San Carlos, Madrid), Patricia Javaloyes Victoria (Hospital General Universitario de Alicante, Alicante), Elena Laserna Martínez (Hospital Mollet, Barcelona), Rosa Malo de Molina (University Hospital Puerta de Hierro Majadahonda, Madrid), Pedro J. Marcos (Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña, INIBIC, Sergas, Universidade de A Coruña), Rosario Menéndez (Pneumology Service, University and Polytechnic Hospital La Fe, Valencia), Ana Pando-Sandoval (Hospital Universitario Central de Asturias, Area de Gestion Clinica de Pulmon, Servicio de Neumologia, Oviedo), Cristina Prat Aymerich, Alicia Lacoma de la Torre, and Ignasi García-Olivé (Microbiology Department and Pneumology Department, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol, Badalona, and Universitat Autònoma de Barcelona, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III), Jordi Rello and Silvia Moyano (Critical Care Department, Hospital Vall d’Hebron, Barcelona), Francisco Sanz (Servicio de Neumología, Consorci Hospital General Universitari de Valencia, Valencia), Oriol Sibila and Ana Rodrigo-Troyano (Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona), Jordi Solé-Violán (Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria), Ane Uranga (Pulmology Department, Hospital of Galdakao-Usansolo), Job F. M. van Boven (Hospital Universitari Son Espases, Palma de Mallorca), Ester Vendrell Torra and Jordi Almirall Pujol (Intensive Care Medicine, Hospital de Mataró); South Africa: Charles Feldman (Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand); South Korea: Ho Kee Yum (Inje University Seoul Paik Hospital); Togo: Arnauld Attannon Fiogbe (Pulmonology and Infectious Diseases Service/University Hospital of Sylvanus Olympio, Lomé); Tunisia: Ferdaous Yangui (Department of Pneumology, Hospital of Internal Forces Security, Marsa, Tunis); Turkey: Semra Bilaceroglu (Izmir Dr Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, Izmir), Levent Dalar (Pulmonary Medicine, Istanbul Bilim University, Istanbul), Ufuk Yilmaz (Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir); Ukraine: Artemii Bogomolov (Vinnitsa National Pirogov Memorial Medical University, Vinnitsa Regional Antituberculosis Hospital, Vinnitsa); United Arab Emirates: Naheed Elahi (Dubai Hospital); United Kingdom: Devesh J. Dhasmana (Victoria Hospital, Kirkcaldy, NHS Fife), Andrew Feneley, Rhiannon Ions, Julie Skeemer, and Gerrit Woltmann, University Hospitals of Leicester NHS Trust and University of Leicester), Carole Hancock (Royal Respiratory Research Team, Royal Liverpool University Hospital, Liverpool), Adam T. Hill (Royal Infirmary and University of Edinburgh), Banu Rudran (The Royal London Hospital, Barts Health Trust, London), Silvia Ruiz-Buitrago and Marion Campbell (Hairmyres Hospital, East Kilbride), Paul Whitaker (Department of Respiratory Medicine, St James’s Hospital, Leeds), Alexander Youzguin (Southport and Ormskirk Hospitals NHS Trust), Anika Singanayagam (Imperial College Healthcare NHS Trust, London); United States: Karen S. Allen (University of Oklahoma Health Sciences Center, Oklahoma City), Veronica Brito (Texas A&M Health Science Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple); Jessica Dietz (Fargo VA Health Care System, Fargo, North Dakota), Claire E. Dysart and Susan M. Kellie (Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin; Division of Infectious Diseases, University of New Mexico School of Medicine; and Raymond G. Murphy VA Medical Center, Albuquerque, New Mexico), Ricardo A Franco-Sadud and Garnet Meier (Division of Hospital Medicine, Cook County Hospital, Chicago, Illinois), Mina Gaga (7th Respiratory Medical Department and Asthma Center, Athens Chest Hospital), Thomas L. Holland and Stephen P. Bergin (Department of Medicine, Duke University Medical Center and School of Medicine, Duke Clinical Research Institute, Durham), Fayez Kheir (Department of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana), Mark Landmeier (Division of Pulmonary and Critical Care Medicine, Northwestern Memorial Hospital, Chicago, Illinois), Manuel Lois (John Peter Smith Hospital, Fort Worth, Texas), Girish B. Nair (Interstitial Lung Disease Program and Pulmonary Rehabilitation, SUNY Stony Brook, and Winthrop University Hospital, Mineola, New York), Hemali Patel (Department of Medicine, Division of General Internal Medicine, Hospital Medicine Group, University of Colorado, Denver), Katherine Reyes (Henry Ford Hospital, Detroit, Illinois), William Rodriguez-Cintron, (Pulmonary/Critical Care Medicine VA Caribbean Healthcare System, San Juan Puerto Rico), Shigeki Saito (Tulane University, New Orleans), Nilam J. Soni, Julio Noda, Cecilia I. Hinojosa, Stephanie M. Levine, Luis F. Angel, and Antonio Anzueto (Divisions of Hospital Medicine and Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center San Antonio, San Antonio), K. Scott Whitlow, John Hipskind, Kunal Sukhija, and Vicken Totten (Kaweah Delta Health Care District, Department of Emergency Medicine, Visalia, California), Richard G. Wunderink and Ray D. Shah (Northwestern University Feinberg School of Medicine, Chicago, Illinois); Zambia: Kondwelani John Mateyo (Department of Internal Medicine, University Teaching Hospital, Lusaka). Other investigators: Lorena Noriega, Ezequiel Alvarado, Mohamed Aman, and Lucía Labra. Disclaimer. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the Department of Veterans Affairs. Financial support. This project was not funded and relied solely on voluntary site and investigator participation. M. I. R.’s time is partially protected by the National Heart, Lung, and Blood Institute (award K23HL096054).
UN SDGs
Dieser Output leistet einen Beitrag zu folgendem(n) Ziel(en) für nachhaltige Entwicklung
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SDG 3 – Gesundheit und Wohlergehen
Strategische Forschungsbereiche und Zentren
- Forschungsschwerpunkt: Infektion und Entzündung - Zentrum für Infektions- und Entzündungsforschung Lübeck (ZIEL)
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