| Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome. | |
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MedLine Citation:
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PMID: 22390624 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Clin Microbiol Infect ABSTRACT: The number of elderly patients in the community with immunosuppressive conditions has increased progressively over recent decades. We sought to determine the incidence, causative organisms and outcome of community-acquired pneumonia (CAP) occurring in immunocompromised older patients. We prospectively compared cases of CAP in immunocompromised and non-immunocompromised patients admitted to five public hospitals in three Spanish regions. Of 320 cases studied, 115 (36%) occurred in immunocompromised patients, including: solid or hematological malignancy (97), corticosteroids or other immunosuppressive drugs (44), solid organ or stem cell transplant (five), and other conditions (eight). The etiology was established in 44% of immunocompromised patients vs. 32% of non-immunocompromised patients (p 0.03). Streptococcus pneumoniae was the most common causative organism in both groups (29% vs. 21%; p 0.08), followed by Legionella pneumophila (3% vs. 6%; p 0.01). Gram-negative bacilli were more frequent among immunocompromised patients (5% vs. 0.5%; p <0.01), particularly Pseudomonas aeruginosa (3% vs. 0%; p 0.04). Nocardiosis was only observed in immunocompromised patients (two cases). Bacteremia occurred similarly in the two groups. No significant differences were found with respect to ICU admission (8%, in both groups) or the length of stay (12.5 vs. 10.4 days). The early (<48 h) (3.5 vs. 0.5%; p 0.04) and overall case-fatality rates (12% vs. 3%; p <0.01) were higher in immunocompromised patients. In conclusion, a substantial number of older patients hospitalized for CAP are immunocompromised. Although relatively uncommon, CAP due to gram-negative bacilli, including P. aeruginosa, is more frequent among these patients. CAP occurring in immunocompromised patients causes significant morbidity and mortality. |
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Authors:
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D Sousa; I Justo; A Domínguez; A Manzur; C Izquierdo; L Ruiz; M Nebot; J-M Bayas; J-M Celorrio; W Varona; P Llinares; E Miguez; E Sánchez; J Carratalá |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-10 |
Journal Detail:
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Title: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Volume: - ISSN: 1469-0691 ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-3-6 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9516420 Medline TA: Clin Microbiol Infect Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases. |
Affiliation:
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Department of Infectious Diseases. Complejo Hospitalario Universitario A Coruña, A Coruña Department of Public Health, University of Barcelona, Barcelona CIBER Epidemiología y Salud Pública (CIBERERSP) Department of Infectious Diseases. Hospital Universitario de Bellvitge, Barcelona Department of Health, Generalitat of Catalonia, Barcelona Public Health Agency of Barcelona, Barcelona Department of Preventive Medicine and Epidemiology, Hospital Clinic, Barcelona Department of Preventive Medicine, Hospital Ernest Lluch, Calatayud Department of Preventive Medicine, Hospital Royo Villanova, Zaragoza, Spain. |
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