scholarly journals Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

2018 ◽  
Vol 68 (9) ◽  
pp. 1482-1493 ◽  
Author(s):  
Marta Francesca Di Pasquale ◽  
Giovanni Sotgiu ◽  
Andrea Gramegna ◽  
Dejan Radovanovic ◽  
Silvia Terraneo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Viral Infections ◽  
Fungal Infections ◽  
Secondary Analysis ◽  
Community Acquired Pneumonia ◽  
Empiric Antibiotic Therapy ◽  
Immunocompromised Patients ◽  
Steroid Use ◽  
Hematological Cancer ◽  
International Multicenter Study

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.

scholarly journals A Study on Prevalence and Characterization of Candida Species in Immunocompromised Patients

2021 ◽  
Author(s):  
Dhanapal Nandini ◽  
J. Manonmoney ◽  
J. Lavanya ◽  
K.V. Leela ◽  
Sujith
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Predisposing Factors ◽  
Immunocompromised Patients ◽  
Candida Spp ◽  
Gram Staining ◽  
Number Of Patients ◽  
Candida Infections ◽  
Associated Risk Factors

Candida spp. is one among the major causes of nosocomial infection, with candidemia gaining increasing prevalence worldwide in parallel with mortality rates ranging from 10-49%. Epidemiology and predisposing factors of candidemia have changed since the number of patients receiving transplants and immunosuppressive therapy, the use of broadspectrum antimicrobials, and the number of AIDS patients have increased. Candidemia is more common among patients with subcutaneous and cutaneous candida infections, through percutaneous inoculation. Major predisposing factors for invasive candidiasis includes neutropenia, haematological malignancies, bone marrow transplantation, total parenteral nutrition, chemotherapy, invasive procedures, and immune-suppressive agents. This study analyses the risk factors of immunocompromised patients with candidemia and antibiogram of Candida spp. isolated from ICU patients. To evaluate the prevalence, distribution and antibiogram of Candida spp., associated risk factors, and outcome in candidemia patients. Blood samples received from patients with clinically suspected fungal infections were subjected to gram staining, culture, sugar assimilation & fermentation, Candida Chrome agar (CCA) & Corn meal agar for identification and speciation. Antifungal susceptibility tests were performed by disk-diffusion tests. Among a total of 337 samples received, 22 (6.5%) samples were positive for candida infections, of which Candida tropicalis 9 (41%) was the predominant isolate followed by C. albicans 5 (23%), Candida glabrata 4 (18%), Candida parapsilosis 2 (9%) and Candida krusei 2 (9%). Male patients had a higher prevalence of candidemia 15 (68.2%). Among the age group of 51-70 years, uncontrolled DM(Diabetes mellitus) and CKD (chronic kidney disease) were found to be the predominant co-morbidities with candidemia.

Invasive Fungal Infections in Reduced Intensity Cord Blood Transplantation (RICBT).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3226-3226
Author(s):  
Shigesaburo Miyakoshi ◽  
Koichiro Yuji ◽  
Eiji Kusumi ◽  
Daisuke Kato ◽  
Shinsuke Takagi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cord Blood ◽  
Acute Gvhd ◽  
Fungal Infections ◽  
Cord Blood Transplantation ◽  
Invasive Fungal Infections ◽  
Steroid Use ◽  
Blood Transplantation ◽  
Reduced Intensity

Abstract <Background> Invasive fungal infection is one of the most fatal complications after stem cell transplantation (SCT). EBMT group reported the risk factors of invasive fungal infections were delayed neutrophile engraftment and steroid use for acute graft versus host disease (GVHD) in cord blood transplantation with myeloablative regimens. However it has not been clear about invasive fungal infections after RICBT. <Objective> The 1st purpose of this report was to investigate the incidence and pathogens of invasive fungal infections and the 2nd was to identify the risk factors for fungal infections after RICBT. <Patients and Methods> We reviewed medical records of 103 patients with hematological diseases who had received RICBT between March 2002 and May 2005 at Toranomon Hospital, Tokyo, Japan. Median age was 57 years (17–79). Primary diseases were advanced (n=81) or standard (n=22). Median follow-up was 14 months (0.5–27). Conditioning regimen was fludarabine 125 mg/m2, melphalan 80 mg/m2 and TBI 4 Gy. GVHD prophylaxis was cyclosporine (n=67) or tacrolimus (n=43). Median total nucleated cells (TNC): 2.8 x 10^7 cells (1.7–5.2); Median CD34+: 0.78 x 10^5 cells (0.01–3.28); HLA match: 6/6 (n=2), 5/6 (n=16), 4/6 (n=88), 3/6 (n=1). Fluconazole 200mg/day was used as prophylaxis of fungal infections. Diagnosis of invasive fungal infection was made with the following EORTC/MSG criteria. The following factors were considered potential predictors of outcomes about 2nd purpose: patient’s age, infused TNC dose, disease status at transplantation, speed of netrophile engraftment, pre-engraftment reactions (PER) which we reported (Clin Cancer Res.10:3586–92, 2004), and acute GVHD. <Results> Neutrophile (>500/μL) and platelet recovery (>20,000/μL) were observed in 83% at day 60 (median; 22 day), 55% at day 100 (43day), respectively. Cumulative incidence of acute GVHD (II-IV) was 33%. OS were 39% (95% CI: 29–50) in all cases, 67% (95% CI: 47–87) in standard, and 32% (95% CI: 20–43) in advanced (p<0.05), respectively. Incidence of invasive fungal infections was 12% (95% CI: 6–20) and median onset day was 23 days (1–84) after RICBT. Pathogens of invasive fungal infections comprised 9 cases of probable invasive pulmonary aspergillosis, and one case each of Candida pneumonia and Trichosporon sepsis. Incidence of invasive fungal infections in patients with PER+/steroids + (n=22) was 28% (95% CI: 9–43), in patients without PER (n=80) was 7% (95% CI: 1–14). In multivariate analysis, the most important risk factor of invasive fungal infections was steroid use for PER (p<0.05), while other factors did not influence. <Discussion/Conclusion> In our experience with reduced intensity cord blood transplantation, the only risk factor for invasive fungal infections was steroid use for PER within 30 days. Invasive fungal infections, especially invasive aspergillosis, remain an important complication after allogeneic stem cell transplantation, regardless of the type of conditioning regimens and the sources of stem cells. Figure Figure

ARMS as a Genotyping PCR, a New Technique for Detection of Liver Transplantation Recipients’ C3FF, C3FS, C3SS Allotypes as Predisposing Factor For Post-Transplantation Infections

2021 ◽  
Vol 30 (1) ◽  
pp. 183-190
Author(s):  
Samah M. Awad ◽  
Sanaa S. Hamam
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Viral Infections ◽  
Fungal Infections ◽  
Microbial Colonization ◽  
Amplification Refractory Mutation System ◽  
Sample Collection ◽  
Post Transplantation ◽  
Predisposing Factor ◽  
Microbiological Methods

Background: Complement is a crucial branch of both non-specific and specific immune system. C3 is the third complement component which plays a protective role in viral infections. There are two co-dominant inherited variants or allotypes for C3: C3 fast (C3F) and C3 slow (C3S). C3F variant has been linked to multiple diseases production including infections among liver transplantation recipients. Objectives: To investigate the most common risk factors for post-liver transplantation infections especially preoperative colonization. To identify types and rates of post-liver transplantation infections and their causing organisms. To identify C3 allotypes for both liver transplantation donors and recipients, and to correlate recipients’ allotypes with post-transplantation infections. Methodology: This study is a prospective study; it was conducted from January 2017 to August 2019 on 64 chronic cirrhotic patients, experienced liver transplantation in the National Liver Institute ICU, Menoufia, Egypt, and their donors. Blood cultures and other samples were collected according to site of infection using standard Microbiological sample collection methods and bacterial isolated were identified by standard microbiological methods using VITEK2 Compact automated ID/AST instrument. CMV IgG and IgM were detected by ELISA method. DNA was extracted and the extract was used for detection of C3S and C3F alleles by using Amplification Refractory Mutation System (ARMS). Results: The most common cause for liver transplantation was HCV related liver cirrhosis (26.56%). Risk factors for postliver transplantation were Pre-operative microbial colonization (100%) and long operative time (9.875±2.45 h). 39.8% of post-transplantation infections occurred during second week post-operatively and the commonest infections were drain infections (29.5%) and urinary tract infection (27.3%). 51.7% of liver transplantation recipients were C3FF, 32.8% were C3FS and 15.6% were C3SS. C3FF recipients showed increased relative risk to develop CMV (5.2) and bacterial & fungal infections (2.2) than other recipients’ allotypes. Conclusion: A comprehensive infectious diseases workup including detection of C3 allotype of the candidate for liver transplantation should be done pre-operatively to early detect and treat infections which can improve the outcome of the operation dramatically and improve patients’ life style. More studies should be done to find out if there is relation between donors’ and recipients’ C3 allotypes as currently no clear data still present.

Pulmonary fungal infections in immunocompromised patients: incidence and risk factors

Mycoses ◽  
1994 ◽  
Vol 37 (9-10) ◽  
pp. 329-335 ◽  
Author(s):  
M. von Eiff ◽  
N. Roos ◽  
W. Fegeler ◽  
C. von Eiff ◽  
M. Zühlsdorf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Immunocompromised Patients ◽  
Pulmonary Fungal Infections

scholarly journals Clinical Progress Note: Procalcitonin in the Diagnosis and Management of Community-Acquired Pneumonia in Hospitalized Adults

2019 ◽  
Vol 14 (11) ◽  
pp. 691-693 ◽  
Author(s):  
Justin J Choi ◽  
Matthew W McCarthy ◽  
Matthew S Simon ◽  
Arthur T Evans ◽  
Wesley H Self ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Viral Infections ◽  
Secondary Analysis ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Antibiotic Overuse ◽  
Diagnosis And Management ◽  
The Us

Community-acquired pneumonia (CAP) accounts for more than 1.5 million adult hospitalizations and 100,000 deaths each year in the United States.1 Antibiotic overuse in the hospital setting is an important contributor to the rise of antibiotic resistance, prompting increased efforts to limit inappropriate antibiotic use in hospitals.2 Procalcitonin, a precursor of the hormone calcitonin, is upregulated in bacterial infections and downregulated in viral infections. The US Food and Drug Administration has approved it as a serum biomarker to assist clinicians with decisions about using antibiotics.3 There is no consensus on how to best use procalcitonin in the management of CAP. We provide a practical update that includes a review of recent literature, added secondary analysis, and expert opinion surrounding the use of procalcitonin in the diagnosis and management of CAP in hospitalized adults.

Incidence and Risk Factors of Early Severe Infections after Unrelated Cord Blood Transplantation. an Eurocord-Netcord Analysis.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2144-2144
Author(s):  
Vanderson Rocha ◽  
Sylvie Chevret ◽  
Irina Ionescu ◽  
Federico Garnier ◽  
Eliane Gluckman
Keyword(s):  
Risk Factors ◽  
Cord Blood ◽  
Bacterial Infections ◽  
Acute Gvhd ◽  
Viral Infections ◽  
Fungal Infections ◽  
Cumulative Hazard ◽  
Neutrophil Recovery ◽  
Severe Infections ◽  
Unrelated Cord Blood

Abstract Delayed neutrophil recovery and higher incidence of infections episodes have been observed after unrelated cord blood transplant (UCBT). However, no data is available on the incidence, type and risk factors for severe infections after UCBT. We have analyzed retrospectively 510 UCBT performed from 1994 to 2002 in 55 Eurocord centers. The median age was 6.9 years, the median follow-up for survivors was 36.6 months (3–100); 396 (77%) patients had hematological malignancies, 65 (13%) inborn errors and 49 (10%) bone marrow failure. Conditioning was TBI based in 50% and associated to ATG/ALG in 86%. CsA and corticoides for GVHD prophylaxis was frequently used (77%) and 269 patients (53%) received hematopoietic growth factor. The donor was more frequently 5/6 (n=216, 43%) or 4/6 (n=204, 41%) HLA disparate. The median number of nucleated cells and CD34+ cells infused was 3.8x10e7/kg and 1.6 x10e5/kg, respectively. 95% of the patients were transplanted in a LAF room. Prophylaxis of infections varied among centers. Incidence of first infections were analysed using competing risk analysis; risk factors were studied using cumulative hazard analysis of all infectious episodes occuring during 100 days after UCBT. Results: Cumulative Incidence (CI) of neutrophil recovery, acute GVHD (II–IV), and 100 days mortality were 75%, 38% and 32% respectively. CI at day 100 of first overall, bacterial, viral and fungal infections were respectively 69%, 49%, 32% and 10%. During the first 100 days, 686 severe infections episodes were diagnosed in 352 patients. A total of 404 episodes were from bacteria origin: 276 gram +; 124 gram- and 4 others, 189 severe viral infections or diseases episodes (142 CMV, 21 adenovirus, 12 EBV and 12 Herpes simplex or HHV6 and 2 para-myxo-virus, 54 episodes of severe fungal infections (26 candidemia, 20 aspegillus and 8 other), 5 episodes were of toxoplasmosis and 34 episodes were not classified. In a multivariate analysis the following factors decreased the cumulative hazard of 1) bacterial infections: shorter time to engraftment (HR: 0.22, p<0.0001); 2) viral infections: negative CMV serology (HR: 0.28, p<0.001); less than 3 out of 6 HLA disparate (HR: 0.21, p=0.03) and shorter time to engraftment (HR: 0.40, p=0.002); and finaly for 3) fungal infections: recipient’s age <16 years (HR: 0.10, p=0.004), malignant disease (HR:0.13, p=0.03), shorter time to engraftment (HR:0.17, p=0.02); and absence of acute GVHD III-IV (HR 0.24, p=0.03). Considering all types of infections, among the factors cited above, period of UCBT performed (after 1998) was also associated with a decreased hazard of severe infections at day 100. In conclusion, in this retrospective analysis, bacterial infections appeared early, followed by viral and fungal infections during the first 100 days after UCBT. Delayed engraftment was frequently associated with increased risk of all types of infections. Aproaches that will improve time to engraftment after UCBT might decrease the incidence and severity of early infections after UCBT.

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