Clinical Outcomes of Immunocompromised Adults Hospitalized with Pneumococcal Pneumonia: A Case-Control Study.

Julio Ramirez,Thomas Chandler,Jose Bordon,Stephen Furmanek,Forest Arnold

doi:10.3390/microorganisms9081746

Abstract

S. pneumoniae is a primary etiologic agent of CAP in immunocompromised adults (ICA). Data on clinical outcomes of ICA hospitalized with pneumococcal pneumonia (PP) is limited. The objectives of this study were (1) to define clinical presentation and outcomes of ICA hospitalized with PP and (2) to compare the data to non-immunocompromised adults (non-ICA) hospitalized with PP. This was a case–control study of ICA hospitalized with PP (cases) and non-ICA hospitalized with PP (controls). Data were collected on clinical presentation, treatment, and outcomes. Evaluated clinical outcomes included time to clinical stability (TCS), length of hospitalization (LOH), clinical failure (CF), cardiovascular events (CE), and in-hospital mortality (IHM). One ICA was matched to two non-ICA through propensity score matching. A total of 93 ICA hospitalized with PP and 186 non-ICA hospitalized with PP were evaluated. Antibiotic therapy was appropriate in all patients. Clinical outcomes for ICA versus non-ICA were as follows: TCS 2 days vs. 2 days (p = 0.392); LOH 5 days vs. 5 days (p = 0.067); CF 4% vs. 6% (p = 0.618); CE 10% vs. 6% (p = 0.375); and IHM 5% vs. 3% (p = 0.296). In hospitalized patients with PP who are treated with appropriate antibiotic therapy, the presence of an abnormal immune system does influence clinical outcomes.

Highlights

Immunocompromised patients are at high risk for development of community-acquired pneumonia (CAP)
It is accepted that immunocompromised patients are at high risk for development of Streptococcus pneumoniae CAP, but data on the clinical outcomes of these patients once they acquired pneumococcal pneumonia is limited [2,3]
A total of 93 immunocompromised adults hospitalized with pneumococcal pneumonia were included in analysis and matched with 186 non-immunocompromised adult controls

Summary

Introduction

Immunocompromised patients are at high risk for development of community-acquired pneumonia (CAP). In this population, CAP may be due to opportunistic pathogens (e.g., Pneumocystis jirovecii), as well as the traditional typical and atypical pathogens causing. It is accepted that immunocompromised patients are at high risk for development of Streptococcus pneumoniae CAP, but data on the clinical outcomes of these patients once they acquired pneumococcal pneumonia is limited [2,3]. It can be speculated that in immunocompromised patients with pneumococcal pneumonia, the presence of a compromised immune system may negatively impact clinical outcomes. Once patients are on appropriate antibiotic therapy, a compromised immune system may not play a significant role in the patient’s recovery and may not impact clinical outcomes

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