Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis.

Objectives: (1) to identify the opportunistic fungi from sputum and bronchial wash of patients with lower respiratory tract (LRT) infections in immunocompromised (IC) and immunocompetent (IP) patients, and apparently healthy controls, (2) to detect antibodies against Aspergillus species by double immunodiffusion test (ID). Subjects and methods: Three hundred patients suffering from LRT infections of both IC (150/300) and IP (150/300) patients were included in the study. The clinical specimens collected were samples of sputum (247), bronchial wash (80), and blood (300). The control group was 50 apparently healthy individuals, from whom sputum and blood were obtained. The identification of the isolated fungi was carried out by direct fluorescent and/or light microscopy, culture on different media, and biochemical tests. Moreover, the serums of patients with Aspergillus isolates were tested by double ID test for the detection of specific antibody. Results: One hundred eighty patients showed fungal elements in their clinical specimens (60%). Two hundred four funguses were detected, including 24 samples with 2 types of isolates. The identified fungi were encountered from both IC (60.9%) and IP (39.1%) patients with a significant difference between them (p< 0.001). Nine opportunistic genus-species were identified. Five were filamentous type namely Aspergillus spp., Penicillium spp., Cladosporium spp., Fusarium spp., and Geotrichum spp., while the other 4 were unicellular organisms including Candida spp., Saccharomyces cereviciae, Cryptococcus neoformans, and Rhodotorula rubra. In the control group, 36% showed fungal isolates in their sputa, and the ID test showed a positive result for antibody in only one patient with Aspergillus isolate. Conclusions: Many opportunistic fungi are important uncommon pathogens in LRT infections in IC patients. The ID test is of limited value for the detection of specific antibody of Aspergillus spp. Keywords: Opportunistic fungi, fungi in L.R.T.

With advancements in medical technology and the growth of an aging society, the number of immunocompromised patients has increased progressively. Klebsiella pneumoniae (K. pneumoniae) is one of the most common opportunistic pathogens, causing a severe disease burden. We aimed to further clarify the differences in respiratory tract K. pneumoniae infections between immunocompromised and immunocompetent populations. We retrospectively compared cases of respiratory tract K. pneumoniae infection in immunocompromised and immunocompetent patients admitted to Ruijin Hospital in Shanghai between January 2019 and August 2020 to clarify the differences between the two groups. We enrolled 400 immunocompromised patients and 386 immunocompetent patients. Compared to the immunocompetent group, immunocompromised patients were more likely to develop bacteremia and shock and to require mechanical ventilation support during hospitalization. Immunocompromised patients also had a greater probability of polymicrobial infection and a higher rate of antibacterial resistance to carbapenem, which resulted in a higher intensive care unit admission rate, 30-day case fatality rate (CFR), and 6-month CFR. Multivariate analysis indicated that immunocompromised patients with respiratory diseases (odds ratio [OR], 2.189; 95% confidence interval [CI], 1.103-4.344; P = 0.025) and cardiovascular diseases (OR, 2.008; 95% CI, 1.055-3.822; P = 0.034), using mechanical ventilation (OR, 3.982; 95% CI, 2.053-7.722; P = 0.000), or infected with multidrug-resistant K. pneumoniae (OR, 3.870; 95%, 1.577-9.498; P = 0.003) were more likely to have a higher 30-day CFR. The disease burden of K. pneumoniae infection in immunocompromised patients is high. Immunocompromised patients who presented with respiratory diseases and cardiovascular diseases, used mechanical ventilation, or were infected with multidrug-resistant K. pneumoniae experienced a higher 30-day mortality rate.

BackgroundConcerning viral pneumonia, few large-scale comparative studies have been published describing non-HIV immunocompromised and immunocompetent patients, but the epidemiological characteristics of different viruses or underlying diseases in immunocompromised hosts are lacking.MethodsWe retrospectively recruited patients hospitalised with viral pneumonia from six academic hospitals in China between August 2016 and December 2019. We measured the prevalence of comorbidities, coinfections, nosocomial infections, and in-hospital mortalities.ResultsOf the 806 patients, 370 were immunocompromised and 436 were immunocompetent. The disease severity and in-hospital mortality of immunocompromised patients were higher than those of immunocompetent patients. During the influenza season, an increased number of cases of influenza virus (IFV) infection were found in the immunocompromised group, followed by cases of cytomegalovirus (CMV) and respiratory syncytial virus (RSV) infection. During the non-influenza season, CMV was the main virus detected in the immunocompromised group, while RSV, adenovirus (AdV), parainfluenza virus (PIV), and rhinovirus (HRV) were the main viruses detected in the immunocompetent group. Pneumonia caused by Pneumocystis jirovecii (22.4%), Aspergillus spp. (14.1%), and bacteria (13.8%) were the most frequently observed coinfections in immunocompromised patients but not in immunocompetent patients (Aspergillus spp. [10.8%], bacteria [7.1%], and Mycoplasma spp. [5.3%]). CMV infection and infection with two-or-more viruses were associated with a higher in-hospital mortality rate than non-IFV infection. However, patients with IFV and non-IFV infection in immunocompromised patients had similar disease severity and prognosis.ConclusionsImmunocompromised patients have a high frequency of coinfections, and a higher mortality rate was observed among those infected with CMV and two-or-more viruses. In addition, patients with IFV and non-IFV infection in immunocompromised patients had similar same disease severity and prognosis. The type of viral infection varied with seasons.

Metagenomic next-generation sequencing (mNGS) technology has been widely used to diagnose various infections. Based on the most common pathogen profiles, targeted mNGS (tNGS) using multiplex PCR has been developed to detect pathogens with predesigned primers in the panel, significantly improving sensitivity and reducing economic burden on patients. However, there are few studies on summarizing pathogen profiles of pulmonary infections in immunocompetent and immunocompromised patients in Jilin Province of China on large scale. From January 2021 to December 2023, bronchoalveolar lavage fluid (BALF) or sputum samples from 546 immunocompetent and immunocompromised patients with suspected community-acquired pneumonia were collected. Pathogen profiles in those patients on whom mNGS was performed were summarized. Additionally, we also evaluated the performance of tNGS in diagnosing pulmonary infections. Combined with results of mNGS and culture, we found that the most common bacterial pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii in both immunocompromised and immunocompetent patients with high detection rates of Staphylococcus aureus and Enterococcus faecium, respectively. For fungal pathogens, Pneumocystis jirovecii was commonly detected in patients, while fungal infections in immunocompetent patients were mainly caused by Candida albicans. Most of viral infections in patients were caused by Human betaherpesvirus 5 and Human gammaherpesvirus 4. It is worth noting that, compared with immunocompetent patients (34.9%, 76/218), more mixed infections were found in immunocompromised patients (37.8%, 14/37). Additionally, taking final comprehensive clinical diagnoses as reference standard, total coincidence rate of BALF tNGS (81.4%, 48/59) was much higher than that of BALF mNGS (40.0%, 112/280). Our findings supplemented and classified the pathogen profiles of pulmonary infections in immunocompetent and immunocompromised patients in Jilin Province of China. Most importantly, our findings can accelerate the development and design of tNGS specifically used for regional pulmonary infections.

Computed tomography (CT) findings in patients with pulmonary cryptococcosis have been reported, however, many reports were limited by the small number of patients, and not taken into account the distinction between immunocompetent and immunocompromised patients. To retrospectively evaluate thoracic CT findings in patients with pulmonary cryptococcosis whose immune status ranged from normal to severely compromised, and determine characteristic imaging features of pulmonary cryptococcosis between patients with different immune status. CT scan findings of 29 immunocompetent and 43 immunocompromised patients with clinically proven pulmonary cryptococcosis were reviewed retrospectively. Different patterns of CT scan abnormalities between immunocompromised and immunocompetent patients, AIDS and non-AIDS immunocompromised patients were compared by Fisher's exact test. Pulmonary nodules/masses, either solitary or multiple, were the most common CT finding, present in 65 (90.3%) of the 72 patients; associated findings included CT halo sign (n = 24), cavitation (n = 23), and air bronchogram (n = 17). Areas of consolidation (n = 14), areas of GGO (n = 13), linear opacities (n = 11), lymphadenopathy (n = 5), and pleural effusion (n = 8) were uncommon. The parenchymal abnormalities were peripherally located in 47 (65.2%) of the cases. Cavitations within nodules/masses were more frequently present in immunocompromised patients than in immunocompetent patients (P = 0.009), and in AIDS patients than in non-AIDS immunocompromised patients (P = 0.002). Air bronchograms within nodules/masses were more frequent present in immunocompetent patients than in immunocompromised patients (P = 0.005). Nodules/masses with halo sign were less frequent in AIDS patients than those in non-AIDS immunocompromised patients (P = 0.027). Pulmonary cryptococcosis should be considered in the differential diagnosis of solitary or multiple pulmonary nodules. Cavitations within nodules/masses were more commonly seen in immunocompromised patients, especially AIDS patients, while air bronchograms were more commonly seen in immunocompetent patients.

The aim of our study was to investigate the epidemiology and risk factors of Klebsiella pneumoniae (KP) infection in immunocompromised patients and to compare the differences in prognosis among patients with different immune states in the extended-spectrum beta-lactamase KP (ESBL-KP), the carbapenem-resistant KP (CRKP), and the non-multidrug-resistant KP (non-MDR-KP) groups. We conducted a retrospective study in immunocompromised and immunocompetent patients with KP infections who were admitted to Chaohu Hospital of Anhui Medical University from January 2023 to December 2023. We compared demographics, clinical characteristics, treatments, and outcomes across these groups and examined the impact of ESBL-KP, CRKP and non-MDR-KP on cumulative survival rates in populations with different immune states by plotting Kaplan-Meier curves. Our study included 228 immunocompromised patients and 200 immunocompetent patients. Compared to the immunocompetent group, immunocompromised patients were more likely to have a history of surgery and to use hormone frequently. They tended to rely more on medical devices, including urinary catheters, nasogastric catheters, arterial catheters, venous catheters, mechanical ventilation and endoscopy. Immunocompromised patients had a poorer recovery and were rehospitalized more often than those in immunocompetent patients. In the multivariable analysis, age-adjusted Charlson comorbidity index (aCCI) (OR: 1.292, 95%CI: 1.086-1.537, P < 0.004) and microbiological clearance failure (OR: 4.175, 95%CI: 1.966-8.866, P < 0.001) were the most important risk factors for mortality in immunocompromised patients infected with KP. It was further observed that immunocompromised patients in the ESBL-KP group had the lowest cumulative survival. In contrast, among both all participants and immunocompetent patients, the CRKP group had the lowest cumulative survival, followed by the ESBL-KP group. The clinical characteristics, treatment process and prognosis in immunocompromised patients with KP infections are significantly different from those in immunocompetent patients. In clinical settings, the standardization of invasive procedures and the rational use of antibiotics represent the most effective strategies for preventing and treating KP infection.

Human Parvovirus B19

To describe CT findings of non-tuberculous mycobacteria (NTM) pulmonary infection in non-AIDS immunocompromised patients (ICPs) and to compare these findings with those in immunocompetent patients. From July 2000 to August 2007, 369 patients (mean age 58.3 years; 169 males and 200 females) with pulmonary NTM infection were retrospectively reviewed. Of these 369 patients, 24 ICPs (mean age 64.8 years; 15 males and 9 females) were identified. 16 patients had diabetes mellitus, and 6 patients had received long-term steroid therapy. One had received solid organ transplantation and one had received high-dose chemotherapy for haematological disease. 24 age- and sex-matched immunocompetent patients (mean age 64.6 years; 15 males and 9 females) were selected as the control group from the same registry. CT images were reviewed in consensus by three chest radiologists, who were blinded to immune status. Each lung lobe was evaluated in terms of extent of the lesion, bronchiectasis, parenchymal opacity and the presence of ancillary findings. results: A total of 287 lobes were evaluated in ICPs and the control group. The ICPs showed a higher prevalence of ill-defined nodules, with cavities and large opacity >2 cm with/without cavity (p=0.03, 0.04 and 0.02, respectively). Regardless of the immune status, the most common CT findings were bronchiectasis and ill-defined nodules without cavity. The most common CT findings of pulmonary NTM infection in ICPs were bronchiectasis and ill-defined nodules, similar to those in the control group. Ill-defined nodules with cavity and large opacity >2 cm with/without cavity were more frequently found in ICPs. In patients affected by NTM infection, large opacities and cavitation in pulmonary nodules are more frequent in ICPs than in immunocompetent patients.

Immunocompromised patients with acute colonic diverticulitis are at high risk for complications and failure of non-surgical treatment. However, evidence on the comparative outcomes of immunocompromised and immunocompetent patients with diverticulitis is lacking. This systematic review and meta-analysis investigated the outcomes of medical treatment in immunocompromised and immunocompetent patients with diverticulitis. A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library. Studies comparing the clinical outcomes of immunocompromised and immunocompetent patients with diverticulitis were included. A total of 10 studies with 1,946,461 subjects were included in the quantitative synthesis. The risk of emergency surgery and postoperative mortality after emergency surgery was significantly higher in immunocompromised patients than in immunocompetent patients with diverticulitis (risk ratio [RR], 1.76; 95% confidence interval [CI], 1.31-2.38 and RR, 3.05; 95% CI, 1.70-5.45, respectively). Overall risk of complications associated with diverticulitis was non-significantly higher in immunocompromised than in immunocompetent patients (RR, 1.24; 95% CI, 0.95-1.63). Overall mortality irrespective of surgery was significantly higher in immunocompromised than in immunocompetent patients with diverticulitis (RR, 3.65; 95% CI, 1.73-7.69). By contrast, postoperative mortality after elective surgery was not significantly different between immunocompromised and immunocompetent patients with diverticulitis. In subgroup analysis, the risk of emergency surgery and recurrence was significantly higher in immunocompromised patients with complicated diverticulitis, whereas no significant difference was shown in mild disease. Immunocompromised patients with diverticulitis should be given the best medical treatment with multidisciplinary approach because they had increased risks of surgery, postoperative morbidity, and mortality than immunocompetent patients.

The differences in the clinical features and outcomes of respiratory adenovirus infection (RAI) between immunocompetent and immunocompromised adult patients remain unclear. Thirty-nine adult RAI patients, including 28 (71.8%) immunocompetent patients and 11 (28.2%) immunocompromised patients were enrolled in this retrospective study. Demographic characteristics, symptoms, laboratory tests, radiographic findings, therapies and clinical outcomes were compared between the two groups. We found fever (94.9%), cough (66.7%) and sputum production (56.4%) were the most frequent symptoms. Compared with immunocompetent RAI patients, the immunocompromised RAI patients were more likely to experience anaemia (g/l; 90.8 ± 24.0 vs 134.3 ± 14.6, P &lt; 0.001), thrombocytopaenia ( × 109/l; 116.9 ± 92.7 vs 178.4 ± 74.6, P = 0.037), hypoalbuminaemia (g/l; 29.6 ± 5.5 vs 36.9 ± 5.2, P &lt; 0.001), hyponatraemia (mmol/l; 134.8 ± 5.6 vs 138.5 ± 3.9, P = 0.026) and low levels of cholinesterase (U/l; 2650.5 ± 1467.4 vs 5892.8 ± 1875.1, P &lt; 0.001). Chest computed tomography (CT) scans indicated that lung infiltrate was the most common finding (64.1%). Immunocompromised patients had a higher likelihood of bilateral lung involvement (72.7%) and lower lobe involvement (81.8%) of both lungs. The hospitalized mortality rate was 27.3% in immunocompromised RAI patients, but no death occurred among immunocompetent RAI patients (P = 0.018). Our data suggested immunocompromised RAI patients had worse laboratory test results, more bilateral lung and lower lobe involvement and higher in-hospital mortality compared with immunocompetent RAI patients.

ABSTRACTQuantiFERON-TB Gold Plus (QFT-Plus) is an emerging QuantiFERON test after QuantiFERON-TB Gold In-Tube (QFT-GIT) for tuberculosis infection detection; it is an IFN-γ release assay. We compared QFTPlus, which has an additional TB antigen 2 (TB2) tube to induce cell-mediated (CD8+ T cell) immune responses, with QFT-GIT. We conducted this study to assess the agreement of the QFT-GIT and QFT-Plus assays in immunocompromised patients in a clinical setting. A total of 278 immunocompromised patients and 175 immunocompetent patients from different departments were continuously enrolled from August 2020 to March 2021, and each patient underwent both tests. Correlations between QFT-GIT and QFT-Plus assays showed good agreement (κ value = 0.859). Patients receiving long-term immunosuppressant therapy had the lowest concordance between QFT-GIT and QFT-Plus assays; 9 out of 11 positive latent tuberculosis infection (LTBI) cases were diagnosed by the QFT-Plus assay, implying that QFT-Plus may detect more LTBI than QFT-GIT does in these patients. Indeterminate results were associated with lower lymphocyte, CD4+ T cell, and CD8+ T cell absolute counts, and with lower CD4/CD8 ratios. In conclusion, we found that the QFT-GIT and QFT-Plus assays had high agreement not only in immunocompetent patients but also in immunocompromised patients. QFT-Plus may detect more LTBI than QFT-GIT in patients receiving long-term immunosuppressant therapy. Thresholds were established for lymphocyte absolute counts of >1.15 × 109 cells, and for CD4+ T cell absolute counts of >467.7 × 106 to 478.5 × 106 cells, which may lessen the incidence of indeterminate results.IMPORTANCE This study evaluated the performance of QFT-GIT and QFT-Plus in the diagnosis of M. tuberculosis infection in immunocompromised patients and found that QFT-Plus may detect more LTBI than QFT-GIT does in patients receiving long-term immunosuppressant therapy. We believe that our study makes a significant contribution to the literature because it highlights the different diagnostic accuracies of QFT-GIT and QFT-Plus in different subpopulations of immunocompromised and immunocompetent patients. Selecting a test with better performance, particularly in patients with a high risk of developing active TB, may assist the health sector in better managing TB. Furthermore, we believe that this study will be of significance to the diagnosis of LTBI.

Background The coronavirus disease 2019 (COVID-19) pandemic has caused significant mortality for patients worldwide. The clinical outcomes of COVID-19 among immunosuppressed patients, who are at presumably risk of more severe disease have not been well characterized. Clinical outcome between immunocompetent and immunocompromised patients hospitalized with COVID-19 Methods We performed a retrospective cohort study including all adult patients hospitalized with COVID-19 during July to December 2021. Primary outcome was a 3-month death among immunocompetent and immunocompromised patients. Secondary outcomes included superimposed infections and intensive care unit (ICU) admission within a 6-month period, and factors associated with death in immunocompromised patients. Comparison between immunocompromised patients hospitalized with COVID-19 who were dead and survived during 3 months after COVID-19 Results 303 patients were enrolled (239 immunocompetent and 64 immunocompromised patients, with mean age of 71 (±14) and 63 (±16) years, respectively). Immunocompromised patients showed more superimposed herpes simplex virus infection (3.1% vs. 0%, P 0.006). There was a trend towards higher ICU admission rate (20.3% vs. 11.%, P 0.058) in the immunocompromised group. However, the 3-month death between both groups did not differ significantly (24.7% immunocompromised vs 20.5% immunocompetent, P 0.437). Interestingly, there was a higher death among immunocompromised patients who had co-infections (61.5% vs. 32.4%, P 0.019) and superimposed infections (56.5% vs. 17.9%, P 0.002). On the other hand, there was a lower death rate in immunocompromised patients receiving immunosuppressive drugs prior to COVID-19 diagnosis (12.9% vs. 59.2%, P &amp;lt; 0.001). Conclusion Three-month mortality rate did not differ between immunocompromised and immunocompetent patients. Superimposed and co-infections increased mortality in immunocompromised COVID-19 patients. Prior use of immunosuppressive agents was associated with less mortality, which may be explained by less detrimental inflammatory response. Disclosures All Authors: No reported disclosures

Stenotrophomonas maltophilia (S. maltophilia) is a globally emerging, rare, waterborne, aerobic, gram-negative, multiple-drug-resistant organism, most commonly associated with respiratory tract infection in humans. Computed tomography (CT) findings in patients with S. maltophilia pneumonia are rarely reported. To compare CT findings between immunocompromised and immunocompetent patients, and to determine characteristic imaging findings of S. maltophilia pneumonia. CT findings of eight immunocompromised and 29 immunocompetent patients with proven S. maltophilia pneumonia were reviewed retrospectively. Different patterns of CT abnormalities between immunocompromised and immunocompetent patients were compared by Fisher's exact test. Patchy ground-glass opacities (GGOs) were the most common CT findings, present in 36 (97.3%) of the 37 patients. Among the patients with patchy GGOs, consolidation was seen in 29 (78.4%) patients, and centrilobular nodules were noted in 15 (40.5%) patients. The transaxial distribution of the parenchymal abnormalities was predominantly randomly distributed in 30 (81.1%) cases. Regarding longitudinal plane involvement, the predominant zonal distributions were the diffuse distribution (n=23, 62.2%) and the lower lung zone (n=14, 37.8%). None of the patients showed upper lung zone predominance. The proportion of patients with parenchymal CT findings or associated findings in the immunocompromised patients was not significantly different from that of the immunocompetent patients. However, lower lung zone predominance on the longitudinal plane was significantly more common in immunocompetent patients than in immunocompromised patients (14/29 vs. 0/8, P=0.015). And diffuse distribution of parenchymal abnormalities on a longitudinal plane was significantly more frequent in immunocompromised patients than in immunocompetent patients (8/8 vs. 15/29, P=0.015). The most common CT patterns of S. maltophilia pneumonia in immunocompromised and immunocompetent patients were patchy GGOs and consolidation. However, in immunocompetent patients, parenchymal abnormalities were more predominately distributed in lower lung zone than in immunocompromised patients; and in immunocompromised patients, parenchymal abnormalities were more diffusely distributed than in immunocompetent patients.

BackgroundNocardiosis may cause fatal infections in immunocompromised and immunocompetent patients. While there are many different species, Nocardia farcinica, has been a clinically important cause but less frequently identified species. We present a case of an immunocompromised patient successfully treated with a multi-drug regimen for disseminated nocardiosis due to Nocardia farcinica.MethodsThe patient is a 65-year-old male with a history of Autoimmune Hemolytic Anemia (AIHA) who presented with fevers, chills, symptomatic anemia, and new left lower extremity weakness associated with spasms over several days prior to arrival.Results6 months prior, he had received treatment for AIHA with rituximab, cyclophosphamide, and high dose corticosteroids. Head CT revealed a 1.5cm right posterior frontal lobe mass with surrounding edema. CT thorax revealed innumerable spiculated pulmonary nodules and masses bilaterally. Lung biopsy as well as blood culture were positive for Nocardia farcinica, specimen was sent to reference laboratory for susceptibility testing. He was initially treated with imipenem and IV Bactrim. Subsequently, clinical exam findings were unchanged and repeat MRI brain showed enlarging frontal mass. Linezolid and IV amikacin were added to the regimen based on susceptibility results. Patient was discharged home but returned to hospital shortly after discharge with severe hemolytic anemia, suspected to be due to Bactrim administration. The patient was later discharged home on Imipenem, IV amikacin, oral Linezolid, and oral Moxifloxacin in stable condition without surgical intervention and with improved left lower extremity weakness.ConclusionDisseminated Nocardiosis is known to cause fatal pulmonary and CNS infections in immunocompromised patients and requires aggressive therapy usually with multiple antibiotics. Nocardia farcinica infections are particularly clinically complex given the organism’s multiple inherent resistance mechanisms, interpretation of in vitro susceptibility testing, and possible adverse effect profile of treatment regimen.DisclosuresAll Authors: No reported disclosures.

status: Published