Immunocompromised adults with pneumonia represent a growing and heterogeneous patient
population requiring a tailored diagnostic and therapeutic approach. This review synthesizes
insights from the latest consensus documents and guidelines to provide a structured
framework for clinicians managing pneumonia in immunocompromised hosts.
Patients are stratified into four categories of immune dysfunction: severely immunocompromised,
immunocompromised, abnormal immune system (not at risk for opportunistic pathogens),
and no identifiable immune abnormality. This classification informs both the likelihood
of infection with core respiratory pathogens and opportunistic pathogens. A comprehensive
microbiological evaluation is critical, incorporating sputum, nasopharyngeal swabs,
blood cultures, urinary antigens, and, when indicated, bronchoalveolar lavage and
biopsy.
For most immunocompromised patients presenting with community-acquired pneumonia,
empiric therapy parallels that of non-immunocompromised hosts. Empiric coverage for
opportunistic pathogens is warranted in unstable patients with compatible risk factors,
when delay therapy may increase mortality.
