General Approach to Immunocompromised Patients with Pneumonia: Insights from the Latest Consensus Documents

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 delayed therapy may increase mortality.