The two largest groups under this category, cancer
patients and HIV-positive patients, both have pneumonia
recommendations from specialty-specific guidelines.29,30
There are no data regarding either non-neutropenic cancer
patients or those receiving chemotherapy with pneumonia;
however, when a patient presents with suspected pneumonia
and febrile neutropenia, Pseudomonas coverage is indicated.29
In HIV-infected patients, the most common pathogens
are S. pneumoniae and H. influenzae, but Pseudomonas
and S. aureus may be prominent in patients with
advanced disease.30 Current HIV guidelines are similar to
current community-acquired pneumonia guidelines and do
not recommend treatment for resistant organisms without
specific risk factors.7,30 As defined in health care-associated
pneumonia studies, immunosuppression encompasses a
wide range of patients with varying risk at different stages
of disease processes. These populations should not be included
as health care-associated pneumonia patients, but
disease-specific characteristics (febrile neutropenia in cancer,
CD4 count in HIV) should be considered when making
treatment decisions.