Critical Challenges: Respiratory Infections in Immunocompromised ICU Patients

Catia Cilloniz, PhD

Julio Ramirez, MD

Currently, we are observing an increasing proportion of the immunocompromised population, primarily due to the rise in cancer survival rates, the increase in transplants, and the use of immunosuppressive therapies. Immunocompromised individuals are a heterogeneous population affected by various conditions and therapies, who experience significant morbidity and mortality due to respiratory infections. The increased risk of infections in immunocompromised individuals, which often become complicated and put their lives at risk, contributes to a higher proportion of these patients requiring admission to the intensive care unit.

Respiratory infections, especially in critically ill immunocompromised patients, generate a significant challenge for clinicians and their management of the patient because of the atypical presentation and the weakened immune system. This issue of SRCCM features expert reviews on relevant aspects of pulmonary disease in critically ill immunocompromised patients, covering a structures framework that includes the understanding of immunosuppression covered by the article of Dr. Scott Evans title “Definition of Immunosuppression,” understanding immunosuppression is critical for recognizing infection risks and implementing appropriate preventive and therapeutic strategies; applying consensus guidelines addressed by Dr. Julio Ramirez in the article “General Approach to Immunocompromised Patients with Pneumonia: Insights from the Latest Consensus Documents” discuss how an structured, evidence-based approach improves patient outcomes, emphasizing early diagnosis, targeted treatment, and multidisciplinary care; utilizing advanced microbial diagnosis was covered by Prof. Chiagozie Pickens in the article “Microbial Diagnosis of Respiratory Infections in Immunocompromised Patients: Invasive and Non-Invasive Sampling Methods, Standard and Molecular” in which she described how combining traditional and molecular diagnostic methods enhances pathogen detection, leading to timely and accurate treatment. The radiological diagnostics was addressed by Prof. Suhail Raoof in his article “Radiological Approach to Severe Respiratory and Pulmonary Complications in Immunocompromised Patients,” where he explains how imaging plays a crucial role in diagnosing infections and complications, aiding in timely and precise clinical decision-making. The issue also addressed respiratory infection in specific populations, such as HIV patients, where the early identification and management of opportunistic infections, along with ART, significantly reduce morbidity and mortality was observed. This topic was covered by Prof. Catia Cilloniz in the article “Pulmonary Infections in HIV Patients.” Other important populations are posttransplant recipients, in whom vigilant monitoring and tailored antimicrobial therapy are essential to prevent and manage infections in transplant recipients. This topic was covered by Prof. Luis Felipe Reyes in the article, “Pulmonary Infections in Post-Solid Organ Transplantation.” Prof. Elie Azoulay covered “Pulmonary Infections in Hematologic Disease,” where he discusses how a rapid intervention with broad-spectrum antimicrobials and supportive care is vital for reducing infection-related complications in these patients. In those patients in immunosuppressive therapy, where we know that the risk assessment and prophylactic measures are key in minimizing severe infections was addressed by Prof. Rodrigo Cavalazzi in his article “Pulmonary Infections in Patients Receiving Corticosteroids and Other Immunomodulator.” Distinguishing between infectious and noninfectious causes prevents misdiagnosis and unnecessary antibiotic use. This important topic was addressed by Prof. Denisse Battaglini in the article “Conditions that Mimicking Respiratory Infections in Critically ill Immunocompromised Patients,” where she discusses how distinguishing infections from mimicking conditions prevents misdiagnosis, while noninvasive ventilation serves as a crucial respiratory support strategy. Finally, Prof. Massimo Antonelli covers the topic of “Non-Invasive Ventilation in Immunocompromised Patients with Respiratory Failure,” in which he discusses NIV as an effective respiratory support strategy, reducing the need for intubation and improving survival rates in selected patients.

Respiratory infections in critically ill immunocompromised patients is an important and challenging issue with complex diagnostic and therapeutic aspects. In this issue, we have tried to be comprehensive and contemporary about the immunosuppression effects, cutting-edge diagnostics, specific infections in specific patient cohorts, and treatment options. By publishing expert perspectives, we aim to deliver practical guidance to clinicians confronted with such complex cases and to enhance patient outcomes.

Publication History

Received: 14 October 2025

Accepted: 23 October 2025

Article published online:
17 November 2025