1
|
Lécuyer R, Issa N, Camou F, Lavergne RA, Gabriel F, Morio F, Canet E, Raffi F, Boutoille D, Cady A, Gousseff M, Crabol Y, Néel A, Tessoulin B, Gaborit B. Characteristics and Prognosis Factors of Pneumocystis jirovecii Pneumonia According to Underlying Disease: A Retrospective Multicenter Study. Chest 2024; 165:1319-1329. [PMID: 38215935 DOI: 10.1016/j.chest.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Pneumocystis jirovecii pneumonia (PcP) remains associated with high rates of mortality, and the impact of immunocompromising underlying disease on the clinical presentation, severity, and mortality of PcP has not been adequately evaluated. RESEARCH QUESTION Does the underlying disease and immunosuppression causing PcP impact the outcome and clinical presentation of the disease? STUDY DESIGN AND METHODS In this multicenter retrospective observational study, conducted from January 2011 to December 2021, all consecutive patients admitted with a proven or probable diagnosis of PcP according to the European Organisation for Research and Treatment of Cancer consensus definitions were included to assess the epidemiology and impact of underlying immunosuppressive diseases on overall and 90-day mortality. RESULTS Overall, 481 patients were included in the study; 180 (37.4%) were defined as proven PcP and 301 (62.6%) were defined as probable PcP. Patients with immune-mediated inflammatory diseases (IMIDs) or solid tumors had a statistically poorer prognosis than other patients with PcP at day 90. In multivariate analysis, among the HIV-negative population, solid tumor underlying disease (OR, 5.47; 95% CI, 2.16-14.1; P < .001), IMIDs (OR, 2.19; 95% CI, 1.05-4.60; P = .037), long-term corticosteroid exposure (OR, 2.07; 95% CI, 1.03-4.31; P = .045), cysts in sputum/BAL smears (OR, 1.92; 95% CI, 1.02-3.62; P = .043), and SOFA score at admission (OR, 1.58; 95% CI, 1.39-1.82; P < .001) were independently associated with 90-day mortality. Prior corticotherapy was the only immunosuppressant associated with 90-day mortality (OR, 1.67; 95% CI, 1.03-2.71; P = .035), especially for a prednisone daily dose ≥ 10 mg (OR, 1.80; 95% CI, 1.14-2.85; P = .010). INTERPRETATION Among patients who were HIV-negative, long-term corticosteroid prior to PcP diagnosis was independently associated with increased 90-day mortality, specifically in patients with IMIDs. These results highlight both the needs for PcP prophylaxis in patients with IMIDs and to early consider PcP curative treatment in severe pneumonia among patients with IMIDs.
Collapse
Affiliation(s)
- Romain Lécuyer
- Internal Medicine and Infectious Diseases, Centre Hospitalier Bretagne-Atlantique, Vannes, France; Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR1155, Nantes, France
| | - Nahéma Issa
- Intensive Care and Infectious Disease Unit, Groupe Saint-André, University Hospital, Bordeaux, France
| | - Fabrice Camou
- Intensive Care and Infectious Disease Unit, Groupe Saint-André, University Hospital, Bordeaux, France
| | - Rose-Anne Lavergne
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR1155, Nantes, France
| | - Frederic Gabriel
- Centre Hospitalier Universitaire de Bordeaux, Service de Parasitologie Mycologie, Bordeaux, France
| | - Florent Morio
- Nantes Université, CHU Nantes, Cibles et médicaments des infections et de l'immunité, IICiMed, UR1155, Nantes, France; Laboratoire de Parasitologie-Mycologie, Institut de Biologie, University Hospital, Nantes, France
| | - Emmanuel Canet
- Medical Intensive Care, University Hospital, Nantes, France
| | - François Raffi
- Department of Infectious Diseases, University Hospital of Nantes and Centre d'Investigation Clinique 1413, INSERM, Nantes, France
| | - David Boutoille
- Department of Infectious Diseases, University Hospital of Nantes and Centre d'Investigation Clinique 1413, INSERM, Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Anne Cady
- Department of Microbiology, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Marie Gousseff
- Internal Medicine and Infectious Diseases, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Yoann Crabol
- Internal Medicine and Infectious Diseases, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | - Antoine Néel
- CRTI UMR 1064, INSERM, Université de Nantes, Nantes, France; Department of Internal Medicine, University Hospital, Nantes, France
| | - Benoît Tessoulin
- INSERM, U1232, Hematology Department, Nantes University Hospital, CRCI(2)NA, Nantes University, Nantes, France
| | - Benjamin Gaborit
- Department of Infectious Diseases, University Hospital of Nantes and Centre d'Investigation Clinique 1413, INSERM, Nantes, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France.
| |
Collapse
|