Journal Article

Infectious disease ward admission positively influences P. jiroveci pneumonia (PjP) outcome: A retrospective analysis of 116 HIV-positive and HIV-negative immunocompromised patients

Gentilotti, Elisa, Apice, Fabiana, Di Veroli, Ambra, Coppola, Luigi, Malagnino, Vincenzo, Sarmati, Loredana, Berrilli, Federica, Ricciardi, Alessandra, Mari, Alessia, Cerva, Carlotta, Maffongelli, Gaetano, Toschi, Nicola, Parisi, Saverio Giuseppe, Di Cave, David, Andreoni, Massimo

2017

Overview

P. jiroveci (Pj) causes a potentially fatal pneumonia in immunocompromised patients and the factors associated with a bad outcome are poorly understood. A retrospective analysis on Pj pneumonia (PjP) cases occurring in Tor Vergata University Hospital, Italy, during the period 2011-2015. The patients' demographic, clinical and radiological characteristics and the Pj genotypes were considered. The study population included 116 patients, 37.9% of whom had haematological malignancy or underwent haematological stem cell transplantation (HSCT), 22.4% had HIV infection, 16.4% had chronic lung diseases (CLD), 7.8% had a solid cancer, and 3.4% underwent a solid organ transplant (SOT). The remaining 12.1% had a miscellaneous other condition. At univariate analysis, being older than 60 years was significantly correlated with a severe PjP (OR [95%CI] 2.52 [0.10-5.76]; p = 0.031) and death (OR [95%CI] 2.44 [1.05-5.70]; p = 0.036), while a previous trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were significantly associated with a less severe pneumonia (OR[95%CI] 0.35 [0.15-0.84], p = 0.023); moreover, death due to PjP was significantly more frequent in patients with CLD (OR[95%CI] 3.26 [1.17-9.05]; p = 0.019) while, admission to the Infectious Diseases Unit was significantly associated with fewer deaths (OR[95%CI] 0.10 [0.03-0.36], p = 0.002). At multivariate analysis, a better PjP outcome was observed in patients taking TMP/SMX prophylaxis and that were admitted to the Infectious Diseases Unit (OR[95%CI] 0.27 [0.07-1.03], p = 0.055, OR[95%CI] 0.16 [0.05-0.55]; p = 0.004, respectively). In conclusion, in our study population, TMP/SMX prophylaxis and infectious disease specialist approach were variables correlated with a better PjP outcome.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / Age / Aged / Aged, 80 and over / AIDS / Air spora / Alveoli / Anti-Bacterial Agents - pharmacology / Anti-Bacterial Agents - therapeutic use / Antibiotics / Antibodies / Antiretroviral agents / Assaying / Biology and Life Sciences / Blood cancer / Bronchus / Cancer / Chronic obstructive pulmonary disease / Clinical microbiology / Colonization / Communicable Diseases / Comorbidity / Computed tomography / Corticoids / Corticosteroids / Cough / Deoxyribonucleic acid / Diagnosis / Disease prevention / DNA / Drugs / Epidemiology / Female / Fever / Fungi / Genotypes / Health care / Hematology / High resolution / HIV / HIV Infections - complications / HIV Infections - drug therapy / HIV Infections - epidemiology / HIV Seropositivity / Hospital admission and discharge / Hospitals / Human immunodeficiency virus / Humans / Immunocompromised Host / Immunosuppression / Incidence / Infections / Infectious diseases / Influence / Intervention / Italy - epidemiology / Laboratories / Leukemia / Lung diseases / Male / Medical prognosis / Medical records / Medicine / Medicine and Health Sciences / Microbiology / Middle Aged / Monoclonal antibodies / Mortality / Multivariate analysis / Mutation / Nucleotide sequence / Odds Ratio / Outcome Assessment (Health Care) / Patient Admission / Patient outcomes / Patients' Rooms / Physical Sciences / Pneumocystis carinii - classification / Pneumocystis carinii - genetics / Pneumocystis carinii - isolation & purification / Pneumocystis carinii pneumonia / Pneumonia / Pneumonia, Pneumocystis - diagnosis / Pneumonia, Pneumocystis - drug therapy / Pneumonia, Pneumocystis - epidemiology / Pneumonia, Pneumocystis - etiology / Prophylaxis / Radiology / Research and Analysis Methods / Respiration / Respiratory diseases / Retrospective Studies / Risk Factors / Secretions / Stem cell transplantation / Stem cells / Studies / Tomography, X-Ray Computed / Transplantation / Transplants & implants / Trimethoprim / Viruses / Young Adult