Efficacy of caspofungin combined with trimethoprim/sulfamethoxazole as first-line therapy to treat non-HIV patients with severe pneumocystis pneumonia
Efficacy of caspofungin combined with trimethoprim/sulfamethoxazole as first-line therapy to treat non-HIV patients with severe pneumocystis pneumonia
复制标题
卡泊芬净联合甲氧苄啶/磺胺甲恶唑一线治疗非 HIV 重症肺孢子虫肺炎患者的疗效
DOI：
10.3892/etm.2017.5516
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发表时间：
2018-02-01
影响因子：
2.7
通讯作者：
Zhang, Ning
中科院分区：
文献类型：
--
作者：
Zhang, Gensheng;Chen, Miaomiao;Zhang, Ning
卡泊芬净联合甲氧苄啶/磺胺甲恶唑（TMP/SMZ）作为非hiv阳性严重肺囊虫性肺炎（PCP）患者的补救性治疗效果不佳。目前尚不清楚使用这种联合策略作为一线治疗是否会改善患者的预后。本研究旨在评估卡泊芬净联合TMP/SMZ作为非hiv阳性严重PCP患者一线治疗的疗效。一项回顾性队列研究于2016年3月至2017年2月进行。比较两组患者分别接受一线和二线治疗的临床特征和转归。此外，还对以往研究中的类似病例进行了评估。本研究共纳入14例患者（平均年龄58.79±14.41岁）；其中9例患者接受卡泊芬净和TMP/SMZ作为一线治疗，5例患者接受卡泊芬净作为二线治疗。总阳性有效率为71.43%(10/14)，一线和二线治疗组分别为88.89（8/9）和40.00%(2/5)，差异有统计学意义（P=0.095）。一线治疗组（5/ 6,83.33%）和二线治疗组（0/ 3,0%）需要有创机械通气患者的阳性反应率差异有统计学意义（P=0.048）。全因住院死亡率为42.86%(6/14)，一线和二线治疗组的死亡率分别为33.33%（3/9）和60.00% (3/5)（P=0.580）。结合既往报道病例27例，一线治疗组阳性反应率（11/12,91.67%）显著高于二线治疗组（8/15,53.33%，P=0.043）。尽管一线治疗组的全病程死亡率与二线治疗组的50%相似，但两组之间的全因死亡率无显著差异（25.00 vs 46.67%， P=0.424）。因此，本研究结果表明，卡泊芬净联合TMP/SMZ作为一线治疗可能是治疗非hiv阳性严重PCP患者的一种有希望和有效的策略，特别是对于那些需要有创机械通气的患者。
Combined treatment with caspofungin and trimethoprim/sulfamethoxazole (TMP/SMZ) as salvage therapy in non-HIV positive patients with severe pneumocystis pneumonia (PCP) yields poor outcomes. It remains unknown whether the use of this combination strategy as a first-line therapy would improve patient outcomes. The present study aimed to assess the efficacy of caspofungin combined with TMP/SMZ as a first-line therapy in non-HIV positive patients with severe PCP. A retrospective cohort study was conducted between March 2016 and February 2017. Patient clinical characteristics and outcomes were compared between two groups receiving first-line and second-line therapy respectively. In addition, similar cases from previous studies were assessed. A total of 14 patients were included in the present study (mean age, 58.79 +/- 14.41 years); including 9 patients receiving caspofungin and TMP/SMZ as a first-line therapy and 5 that received it as a second-line therapy. The overall positive response rate was 71.43% (10/14), with 88.89 (8/9) and 40.00% (2/5) in the first-line and second-line therapy groups, respectively (P=0.095). The positive response rates of patients requiring invasive mechanical ventilation differed significantly between the first-line (5/6, 83.33%) and the second-line (0/3, 0%) therapy groups (P=0.048). All-cause hospital mortality was 42.86% (6/14), with mortality rates of 33.33 (3/9) and 60.00% (3/5) in the first-line and second-line therapy groups, respectively (P=0.580). Combined with previously reported cases (n=27), the positive response rate was significantly greater in the first-line therapy group (11/12, 91.67%) than in the second-line therapy group (8/15, 53.33%, P=0.043). No significant differences were in all-cause mortality rates between the two groups (25.00 vs. 46.67%, P=0.424) were identified, despite the fact that all-course mortality in the first-line therapy group was similar to 50% that of the second-line therapy group. Therefore, the results of the present study indicate that combined caspofungin and TMP/SMZ as first-line therapy may be a promising and effective strategy to treat non-HIV positive patients with severe PCP, particularly for those requiring invasive mechanical ventilation.