Pneumocystis pneumonia in hospitalized patients: a detailed examination of symptoms, management, and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected persons
Pneumocystis pneumonia in hospitalized patients: a detailed examination of symptoms, management, and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected persons
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DOI：
10.1111/j.1399-3062.2012.00739.x
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发表时间：
2012-10-01
影响因子：
2.6
通讯作者：
Pappas, P. G.
中科院分区：
文献类型：
--
作者：
McKinnell, J. A.;Cannella, A. P.;Pappas, P. G.
研究背景肺孢子虫肺炎（PCP）是一种严重威胁免疫功能低下者生命的疾病。在预防和治疗与人类免疫缺陷病毒（艾滋病毒）有关的五氯苯酚方面，现有可靠的数据和明确的准则，但在与艾滋病毒无关的五氯苯酚方面，现有的数据很少，也没有准则。我们假设，预防和住院管理HIV-PCP不同的NH-PCP。方法我们对1996年至2008年在亚拉巴马大学医学中心就诊的所有经病理证实的PCP病例进行了回顾性病例分析。使用标准化数据收集工具收集临床表现、住院过程和结局的数据。双变量分析比较了HIV-PCP和NH-PCP患者的预防、持续糖皮质激素治疗和临床结局。结果我们的队列分析包括97例PCP，65例HIV和32例非HIV病例。非HIV病例很少接受初级预防（4%对38%，P = 0.01），并在住院期间接受适当的抗生素治疗（5.2天对1.1天，P < 0.005）。在移植患者中，NH-PCP在移植后平均1066天被诊断出来，大多数患者在疾病发作时正在使用低剂量皮质类固醇（87%）。未检测到连续性皮质类固醇使用（69% vs. 77%，P = 0.39）和90天死亡率（41% vs. 28%，P = 0.20）的显著差异。结论接受器官或干细胞移植的患者在移植后多年仍有发生PCP的风险。在我们的队列中，NH-PCP患者很少接受预防治疗，与HIV-PCP病例相比，开始使用适当的抗生素明显延迟。医疗提供者应该意识到NH-PCP的持续风险，即使在移植后很晚，并考虑更积极的方法来预防和早期经验性治疗PCP。
BackgroundPneumocystis jirovecii pneumonia (PCP) is a life-threatening infection for immunocompromised individuals. Robust data and clear guidelines are available for prophylaxis and treatment of human immunodeficiency virus (HIV)-related PCP (HIV-PCP), yet few data and no guidelines are available for non-HIV-related PCP (NH-PCP). We postulated that prevention and inpatient management of HIV-PCP differed from NH-PCP. Methods We performed a retrospective case review of all pathologically confirmed cases of PCP seen at the University of Alabama Medical Center from 1996 to 2008. Data on clinical presentation, hospital course, and outcome were collected using a standardized data collection instrument. Bivariate analysis compared prophylaxis, adjunctive corticosteroids, and clinical outcomes between patients with HIV-PCP and NH-PCP. Results Our analysis of the cohort included 97 cases of PCP; 65 HIV and 32 non-HIV cases. Non-HIV cases rarely received primary prophylaxis (4% vs. 38%, P = 0.01) and received appropriate antibiotics later in the course of hospitalization (5.2 days vs. 1.1 days, P < 0.005). Among transplant patients, NH-PCP was diagnosed a mean of 1066 days after transplantation and most patients were on low-dose corticosteroids (87%) at the time of disease onset. No significant differences in adjunctive corticosteroid use (69% vs. 77%, P = 0.39) and 90-day mortality (41% vs. 28%, P = 0.20) were detected. Conclusions Patients who have undergone organ or stem cell transplant remain at risk for PCP for many years after transplantation. In our cohort, patients who developed NH-PCP were rarely given prophylaxis, and initiation of appropriate antibiotics was significantly delayed compared to cases of HIV-PCP. Medical providers should be aware of the ongoing risk for NH-PCP, even late after transplantation, and consider more aggressive approaches to both prophylaxis and earlier empirical therapy for PCP.