Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG

Giacobbe, Daniele Roberto, Dettori, Silvia, Di Pilato, Vincenzo, Asperges, Erika, Ball, Lorenzo, Berti, Enora, Blennow, Ola, Bruzzone, Bianca, Calvet, Laure, Capra Marzani, Federico, Casabella, Antonio, Choudaly, Sofia, Dartevel, Anais, De Pascale, Gennaro, Di Meco, Gabriele, Fallon, Melissa ORCID: https://orcid.org/0000-0002-0267-3829, Galerneau, Louis-Marie, Gallego, Miguel, Giacomini, Mauro, González Sáez, Adolfo, Hänsel, Luise, Icardi, Giancarlo, Koehler, Philipp, Lagrou, Katrien, Lahmer, Tobias, Lewis White, P., Magnasco, Laura, Marchese, Anna, Marelli, Cristina, Marín-Arriaza, Mercedes, Martin-Loeches, Ignacio, Mekontso-Dessap, Armand, Mikulska, Malgorzata, Mularoni, Alessandra, Nordlander, Anna, Poissy, Julien, Russelli, Giovanna, Signori, Alessio, Tascini, Carlo, Vaconsin, Louis-Maxime, Vargas, Joel, Vena, Antonio, Wauters, Joost, Pelosi, Paolo, Timsit, Jean-Francois and Bassetti, Matteo 2023. Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG. Critical Care 27 (1) , 323. 10.1186/s13054-023-04608-1

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Abstract

Background: Pneumocystis jirovecii pneumonia (PJP) is an opportunistic, life-threatening disease commonly affecting immunocompromised patients. The distribution of predisposing diseases or conditions in critically ill patients admitted to intensive care unit (ICU) and subjected to diagnostic work-up for PJP has seldom been explored. Materials and methods: The primary objective of the study was to describe the characteristics of ICU patients subjected to diagnostic workup for PJP. The secondary objectives were: (i) to assess demographic and clinical variables associated with PJP; (ii) to assess the performance of Pneumocystis PCR on respiratory specimens and serum BDG for the diagnosis of PJP; (iii) to describe 30-day and 90-day mortality in the study population. Results: Overall, 600 patients were included in the study, of whom 115 had presumptive/proven PJP (19.2%). Only 8.8% of ICU patients subjected to diagnostic workup for PJP had HIV infection, whereas hematological malignancy, solid tumor, inflammatory diseases, and solid organ transplants were present in 23.2%, 16.2%, 15.5%, and 10.0% of tested patients, respectively. In multivariable analysis, AIDS (odds ratio [OR] 3.31; 95% confidence interval [CI] 1.13–9.64, p = 0.029), non-Hodgkin lymphoma (OR 3.71; 95% CI 1.23–11.18, p = 0.020), vasculitis (OR 5.95; 95% CI 1.07–33.22, p = 0.042), metastatic solid tumor (OR 4.31; 95% CI 1.76–10.53, p = 0.001), and bilateral ground glass on CT scan (OR 2.19; 95% CI 1.01–4.78, p = 0.048) were associated with PJP, whereas an inverse association was observed for increasing lymphocyte cell count (OR 0.64; 95% CI 0.42–1.00, p = 0.049). For the diagnosis of PJP, higher positive predictive value (PPV) was observed when both respiratory Pneumocystis PCR and serum BDG were positive compared to individual assay positivity (72% for the combination vs. 63% for PCR and 39% for BDG). Cumulative 30-day mortality and 90-day mortality in patients with presumptive/proven PJP were 52% and 67%, respectively. Conclusion: PJP in critically ill patients admitted to ICU is nowadays most encountered in non-HIV patients. Serum BDG when used in combination with respiratory Pneumocystis PCR could help improve the certainty of PJP diagnosis.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Pharmacy
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/, Type: open-access
Publisher:	BioMed Central
ISSN:	1364-8535
Date of First Compliant Deposit:	25 August 2023
Date of Acceptance:	10 August 2023
Last Modified:	04 Oct 2023 15:53
URI:	https://orca.cardiff.ac.uk/id/eprint/162036

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