Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG
- Creators
- Giacobbe D. R.
- Dettori S.
- Di Pilato V.
- Asperges E.
- Ball L.
- Berti E.
- Blennow O.
- Bruzzone B.
- Calvet L.
- Capra Marzani F.
- Casabella A.
- Choudaly S.
- Dartevel A.
- De Pascale G.
- Di Meco G.
- Fallon M.
- Galerneau L. -M.
- Gallego M.
- Giacomini M.
- Gonzalez Saez A.
- Hansel L.
- Icardi G.
- Koehler P.
- Lagrou K.
- Lahmer T.
- Lewis White P.
- Magnasco L.
- Marchese A.
- Marelli C.
- Marin-Arriaza M.
- Martin-Loeches I.
- Mekontso-Dessap A.
- Mikulska M.
- Mularoni A.
- Nordlander A.
- Poissy J.
- Russelli G.
- Signori A.
- Tascini C.
- Vaconsin L. -M.
- Vargas J.
- Vena A.
- Wauters J.
- Pelosi P.
- Timsit J. -F.
- Bassetti M.
- Cerchiaro M.
- Zaccarelli M.
- Robba C.
- Battaglini D.
- Brunetti I.
- Del Puente F.
- Mora S.
- de la Villa S.
- Valerio M.
- Munoz P.
- Lombardi G.
- Cesarano M.
- Gennenzi V.
- Meersseman P.
- Hermans G.
- Wilmer A.
- Razazi K.
- Carteaux G.
- de Prost N.
- Cornely O. A.
- Seidel D.
- Alastruey-Izquierdo A.
- Garcia Borrega J.
- Bonnal C.
- de Montmollin E.
- Dessajan J.
- Ceresini M.
- Mojoli F.
- Vola A.
- Garnaud C.
- Diaz E.
- Gasch O.
- Prina E.
- Rasch S.
- Dibos M.
- Haschka S.
- Others:
- Giacobbe, D. R.
- Dettori, S.
- Di Pilato, V.
- Asperges, E.
- Ball, L.
- Berti, E.
- Blennow, O.
- Bruzzone, B.
- Calvet, L.
- Capra Marzani, F.
- Casabella, A.
- Choudaly, S.
- Dartevel, A.
- De Pascale, G.
- Di Meco, G.
- Fallon, M.
- Galerneau, L. -M.
- Gallego, M.
- Giacomini, M.
- Gonzalez Saez, A.
- Hansel, L.
- Icardi, G.
- Koehler, P.
- Lagrou, K.
- Lahmer, T.
- Lewis White, P.
- Magnasco, L.
- Marchese, A.
- Marelli, C.
- Marin-Arriaza, M.
- Martin-Loeches, I.
- Mekontso-Dessap, A.
- Mikulska, M.
- Mularoni, A.
- Nordlander, A.
- Poissy, J.
- Russelli, G.
- Signori, A.
- Tascini, C.
- Vaconsin, L. -M.
- Vargas, J.
- Vena, A.
- Wauters, J.
- Pelosi, P.
- Timsit, J. -F.
- Bassetti, M.
- Cerchiaro, M.
- Zaccarelli, M.
- Robba, C.
- Battaglini, D.
- Brunetti, I.
- Del Puente, F.
- Mora, S.
- de la Villa, S.
- Valerio, M.
- Munoz, P.
- Lombardi, G.
- Cesarano, M.
- Gennenzi, V.
- Meersseman, P.
- Hermans, G.
- Wilmer, A.
- Razazi, K.
- Carteaux, G.
- de Prost, N.
- Cornely, O. A.
- Seidel, D.
- Alastruey-Izquierdo, A.
- Garcia Borrega, J.
- Bonnal, C.
- de Montmollin, E.
- Dessajan, J.
- Ceresini, M.
- Mojoli, F.
- Vola, A.
- Garnaud, C.
- Diaz, E.
- Gasch, O.
- Prina, E.
- Rasch, S.
- Dibos, M.
- Haschka, S.
Citation
Description
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.
Additional details
- URL
- https://hdl.handle.net/11567/1144972
- URN
- urn:oai:iris.unige.it:11567/1144972
- Origin repository
- UNIGE