Is cotrimoxazole prophylaxis against Pneumocystis jirovecii pneumonia needed in patients with systemic autoimmune rheumatic diseases requiring immunosuppressive therapies?

Pereda, Claudia Alejandra; Nishishinya-Aquino, María Betina; Brito-García, N; Fontecha, Petra Díaz del Campo; Rúa-Figueroa, Íñigo

doi:10.1007/s00296-021-04808-4

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…This group of conditions encompasses a diverse set of rare diseases that often require immunosuppressive or immunomodulatory therapy. However, recommendations for PCP prophylaxis have been scarce, were only recently established [37][38][39], and are subject to debate [40], in contrast to the well-established guidelines for hematologic or solid organ malignancies and transplant recipients [41][42][43][44][45][46][47]. These findings collectively suggest a need for more systematic consideration of PCP antibiotic prophylaxis in these patient populations.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Kamel,

Boulain

2024

Ann. Intensive Care

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Purpose The recent epidemiology of Pneumocystis pneumonia (PCP) requiring intensive care unit (ICU) admission and the associated spectrum of immunocompromising conditions are poorly described. Methods We analyzed all adult PCP cases admitted to French ICUs via the French medical database system (PMSI), over the period from 2013 to 2019. Results French ICUs admitted a total of 4055 adult patients with PCP. Among all hospitalized PCP cases, the proportion requiring ICU admission increased from 17.8 in 2014 to 21.3% in 2019 (P < 0.001). The incidence of severe PCP rose from 0.85 in 2013 to 1.32/100,000 adult inhabitants in 2019 (P < 0.0001), primarily due to the proportion of HIV-negative patients that increased from 60.6% to 74.4% (P < 0.0001). Meanwhile, the annual number of severe PCP cases among patients with HIV infection remained stable over the years. In-hospital mortality of severe PCP cases was 28.5% in patients with HIV infection and 49.7% in patients without. Multivariable logistic analysis showed that patients with HIV infection had a lower adjusted risk of death than patients without HIV infection (Odds Ratio [OR]: 0.30, 95% confidence interval [95CI]: 0.17–0.55). Comorbidities or conditions strongly associated with hospital mortality included the patient’s age, Simplified Acute Physiologic Score II, congestive heart failure, coagulopathy, solid organ cancer, and cirrhosis. A vast array of autoimmune inflammatory diseases affected 19.9% of HIV-negative patients. Conclusions The number of PCP cases requiring ICU admission in France has risen sharply. While the yearly count of severe PCP cases in HIV-infected patients has remained steady, this rise predominantly affects cancer patients, with a recent surge observed in patients with autoimmune inflammatory diseases, affecting one in five individuals.

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Section: Discussionmentioning

confidence: 99%

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Kamel,

Boulain

2024

Ann. Intensive Care

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“…Patients receiving moderate to high doses of corticosteroids are at risk for developing Pneumocystis jirovecii pneumonia which is associated with a high mortality rate [ 51 ]. However, prophylaxis with cotrimoxazole is associated with potentially severe adverse events, including thrombocytopenia, pancytopenia, liver, and renal failure [ 51 ]. Therefore, there is not a consensus on the need of prophylactic measures in patients required glucocorticoids treatments and the decision should be evaluated for each patient balancing specific risks and benefits.…”

Section: Integration Of Il-1 Blockers In the Treatment Algorithm Of Pericarditismentioning

confidence: 99%

“…Low-dose glucocorticoids (prednisone 0.2-0.5 mg/kg or equivalent) are advisable rather than high doses (prednisone 1 mg/kg or equivalent), because are associated with less recurrences, treatment failure, hospitalizations, and adverse effects [49,50]. Patients receiving moderate to high doses of corticosteroids are at risk for developing Pneumocystis jirovecii pneumonia which is associated with a high mortality rate [51]. However, prophylaxis with cotrimoxazole is associated with potentially severe adverse events, including thrombocytopenia, pancytopenia, liver, and renal failure [51].…”

Section: Integration Of Il-1 Blockers In the Treatment Algorithm Of Pericarditismentioning

confidence: 99%

Interleukin-1 and the NLRP3 Inflammasome in Pericardial Disease

Vecchiè¹,

Buono

Chiabrando

et al. 2021

Curr Cardiol Rep

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Purpose of Review Pericarditis is a generally benign disease, although complications and/or recurrences may occur in up to 30% of cases. New evidence on the pathophysiology of the disease has accumulated in recent years. Recent Findings Recently, it has been shown that the activation of the NLRP3 (NACHT, leucine-rich repeat, and pyrin domain-containing protein 3) inflammasome is central in the pathophysiology of pericarditis. These findings derive from clinical data, an experimental animal model of acute pericarditis supporting a role for the NLRP3 inflammasome in pericarditis, and from indirect evidence of inhibitors of NLRP3 inflammasome in clinical trials. Summary Pericarditis is regarded as a stereotypical response to an acute damage of the mesothelial cells of the pericardial layers. NLRP3 inflammasome, a macromolecular structure sensing damage and releasing pro-inflammatory cytokines, is centrally involved as it releases interleukin (IL)-1β, whose auto-induction feeds an autoinflammatory disease, mostly responsible for recurrences. Colchicine, an inhibitor of NLRP3 inflammasome formation, and IL-1-targeted therapies, such as anakinra and rilonacept, were found to effectively blunt the acute inflammation and reduce the risk for recurrences.

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Position statement on infection screening, prophylaxis, and vaccination in pediatric patients with rheumatic diseases and immunosuppressive therapies, part 2: infection prophylaxis

et al. 2023

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This study aims to provide practical recommendations on prophylaxis for infection in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. A qualitative approach was applied. A narrative literature review was performed via Medline. Primary searches were conducted using MeSH terms and free text to identify articles that analyzed data on infections and vaccinations in pediatric patients with immune-mediated rheumatic diseases receiving immunosuppressive therapy. The results were presented and discussed in a nominal group meeting comprising a committee of 12 pediatric rheumatologists from the Prevention and Treatment of Infections Working Group of the Spanish Society of Pediatric Rheumatology. Several recommendations were generated. A consensus procedure was implemented via a Delphi process that was extended to members of the Spanish Society of Pediatric Rheumatology and the Vaccine Advisory Committee of the Spanish Association of Pediatrics. Participants produced a score ranging from 0 (completely disagree) to 10 (completely agree). Agreement was considered to have been reached if at least 70% of participants voted ≥ 7. The literature review included more than 400 articles. Overall, 63 recommendations were generated (23 on infection prophylaxis) and voted by 59 pediatric rheumatologists and other pediatric specialists, all of whom achieved the pre-established level of agreement. The recommendations on prophylaxis of infection cover vaccination and prophylaxis against varicella zoster virus, tuberculosis, Pneumocystis jiroveccii, and invasive fungal infections in pediatric patients with immune-mediated rheumatic diseases receiving/scheduled to receive immunosuppressive therapy. Conclusion: Based on current evidence and a Delphi process, we provided consensus and updated recommendations on prophylaxis and treatment of infections to guide those caring for pediatric rheumatology patients. What is Known: •Data largely derived from adults find that infectious diseases and related complications are a major cause of morbidity and mortality in patients with immune-mediated rheumatic diseases. •It is crucial to be aware of the preventive measures that should be implemented to prevent these infections in children, although most guidelines are often extrapolated from adult cases. What is New: •In the absence of evidence, a literature review and a Delphi survey were conducted to establish a series of expert recommendations that could prove useful in clinical practice, providing a practical and simple day-to-day approach to be used by pediatric rheumatologists. •The recommendations focus on tuberculosis, herpes zoster virus, fungal infections, and Pneumocystis jirovecii.

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Is cotrimoxazole prophylaxis against Pneumocystis jirovecii pneumonia needed in patients with systemic autoimmune rheumatic diseases requiring immunosuppressive therapies?

Cited by 6 publications

References 26 publications

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions

Interleukin-1 and the NLRP3 Inflammasome in Pericardial Disease

Position statement on infection screening, prophylaxis, and vaccination in pediatric patients with rheumatic diseases and immunosuppressive therapies, part 2: infection prophylaxis

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