Outcomes of Moderate-to-Severe Pneumocystis Pneumonia Treated with Adjunctive Steroid in Non-HIV-Infected Patients

Moon, Song Mi; Kim, Tark; Sung, Heungsup; Kim, Mina; Kim, Sung-Han; Choi, Sang‐Ho; Jeong, Jin‐Yong; Woo, Jun Hee; Kim, Yang Soo; Lee, Sang‐Oh

doi:10.1128/aac.00669-11

Cited by 75 publications

(71 citation statements)

References 15 publications

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“…This apparent discrepancy may be explained by the different outcome periods used in the various studies and the large proportion of lung recipients in the 2 latter studies. Higher mortality rates have been reported in patients with fungal opportunistic infections after SOT, including pneumocystosis (90-day mortality 23.1%, 6/26) [26], aspergillosis (12-week mortality, 39.3%, 44/112) [27], and mucormycosis (90-day mortality 58.2%, 57/105) [27]. We were therefore not surprised to observe that occurrence of an invasive fungal infection in the 6 months prior to nocardiosis (reported in 17.0% of our cohort and in 37.5% of the patients who died) was independently associated with an increased risk of death, as has been suggested previously [8].…”

Section: Discussionmentioning

confidence: 99%

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Lebeaux

Freund

Delden

et al. 2017

Clinical Infectious Diseases

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Background. Solid organ transplant (SOT) recipients are at risk of nocardiosis, a rare opportunistic bacterial infection, but prognosis and outcome of these patients are poorly defined. Our objectives were to identify factors associated with 1-year mortality after nocardiosis and describe the outcome of patients receiving short-course antibiotics (≤120 days).Methods. We analyzed data from a multicenter European case-control study that included 117 SOT recipients with nocardiosis diagnosed between 2000 and 2014. Factors associated with 1-year all-cause mortality were identified using multivariable conditional logistic regression.Results. One-year mortality was 10-fold higher in patients with nocardiosis (16.2%, 19/117) than in control transplant recipients (1.3%, 3/233, P < .001). A history of tumor (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8), invasive fungal infection (OR, 1.3; 95% CI, 1.1-1.5), and donor age (OR, 1.0046; 95% CI, 1.0007-1.0083) were independently associated with 1-year mortality. Acute rejection in the year before nocardiosis was associated with improved survival (OR, 0.85; 95% CI, 0.73-0.98). Seventeen patients received short-course antibiotics (median duration 56 [24-120] days) with a 1-year success rate (cured and surviving) of 88% and a 5.9% risk of relapse (median follow-up 49 months).Conclusions. One-year mortality was 10-fold higher in SOT patients with nocardiosis than in those without. Four factors, largely reflecting general medical condition rather than severity and/or management of nocardiosis, were independently associated with 1-year mortality. Patients who received short-course antibiotic treatment had good outcomes, suggesting that this may be a strategy for further study.

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Section: Discussionmentioning

confidence: 99%

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Lebeaux

Freund

Delden

et al. 2017

Clinical Infectious Diseases

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“…Through multivariate analysis, we found that solid-organ transplantation was significantly associated with a better outcome. Previous reports have shown that mortality rates vary according to underlying disease or condition among non-HIV-infected patients with PCP (3)(4)(5). A Dutch group reported that the overall mortality rate was 35% among 78 HIV-negative patients, with the lowest rate (8%) among 13 kidney transplant recipients (25).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, PCP has been reported with increasing frequency in non-HIV-infected patients, particularly in those with underlying immunosuppressive conditions such as hematologic malignancies, solid tumors, collagen vascular diseases, and solidorgan transplants and those receiving immunosuppressive therapies (2,3). Although clinical outcomes of PCP in HIV-infected patients have improved with the introduction of antiretroviral therapy, mortality rates among other immunocompromised patients with PCP who do not have HIV remain high at 30% to 60% (3)(4)(5). Identifying potential prognostic factors in non-HIV-infected patients with PCP could help clinicians make therapeutic decisions, such as choosing the appropriate site of care (intensive care unit versus general ward) or level of patient monitoring.…”

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confidence: 99%

Cellular Profiles of Bronchoalveolar Lavage Fluid and Their Prognostic Significance for Non-HIV-Infected Patients with Pneumocystis jirovecii Pneumonia

et al. 2015

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“…35 Torr, the administration of adjunctive corticosteroid therapy is recommended within 72 hours of the start of SMX-TMP therapy (9). However, it is not clear whether adjunctive corticosteroids should be administered in non-HIV patients with PCP (10). Previous studies of small populations have reported that the use of adjunctive corticosteroid treatment in non-HIV patients with PCP and hypoxia shortens the duration of both mechanical ventilation and hospitalization (3,4).…”

Section: Discussionmentioning

confidence: 99%

Deterioration of the Immune Response Induced by Sulfamethoxazole-trimethoprim in a Rheumatoid Arthritis Patient with <i>Pneumocystis jirovecii</i> Pneumonia

Gochi¹,

Takayanagi²,

Ishiguro³

et al. 2014

Intern. Med.

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A 73-year-old woman with rheumatoid arthritis treated with methotrexate and prednisolone was admitted with dyspnea and ground-glass opacity on chest CT. We diagnosed her with Pneumocystis jirovecii pneumonia (PCP) based on a positive PCR analysis of Pneumocystis jirovecii and the presence of cysts in bronchoalveolar lavage fluid. The PaO2 was 74.7 Torr on room air, and treatment with sulfamethoxazole-trimethoprim only was initiated. The hypoxemia and ground-glass opacity increased on hospital day 3, and the administration of adjunctive steroid therapy resulted in an improvement in the patient's condition. Although patients with PCP with HIV infection and hypoxemia are often treated with adjunctive steroid therapy to prevent adverse immune reactions, the efficacy of additive steroid administration in case of non-HIV PCP has not been established.

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Outcomes of Moderate-to-Severe Pneumocystis Pneumonia Treated with Adjunctive Steroid in Non-HIV-Infected Patients

Cited by 75 publications

References 15 publications

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Cellular Profiles of Bronchoalveolar Lavage Fluid and Their Prognostic Significance for Non-HIV-Infected Patients with Pneumocystis jirovecii Pneumonia

Deterioration of the Immune Response Induced by Sulfamethoxazole-trimethoprim in a Rheumatoid Arthritis Patient with <i>Pneumocystis jirovecii</i> Pneumonia

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