Pneumocystis jirovecii pneumonia in intensive care units

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...

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Autores: Giacobbe, Daniel Roberto|||0000-0003-2385-1759, Dettori, Silvia, Di Pilato, Vincenzo|||0000-0002-5863-5805, Asperges, Erika|||0000-0002-1618-8867, Ball, Lorenzo, Berti, Enora, Blennow, Ola|||0000-0002-7167-7882, Bruzzone, Bianca, Calvet, Laure, Capra Marzani, Federico, Casabella Pernas, Antonio|||0000-0002-2534-3689, Choudaly, Sofia, Dartevel, Anais, De Pascale, Gennaro, Di Meco, Gabriele, Fallon, Melissa, Galerneau, Louis-Marie, Gallego, Miguel|||0000-0002-8882-4033, Giacomini, Mauro, González Sáez, Adolfo, Hänsel, Luise, Icardi, Giancarlo, Koehler, Philipp|||0000-0002-7386-7495, Lagrou, Katrien, Lahmer, Tobias|||0000-0003-1008-5311, Lewis White, P., Magnasco, Laura, Marchese, Anna, Marelli, Cristina, Marín-Arriaza, Mercedes, Martin-Loeches, Ignacio|||0000-0002-5834-4063, Mekontso-Dessap, Armand|||0000-0001-5961-5577, Mikulska, Malgorzata|||0000-0002-5535-4602, Mularoni, Alessandra, Nordlander, Anna, Poissy, Julien|||0000-0001-6017-5353, Russelli, Giovanna, Signori, Alessio|||0000-0001-6289-9144, Tascini, Carlo|||0000-0001-9625-6024, Vaconsin, Louis-Maxime, Vargas, Joel, Vena, Antonio|||0000-0002-0697-3992, Wauters, Joost|||0000-0002-5983-3897, Pelosi, Paolo|||0000-0001-5055-3023, Timsit, Jean-Francois, Bassetti, Matteo|||0000-0002-0145-9740
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:311732
Acceso en línea:https://ddd.uab.cat/record/311732
https://dx.doi.org/urn:doi:10.1186/s13054-023-04608-1
Access Level:acceso abierto
Palabra clave:Biomarker
Diagnosis
ICU
PCR
Pneumocystis
Pneumonia
Serum β-D-Glucan
Descripción
Sumario: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.

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