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 documento: artigo
Data de publicação:2023
País:España
Recursos:Universitat Autònoma de Barcelona
Repositório:Dipòsit Digital de Documents de la UAB
Idioma:inglês
OAI Identifier:oai:ddd.uab.cat:311732
Acesso em linha:https://ddd.uab.cat/record/311732
https://dx.doi.org/urn:doi:10.1186/s13054-023-04608-1
Access Level:Acceso aberto
Palavra-chave:Biomarker
Diagnosis
ICU
PCR
Pneumocystis
Pneumonia
Serum β-D-Glucan
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oai_identifier_str oai:ddd.uab.cat:311732
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Pneumocystis jirovecii pneumonia in intensive care units
a multicenter study by ESGCIP and EFISG
title Pneumocystis jirovecii pneumonia in intensive care units
spellingShingle Pneumocystis jirovecii pneumonia in intensive care units
Giacobbe, Daniel Roberto|||0000-0003-2385-1759
Biomarker
Diagnosis
ICU
PCR
Pneumocystis
Pneumonia
Serum β-D-Glucan
title_short Pneumocystis jirovecii pneumonia in intensive care units
title_full Pneumocystis jirovecii pneumonia in intensive care units
title_fullStr Pneumocystis jirovecii pneumonia in intensive care units
title_full_unstemmed Pneumocystis jirovecii pneumonia in intensive care units
title_sort Pneumocystis jirovecii pneumonia in intensive care units
dc.creator.none.fl_str_mv 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
author Giacobbe, Daniel Roberto|||0000-0003-2385-1759
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv JIR-ICU investigators
Universitat Autònoma de Barcelona
dc.subject.none.fl_str_mv Biomarker
Diagnosis
ICU
PCR
Pneumocystis
Pneumonia
Serum β-D-Glucan
topic Biomarker
Diagnosis
ICU
PCR
Pneumocystis
Pneumonia
Serum β-D-Glucan
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.
publishDate 2023
dc.date.none.fl_str_mv 2
2023-01-01
2023
2023-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/311732
https://dx.doi.org/urn:doi:10.1186/s13054-023-04608-1
url https://ddd.uab.cat/record/311732
https://dx.doi.org/urn:doi:10.1186/s13054-023-04608-1
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling Pneumocystis jirovecii pneumonia in intensive care unitsa multicenter study by ESGCIP and EFISGGiacobbe, Daniel Roberto|||0000-0003-2385-1759Dettori, SilviaDi Pilato, Vincenzo|||0000-0002-5863-5805Asperges, Erika|||0000-0002-1618-8867Ball, LorenzoBerti, EnoraBlennow, Ola|||0000-0002-7167-7882Bruzzone, BiancaCalvet, LaureCapra Marzani, FedericoCasabella Pernas, Antonio|||0000-0002-2534-3689Choudaly, SofiaDartevel, AnaisDe Pascale, GennaroDi Meco, GabrieleFallon, MelissaGalerneau, Louis-MarieGallego, Miguel|||0000-0002-8882-4033Giacomini, MauroGonzález Sáez, AdolfoHänsel, LuiseIcardi, GiancarloKoehler, Philipp|||0000-0002-7386-7495Lagrou, KatrienLahmer, Tobias|||0000-0003-1008-5311Lewis White, P.Magnasco, LauraMarchese, AnnaMarelli, CristinaMarín-Arriaza, MercedesMartin-Loeches, Ignacio|||0000-0002-5834-4063Mekontso-Dessap, Armand|||0000-0001-5961-5577Mikulska, Malgorzata|||0000-0002-5535-4602Mularoni, AlessandraNordlander, AnnaPoissy, Julien|||0000-0001-6017-5353Russelli, GiovannaSignori, Alessio|||0000-0001-6289-9144Tascini, Carlo|||0000-0001-9625-6024Vaconsin, Louis-MaximeVargas, JoelVena, Antonio|||0000-0002-0697-3992Wauters, Joost|||0000-0002-5983-3897Pelosi, Paolo|||0000-0001-5055-3023Timsit, Jean-FrancoisBassetti, Matteo|||0000-0002-0145-9740BiomarkerDiagnosisICUPCRPneumocystisPneumoniaSerum β-D-GlucanBackground: 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.JIR-ICU investigatorsUniversitat Autònoma de Barcelona 22023-01-0120232023-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/311732https://dx.doi.org/urn:doi:10.1186/s13054-023-04608-1reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:3117322026-06-06T12:50:31Z
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