Table_2_Pneumocystis jirovecii pneumonia in non-HIV patients: need for a more extended prophylaxis.docx

BackgroundPneumocystis jirovecii pneumonia (PCP) has a significant mortality rate for non-HIV immunocompromised patients. Prevention is primarily based on combined trimethoprim and sulfamethoxazole (TMP-SMX) but guidelines on pneumocystosis prophylaxis are scattered and not consensual.ObjectivesThis study aims to describe PCP in non-HIV patients and to review case by case the prior indication of prophylaxis according to specific guidelines.We included patients with confirmed diagnosis of PCP admitted to one university hospital from 2007 to 2020. Prior indication for pneumocystis prophylaxis was assessed according to the specific guidelines for the underlying pathology or treatment.ResultsOf 150 patients with a medical diagnosis of PCP, 78 were included. Four groups of underlying pathologies were identified: hematological pathologies (42%), autoimmune diseases (27%), organ transplantation (17%), and other pathologies at risk of PCP (14%). A small subgroup of 14 patients (18%) had received a prior prescription of pneumocystis prophylaxis but none at the time of the episode. Transfer to intensive care was necessary for 33 (42%) patients, and the mortality rate at 3 months was 20%. According to international disease society guidelines, 52 patients (59%) should have been on prophylaxis at the time of the pneumocystis episode. Lowest compliance with guidelines was observed in the hematological disease group for 24 patients (72%) without prescription of indicated prophylaxis.ConclusionInfectious disease specialists should draw up specific prophylactic guidelines against pneumocystis to promote a better prevention of the disease and include additional criteria in their recommendations according to individual characteristics to prevent fatal cases.

背景：肺孢子虫肺炎（PCP）对非HIV免疫抑制患者具有显著的死亡率。预防措施主要基于复方新诺明（TMP-SMX），然而，关于肺孢子虫病预防的指南分散且缺乏共识。目标：本研究旨在描述非HIV患者的PCP，并按个案回顾根据特定指南的预防指征。我们纳入了2007年至2020年入住一所大学医院的确诊为PCP的病例。根据潜在的病理或治疗方案，评估了预防肺孢子虫的先前指征。结果：在150名患有PCP医疗诊断的患者中，有78名被纳入研究。确定了四种潜在的病理学组：血液学疾病（42%）、自身免疫性疾病（27%）、器官移植（17%）和其他存在PCP风险病理（14%）。14名患者（18%）曾接受过肺孢子虫预防的先前处方，但在发作时并未接受。33名患者（42%）需要转入重症监护室，3个月内的死亡率达20%。根据国际疾病学会指南，52名患者（59%）应在肺孢子虫发作时接受预防。在未接受推荐预防措施的血液病组中，24名患者（72%）对指南的遵守度最低。结论：感染病专家应制定针对肺孢子虫的具体预防指南，以促进疾病的更好预防，并根据个体特征在其推荐中包含额外标准，以预防致命病例。