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免疫受损患者的死亡率显著。预防措施主要基于复方新诺明和磺胺甲噁唑（TMP-SMX）的联合使用，但关于肺孢子虫病预防的指南散乱且缺乏一致性。研究目的：本研究旨在描述非HIV患者的PCP，并依据具体指南逐一审查预防性治疗的先前指征。我们纳入了2007年至2020年间被一所大学医院确诊为PCP的患者。根据潜在病理或治疗的特定指南评估了预防性治疗的先前指征。结果：在150例PCP医学诊断患者中，有78例被纳入研究。确定了四种潜在的病理学组别：血液病（42%）、自身免疫性疾病（27%）、器官移植（17%）以及PCP风险的其他病理（14%）。14名患者（18%）的小组先前已接受过肺孢子虫病预防性治疗的处方，但在病例发生时并未接受。33名患者（42%）需要转入重症监护室，3个月时的死亡率达到20%。根据国际疾病学会指南，应有52名患者（59%）在肺孢子虫病发生时进行预防。在血液病组中，72%的患者（24例）未接受指南中规定的预防性治疗，合规率最低。结论：传染病专家应制定针对肺孢子虫病的特定预防指南，以促进疾病的更好预防，并根据个体特征在其建议中纳入额外的标准，以预防致命病例。