scholarly journals Adequacy to diagnostic recommendations in patients with Pneumocystis jirovecii pneumonia treated with intravenous pentamidine

2021 ◽  
Author(s):  
Lorenzo Cantarelli ◽  
Fernando Gutiérrez Nicolás ◽  
Gloria Julia Nazco Casariego ◽  
Sara García Gil
Keyword(s):  
Safety Profile ◽  
Treatment Effectiveness ◽  
Length Of Hospital Stay ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Microbiological Analysis ◽  
Sample Collection ◽  
Presumptive Diagnosis ◽  
Receive Treatment ◽  
Microbiological Confirmation

Objectives. To determine the rate of microbiological confirmation in the diagnosis of Pneumocystis jirovecii pneumonia in patients treated with intravenous pentamidine and the potential correlation with treatment effectiveness and safety. Material and methods. Single-centre retrospective study (2010-2020), which included those patients who received intravenous pentamidine treatment for at least 48 hours. The sample collection procedure and the microbiological analysis performed were recorded. Efficacy was determined by 14-day mortality rate and admission to the Intensive Care Unit (ICU), and disease control was determined by length of hospital stay and time from completion of treatment to discharge. The safety profile was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results. A total of 17 patients with P. jirovecii pneumonia were treated with pentamidine (76.5% male (n=13); mean age [standard deviation]: 58.6 [15.5]). Microbiological confirmation of the pathogen was established in 47.1% (n=8) of cases. Targeted use of pentamidine significantly reduced the time from treatment completion to hospital discharge (p=0.019). The safety profile was acceptable, with grade I toxicity occurring in one patient. Conclusions. The study shows that more than 50% of patients receive treatment based on a presumptive diagnosis and without adhering to the established recommendations, with repercussions on the duration of admission and recovery of the patient. Future studies with a larger sample size will be necessary to consolidate the results obtained.

Twice weekly prophylaxis with trimethoprim/sulfamethoxazole for Pneumocystis jirovecii pneumonia in pediatric oncology patients

2020 ◽  
pp. 107815522097904
Author(s):  
Monica Awad ◽  
Caroline M Sierra ◽  
Elhaam Mesghali ◽  
Khaled Bahjri
Keyword(s):  
Pediatric Oncology ◽  
Retrospective Cohort ◽  
Hematologic Malignancies ◽  
Primary Objective ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Weekly Dose ◽  
Single Center ◽  
Oncology Patients ◽  
Prophylaxis Therapy

Current recommendations for prophylaxis of Pneumocystis jirovecii pneumonia in oncology patients include administration of trimethoprim/sulfamethoxazole (TMP/SMX) three times weekly or the same total weekly dose given daily. The primary objective of this study was to evaluate the efficacy of two consecutive days per week of TMP/SMX for prevention of Pneumocystis jirovecii pneumonia (PJP) in pediatric oncology patients. A retrospective cohort, single-center analysis was conducted in oncology patients 21 years and younger who received TMP/SMX for PJP prophylaxis between February 1, 2013 and July 31, 2017. Changes to the prophylaxis regimen were documented and analyzed. A total of 322 patients received TMP/SMX on two consecutive days per week for PJP prevention, of whom four had confirmed PJP (1.3%). Neutropenia was the most common reason for switching to alternative prophylaxis therapy (11.5%). Two consecutive prophylaxis days with TMP/SMX may be insufficient to prevent PJP in children with hematologic malignancies. Neutropenia remains a barrier for TMP/SMX use for PJP prophylaxis. Further studies to compare PJP incidence in children receiving alternative prophylaxis regimens should be considered.

scholarly journals Pneumocystis and SARS-CoV-2 Co-Infection: A Case Report and Review of an Emerging Diagnostic Dilemma

2020 ◽  
Author(s):  
Carlos Rubiano ◽  
Kathleen Tompkins ◽  
Subhashini A Sellers ◽  
Brian Bramson ◽  
Joseph Eron ◽  
...  
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Therapeutic Strategies ◽  
Pneumocystis Jirovecii ◽  
Critically Ill Patient ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Diagnostic Dilemma

Abstract We present a case of a critically ill patient with COVID-19 found to have AIDS and Pneumocystis jirovecii pneumonia (PCP). COVID-19 and PCP co-occurrence is increasingly reported and may complicate diagnostic and therapeutic strategies. Patients with severe COVID-19 should be screened for underlying immunocompromise and coinfections should be considered.

scholarly journals COVID-19 and Pneumocystis jirovecii pneumonia: Back to the basics

2021 ◽  
Vol 79 ◽  
pp. 100814
Author(s):  
D. Mouren ◽  
C. Goyard ◽  
E. Catherinot ◽  
C. Givel ◽  
A. Chabrol ◽  
...  
Keyword(s):  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia

scholarly journals 1171. Lower Mortality with Adjuvant Corticosteroid Therapy in non-HIV Infected Patients with pneumocystis jirovecii pneumonia: A Single US Cohort Study and a Proposed Novel Mechanism of Corticosteroids

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S610-S611
Author(s):  
William Mundo ◽  
Carlos Franco-Paredes ◽  
Steven C Johnson ◽  
Leland Shapiro ◽  
Andres Henao-Martinez
Keyword(s):  
Corticosteroid Therapy ◽  
Multivariable Analysis ◽  
Solid Organ Transplantation ◽  
Pneumocystis Jirovecii ◽  
Lower Mortality ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Solid Organ ◽  
Hiv Status ◽  
Predictors Of Mortality ◽  
Hiv Negative

Abstract Background Pneumocystis jirovecii pneumonia (PJP) remains a cause of mortality in HIV-negative patients. The clinical benefit of adjuvant corticosteroids given at the time of PJP antimicrobial therapy in these patients is uncertain. This study aimed to determine if corticosteroids reduced mortality in a cohort of HIV-negative PJP patients, and to propose a novel mechanism explaining corticosteroid benefit in patients regardless of HIV status. Methods We examined a retrospective case series of patients diagnosed with PJP at the University of Colorado Hospital between 1995-2019. Data were collected in 71 PJP-infected patients. Twenty-eight patients were HIV-negative, and 43 were infected with HIV. We performed bivariate and forward, stepwise multivariable logistic regressions to identify predictors of mortality. Results Underlying conditions in HIV-negative patients were hematologic malignancies (28.6%), autoimmune disorders (25.9%), or solid organ transplantation (10.7%). Compared to HIV-positive patients, HIV-negative patients had higher rates and duration of mechanical ventilation and ICU stay. Survival was significantly increased in HIV-negative patients receiving adjunct corticosteroids, with 100% mortality in patients not receiving corticosteroids vs 60% mortality in patients receiving corticosteroids (p=0.034). In an adjusted multivariable model, corticosteroids were associated with lower mortality (OR 13.5, 95% CI: 1.1-158.5, p= 0.039) regardless of HIV status. In a novel model of adjunct corticosteroid benefit, we propose corticosteroids reduce immune-mediated lysis of Pneumocystis organisms that curtails the surfactant-disabling effect of PJP internal contents. Table 1. Multivariable Analysis of Predictors of Mortality in patients with PJP Figure 1. Mortality differences by HIV status and use of steroids in PJP Conclusion We found substantial mortality among HIV-negative patients with PJP and adjunct corticosteroid use was associated with decreased mortality. Adjunct corticosteroid mortality-lowering effect is best explained by suppressing pneumocystis lysis. This reduces surfactant disruption resulting from pneumocystis internal substances. Figure 2. Proposed mechanism of action for benefits of adjunct exogenous corticosteroid therapy during PJP Disclosures All Authors: No reported disclosures

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