Pneumocystis jirovecii pneumonia in intensive care units : a multicenter study by ESGCIP and EFISG
Giacobbe, Daniel Roberto (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences (Itàlia))
Dettori, Silvia (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences (Itàlia))
Di Pilato, Vincenzo (University of Genoa (Itàlia))
Asperges, Erika (Fondazione IRCCS Policlinico San Matteo (Itàlia))
Ball, Lorenzo (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences (Itàlia))
Berti, Enora (Hôpital Henri Mondor. Hôpitaux Universitaires Henri Mondor (França))
Blennow, Ola (Karolinska Institute (Suècia))
Bruzzone, Bianca (San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences (Itàlia))
Calvet, Laure (CHU de Clermont-Ferrand (França))
Capra Marzani, Federico (Fondazione IRCCS Policlinico San Matteo (Itàlia))
Casabella Pernas, Antonio (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Choudaly, Sofia (University of Lille (França))
Dartevel, Anais (Medical Intensive Care Unit. Grenoble Alpes University Hospital (França))
De Pascale, Gennaro (Università Cattolica del Sacro Cuore (Itàlia))
Di Meco, Gabriele (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences (Itàlia))
Fallon, Melissa (University Hospital of Wales(Cardiff, Regne Unit))
Galerneau, Louis-Marie (Medical Intensive Care Unit. Grenoble Alpes University Hospital (França))
Gallego, Miguel (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Giacomini, Mauro (University of Genoa (Itàlia))
González Sáez, Adolfo (Universidad Complutense de Madrid)
Hänsel, Luise (University of Cologne (Alemanya))
Icardi, Giancarlo (San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences (Itàlia))
Koehler, Philipp (University of Cologne (Alemanya))
Lagrou, Katrien (University Hospitals Leuven (Bèlgica))
Lahmer, Tobias (Technical University of Munich)
Lewis White, P. (Cardiff University Centre for Trials Research)
Magnasco, Laura (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences)
Marchese, Anna (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences)
Marelli, Cristina (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences)
Marín-Arriaza, Mercedes (Universidad Complutense de Madrid)
Martin-Loeches, Ignacio (Hospital Clínic i Provincial de Barcelona)
Mekontso-Dessap, Armand (INSERM)
Mikulska, Malgorzata (IRCCS Ospedale Policlinico San Martino (Gènova, Itàlia))
Mularoni, Alessandra (ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione)
Nordlander, Anna (Karolinska Institutet (Estocolm, Suècia))
Poissy, Julien (Université de Lille (França))
Russelli, Giovanna (ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione)
Signori, Alessio (University of Genoa)
Tascini, Carlo (University of Udine)
Vaconsin, Louis-Maxime (Bichat Hospital)
Vargas, Joel (Fondazione Policlinico Universitario A. Gemelli IRCCS)
Vena, Antonio (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences)
Wauters, Joost (University Hospitals Leuven (Bèlgica))
Pelosi, Paolo (San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences)
Timsit, Jean-Francois (Université Paris Cité)
Bassetti, Matteo (IRCCS Ospedale Policlinico San Martino (Gènova, Itàlia))
JIR-ICU investigators
Universitat Autònoma de Barcelona

Data:	2023
Resum:	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.
Drets:	Aquest 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.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Biomarker ; Diagnosis ; ICU ; PCR ; Pneumocystis ; Pneumonia ; Serum β-D-Glucan
Publicat a:	Critical care, Vol. 27 Núm. 1 (december 2023) , p. 323, ISSN 1466-609X

DOI: 10.1186/s13054-023-04608-1
PMID: 37620828

14 p, 1.0 MB

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