| Resumen: |
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. |
visitante ::
identificación
(San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences (Itàlia))
