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Published on: November 8, 2015
Incidence of pneumocystosis among patients exposed to immunosuppression
Sergey Rekhtman1, Andrew Strunk1, Amit Garg1
1Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
Background:
The decision to administer prophylaxis to patients receiving immunosuppression against pneumocystosis remains a dilemma.
Objective:
To determine overall and age-specific 5-year pneumocystosis incidence within a population exposed to immunosuppressants.
Methods:
Retrospective cohort analysis identifying incident pneumocystosis cases among adults without HIV, AIDS, or cancer exposed to immunosuppressant, corticosteroid therapy, or both.
Results:
We identified 406 new cases among patients prescribed an immunosuppressant, corticosteroid, or both. Overall incidence of pneumocystosis was 0.012% (406/3,366,086). Incidence was highest in those exposed to immunosuppressant and corticosteroid medications (0.199%), followed by those exposed to immunosuppressant alone (0.012%), corticosteroid alone (0.008%), and neither medication (0.001%) (P < .001). The greatest risk differences were noted between groups exposed to immunosuppressant and corticosteroid compared with neither (0.198%, 95% confidence interval [CI] 0.166%-0.230%) or immunosuppressant alone (0.188%, 95% CI 0.155%-0.221%). The greatest relative risks (RRs) were noted among those receiving immunosuppressant and corticosteroid compared with those exposed to neither (RR 122.5, 95% CI 100.9-148.8) or immunosuppressant alone (RR 16.5, 95% CI 7.3-37.4).
Limitations:
We could not confirm dose and duration of exposures.
Conclusion:
Incidence of pneumocystosis among patients exposed to immunosuppressants is very low. Prophylaxis for patients receiving combination immunosuppressant and corticosteroid therapy, the group at highest risk, might be warranted.
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