Pneumocystis pneumonia in HIV-negative adults: missed opportunities for prevention
Nicholas Young1, Stephen McBride2, Susan Morpeth3
1Infectious Diseases Service, Waitemata District Health Board, Auckland.
Insights
Pneumocystis pneumonia (PCP) is often preventable in immunocompromised patients. A study found 30.6% of PCP cases were preventable with prophylaxis, highlighting a need for better adherence to guidelines.
Area of Science:
- Infectious Diseases
- Immunocompromised Hosts
- Public Health
Background:
- Pneumocystis pneumonia (PCP) carries a high mortality rate in HIV-negative immunocompromised individuals.
- Antimicrobial prophylaxis can effectively prevent PCP.
- Identifying potentially preventable PCP cases is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of potentially preventable PCP in Auckland, New Zealand.
- To assess the proportion of PCP cases that could have been avoided with appropriate prophylaxis.
- To identify patient groups at highest risk for preventable PCP.
Main Methods:
- Retrospective study of HIV-negative adults diagnosed with PCP.
- Inclusion of patients from Middlemore, North Shore, and Waitakere Hospitals (January 2011 - June 2017).
- Classification of PCP as potentially preventable based on lack of prophylaxis despite common indications.
Main Results:
- 108 patients with PCP were identified; 33 (30.6%) had potentially preventable infections.
- Of those with preventable PCP, 14 (42.4%) died within 30 days.
- Preventable cases were most common in patients with malignancies receiving prolonged high-dose corticosteroids.
Conclusions:
- A significant proportion of PCP cases and associated mortality in Auckland are potentially preventable.
- Improved clinician awareness of PCP prophylaxis indications is needed, especially for patients on long-term corticosteroids for malignancies.
- Implementing prophylaxis guidelines could reduce PCP incidence and deaths.
Aim:
Pneumocystis pneumonia (PCP) has a high mortality rate in HIV-negative immunocompromised patients, but is preventable with antimicrobial prophylaxis. We aimed to determine the incidence of PCP in three hospitals in Auckland, New Zealand that would have been potentially preventable if patients had been prescribed prophylaxis according to commonly proposed indications.
Methods:
We conducted a retrospective study of HIV-negative adults with PCP who were admitted to Middlemore, North Shore or Waitakere Hospitals between January 2011 and June 2017. We classified their PCP as potentially preventable if they had not been prescribed prophylaxis despite having a commonly proposed indication for this.
Results:
Of the 108 patients with PCP, 33/108 (30.6%) had potentially preventable infection. Of these, 14/33 (42.4%) died within 30 days of diagnosis of PCP. Most potentially preventable infections occurred in patients with solid organ or haematologic malignancies who were receiving high-dose corticosteroids for >4 weeks. We estimate that 28 cases of PCP and 12 deaths could have been prevented over the study duration if prophylaxis was prescribed to those with commonly proposed indications.
Conclusion:
There is a substantial incidence of potentially preventable PCP and PCP-related mortality in the Auckland region. This could be reduced by greater clinician familiarity with commonly proposed indications for PCP prophylaxis, particularly for clinicians prescribing prolonged corticosteroid courses to patients with malignancies.
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