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Pneumocystis in the era of prophylaxis: do the guidelines have to change?
Julien Nunes1, Nahéma Issa2, Amandine Dupuis3
1Pharmacy Hospital, Centre Hospitalier de Cosne Cours Sur Loire, 58206, Cosne Cours Sur Loire, France. julien.nunes91@gmail.com.
Insights
Many immunocompromised patients diagnosed with Pneumocystis pneumonia (PCP) were not on prophylaxis, leading to preventable cases and deaths. Prophylaxis should be considered for high-risk individuals, even without formal guidelines.
Area of Science:
- Infectious Diseases
- Immunology
- Pulmonology
Background:
- Pneumocystis pneumonia (PCP) remains a significant opportunistic infection in immunocompromised individuals.
- Effective prophylaxis strategies exist, yet PCP cases persist.
- Understanding patient profiles and prophylaxis adherence is crucial for improving outcomes.
Purpose of the Study:
- To describe the clinical profile of patients diagnosed with Pneumocystis pneumonia (PCP).
- To evaluate the consistency of clinical scenarios with established prophylaxis guidelines.
- To identify gaps in current PCP prophylaxis practices.
Main Methods:
- A single-centre, retrospective study was conducted.
- Data were collected from electronic medical files of adult patients (> 2009 18 years) with a confirmed PCP diagnosis.
- Patient demographics, risk factors, treatment, and outcomes were analyzed.
Main Results:
- 225 patients with PCP were analyzed between January 2015 and June 2020.
- Over 95% of patients were not receiving anti-PCP prophylaxis at diagnosis.
- 14% of patients died during PCP treatment, with higher mortality in autoimmune disease and solid tumor groups.
Conclusions:
- A substantial number of PCP cases occurred over a 5-year period, indicating potential gaps in prophylaxis.
- Most patients were immunosuppressed with known risk factors for PCP.
- Prophylaxis should be strongly considered for immunocompromised patients with risk factors, irrespective of formal recommendations.
Purpose:
In the era of effective prophylaxis, the objective of this study was to describe pneumocystis pneumonia (PCP) patients' profile and evaluate the consistency of clinical situations encountered with the recommended indications for prophylaxis.
Methods:
This was a single-centre, retrospective study. All adults (> 18 years) with a definitive diagnosis of PCP were included. Data were collected from patients' electronic medical files.
Results:
The study examined the medical files of 225 patients diagnosed with PCP and treated between 1 January, 2015, and 30 June, 2020. More than 95% of the patients were not on anti-PCP prophylaxis at the time of PCP diagnosis. There were 32 (14%) deaths before the end of PCP treatment, mainly in auto-immune disease (30%) and solid tumours (38%) groups unlike the solid-organ transplants group, among whom deaths were infrequent. Indeed, 48% of our cohort (n = 107) had both corticosteroid (CS) therapy, immunosuppressive or immunomodulatory treatment, and lymphopaenia and could have been considered at high risk for PCP. Trimethoprim/sulfamethoxazole was administered as first-line PCP curative treatment in 95% of the patients. Toxicities of this drug led to treatment interruption in 25% of the patients (except death).
Conclusions:
This study found a high number of PCP cases over 5 years. Unsurprisingly, most of the patients were immunosuppressed, with risk factors for PCP already described in the literature. This large number of PCP cases should be avoidable and, consequently, questions arise. Faced with these data, prophylaxis should be common sense for immunocompromised patients with risk factors, even if formalised recommendations do not exist.
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