The 2025 EQUAL Pneumocystis Score-an ECMM tool to measure QUALity in Pneumocystis pneumonia management
Luise Haensel1,2, Rosanne Sprute1,2,3, Jan Grothe1,2
1Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Herderstrasse 52, Cologne, NRW 50931, Germany.
Background:
Pneumocystis pneumonia (PCP) is an opportunistic fungal infection. Several guidelines have been published to support its clinical management. However, the complexity and breadth of these guidelines pose challenges for consistent implementation in routine clinical practice.
Objectives:
To develop a scoring tool and quality indicator that facilitates clinical decision making and quantifies adherence to best-practice guidelines for PCP in patients with and without HIV.
Methods:
Key recommendations for the diagnosis, treatment and follow-up of PCP were extracted from current guidelines of the European Council on Infections in Leukaemia (ECIL), the American Society of Transplantation Infectious Diseases Community of Practice (AST-IDCOP), and the IDSA guidelines. Each recommendation was assigned a point value ranging from -1 to 3, weighted according to the strength of recommendation and level of evidence.
Results:
The proposed 2025 European Confederation of Medical Mycology (ECMM) QUALity (EQUAL) Pneumocystis Score consists of 24 items for patients with HIV and 22 for patients without HIV. For diagnosis, bronchoalveolar lavage and immunofluorescence assays received the highest scores due to their superior sensitivity and specificity for sampling and analysis. Trimethoprim/sulfamethoxazole is the treatment of choice and was awarded with the highest score. The addition of corticosteroids for patients with HIV and respiratory failure completes the treatment category. The score is completed with the patient follow-up. For HIV patients a maximum score of 31 and for non-HIV patients a maximum score of 27 is achievable.
Conclusions:
The 2025 EQUAL Pneumocystis Score offers a concise, evidence-based tool for the optimal management of PCP. This can be useful in daily practice for a quick overview and may be used to measure guideline adherence in research settings. It has not yet been assessed whether higher EQUAL Pneumocystis Scores are associated with improved patient outcomes.
Insights
A new scoring tool helps manage Pneumocystis pneumonia (PCP) by simplifying guideline adherence for patients with and without HIV. The EQUAL Pneumocystis Score aids clinical decisions and research.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Decision Support
Background:
- Pneumocystis pneumonia (PCP) is an opportunistic fungal infection.
- Clinical management guidelines for PCP exist but are complex to implement consistently.
- Challenges remain in routine clinical practice for PCP management.
Purpose of the Study:
- Develop a scoring tool and quality indicator for PCP management.
- Facilitate clinical decision-making for PCP diagnosis, treatment, and follow-up.
- Quantify adherence to best-practice guidelines in patients with and without HIV.
Main Methods:
- Extracted key recommendations from ECIL, AST-IDCOP, and IDSA guidelines.
- Assigned point values (-1 to 3) to recommendations based on evidence strength.
- Developed the 2025 European Confederation of Medical Mycology (ECMM) QUALity (EQUAL) Pneumocystis Score.
Main Results:
- The EQUAL Pneumocystis Score has 24 items for HIV+ patients and 22 for HIV- patients.
- Bronchoalveolar lavage and immunofluorescence assays scored highest for diagnosis.
- Trimethoprim/sulfamethoxazole received the highest treatment score; corticosteroids included for HIV+ patients with respiratory failure.
Conclusions:
- The 2025 EQUAL Pneumocystis Score is a concise, evidence-based tool for optimal PCP management.
- The score aids in daily clinical practice and measuring guideline adherence in research.
- Further assessment is needed to correlate EQUAL Pneumocystis Scores with patient outcomes.
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