Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients
Abstract Background The prevalence of pneumocystis pneumonia (PCP) and associated hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, no prior studies have evaluated the effect of early anti-PCP treatment on clinical outcomes in HIV-negative pa...
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| Format: | Article |
| Language: | English |
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BMC
2019-09-01
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| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12931-019-1188-6 |
| _version_ | 1828813673091563520 |
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| author | Ryoung-Eun Ko Soo Jin Na Kyungmin Huh Gee Young Suh Kyeongman Jeon |
| author_facet | Ryoung-Eun Ko Soo Jin Na Kyungmin Huh Gee Young Suh Kyeongman Jeon |
| author_sort | Ryoung-Eun Ko |
| collection | DOAJ |
| description | Abstract Background The prevalence of pneumocystis pneumonia (PCP) and associated hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, no prior studies have evaluated the effect of early anti-PCP treatment on clinical outcomes in HIV-negative patient with severe PCP. Therefore, this study investigated the association between the time to anti-PCP treatment and the clinical outcomes in HIV-negative patients with PCP who presented with hypoxemic respiratory failure. Methods A retrospective observational study was performed involving 51 HIV-negative patients with PCP who presented in respiratory failure and were admitted to the intensive care unit between October 2005 and July 2018. A logistic regression model was used to adjust for potential confounding factors in the association between the time to anti-PCP treatment and in-hospital mortality. Results All patients were treated with appropriate anti-PCP treatment, primarily involving trimethoprim/sulfamethoxazole. The median time to anti-PCP treatment was 58.0 (28.0–97.8) hours. Thirty-one (60.8%) patients were treated empirically prior to confirmation of the microbiological diagnosis. However, the hospital mortality rates were not associated with increasing quartiles of time until anti-PCP treatment (P = 0.818, test for trend). In addition, hospital mortality of patients received early empiric treatment was not better than those of patients received definitive treatment after microbiologic diagnosis (48.4% vs. 40.0%, P = 0.765). In a multiple logistic regression model, the time to anti-PCP treatment was not associated with increased mortality. However, age (adjusted OR 1.07, 95% CI 1.01–1.14) and failure to initial treatment (adjusted OR 13.03, 95% CI 2.34–72.65) were independently associated with increased mortality. Conclusions There was no association between the time to anti-PCP treatment and treatment outcomes in HIV-negative patients with PCP who presented in hypoxemic respiratory failure. |
| first_indexed | 2024-12-12T10:07:03Z |
| format | Article |
| id | doaj.art-1014292aecd047eb9593ded429c1deb5 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-12T10:07:03Z |
| publishDate | 2019-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-1014292aecd047eb9593ded429c1deb52022-12-22T00:27:53ZengBMCRespiratory Research1465-993X2019-09-0120111010.1186/s12931-019-1188-6Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patientsRyoung-Eun Ko0Soo Jin Na1Kyungmin Huh2Gee Young Suh3Kyeongman Jeon4Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDivision of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of MedicineAbstract Background The prevalence of pneumocystis pneumonia (PCP) and associated hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, no prior studies have evaluated the effect of early anti-PCP treatment on clinical outcomes in HIV-negative patient with severe PCP. Therefore, this study investigated the association between the time to anti-PCP treatment and the clinical outcomes in HIV-negative patients with PCP who presented with hypoxemic respiratory failure. Methods A retrospective observational study was performed involving 51 HIV-negative patients with PCP who presented in respiratory failure and were admitted to the intensive care unit between October 2005 and July 2018. A logistic regression model was used to adjust for potential confounding factors in the association between the time to anti-PCP treatment and in-hospital mortality. Results All patients were treated with appropriate anti-PCP treatment, primarily involving trimethoprim/sulfamethoxazole. The median time to anti-PCP treatment was 58.0 (28.0–97.8) hours. Thirty-one (60.8%) patients were treated empirically prior to confirmation of the microbiological diagnosis. However, the hospital mortality rates were not associated with increasing quartiles of time until anti-PCP treatment (P = 0.818, test for trend). In addition, hospital mortality of patients received early empiric treatment was not better than those of patients received definitive treatment after microbiologic diagnosis (48.4% vs. 40.0%, P = 0.765). In a multiple logistic regression model, the time to anti-PCP treatment was not associated with increased mortality. However, age (adjusted OR 1.07, 95% CI 1.01–1.14) and failure to initial treatment (adjusted OR 13.03, 95% CI 2.34–72.65) were independently associated with increased mortality. Conclusions There was no association between the time to anti-PCP treatment and treatment outcomes in HIV-negative patients with PCP who presented in hypoxemic respiratory failure.http://link.springer.com/article/10.1186/s12931-019-1188-6Pneumocystis pneumoniaHIV seronegativityRespiratory insufficiencyTime-to-treatmentTreatment outcome |
| spellingShingle | Ryoung-Eun Ko Soo Jin Na Kyungmin Huh Gee Young Suh Kyeongman Jeon Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients Respiratory Research Pneumocystis pneumonia HIV seronegativity Respiratory insufficiency Time-to-treatment Treatment outcome |
| title | Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients |
| title_full | Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients |
| title_fullStr | Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients |
| title_full_unstemmed | Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients |
| title_short | Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients |
| title_sort | association of time to treatment with outcomes of pneumocystis pneumonia with respiratory failure in hiv negative patients |
| topic | Pneumocystis pneumonia HIV seronegativity Respiratory insufficiency Time-to-treatment Treatment outcome |
| url | http://link.springer.com/article/10.1186/s12931-019-1188-6 |
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