Efficacy of initial caspofungin plus trimethoprim/sulfamethoxazole for severe PCP in patients without human immunodeficiency virus infection
Abstract Background The number of pneumocystis pneumonia (PCP) cases is increasing in immunocompromised patients without human immunodeficiency virus infection (HIV), causing serious morbidity with high mortality. Trimethoprim/sulfamethoxazole (TMP/SMZ) monotherapy has limited effectiveness in the t...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08372-z |
| _version_ | 1797801592110448640 |
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| author | Hui Qi Danjiang Dong Ning Liu Ying Xu Mengzhi Qi Qin Gu |
| author_facet | Hui Qi Danjiang Dong Ning Liu Ying Xu Mengzhi Qi Qin Gu |
| author_sort | Hui Qi |
| collection | DOAJ |
| description | Abstract Background The number of pneumocystis pneumonia (PCP) cases is increasing in immunocompromised patients without human immunodeficiency virus infection (HIV), causing serious morbidity with high mortality. Trimethoprim/sulfamethoxazole (TMP/SMZ) monotherapy has limited effectiveness in the treatment of PCP. Clinical data on whether initial caspofungin plus TMP/SMZ for this disease is superior to monotherapy in non-HIV-infected patients are limited. We aimed to compare the clinical effectiveness of these regimens for severe PCP in non-HIV patients. Methods A retrospective study reviewed 104 non-HIV-infected patients with confirmed PCP in the intensive care unit between January 2016 and December 2021. Eleven patients were excluded from the study because TMP/SMZ could not be used due to severe hematologic disorders or clinical data were missing. All enrolled patients were divided into three groups according to different treatment strategies: Group 1 received TMP/SMZ monotherapy, Group 2 received caspofungin combined with TMP/SMZ as first-line therapy, and Group 3 initially received TMP/SMZ monotherapy and later received caspofungin as salvage therapy. The clinical characteristics and outcomes were compared among the groups. Results A total of 93 patients met the criteria. The overall positive response rate of anti-PCP treatment was 58.06%, and the overall 90-day all-cause mortality rate was 49.46%. The median APACHE II score was 21.44. The concurrent infection rate was 74.19%, among whom 15.05% (n = 14) of those patients had pulmonary aspergillosis, 21.05% (n = 20) had bacteremia, and 23.65% (n = 22) had CMV infections. The patients who received initial caspofungin combination with TMP/SMZ had the best positive response rate (76.74%) compared to others (p = 0.001). Furthermore, the group that received initial caspofungin combined with TMP/SMZ had a 90-day all-cause mortality rate (39.53%) that was significantly different from that of the shift group (65.51%, p = 0.024), but this rate showed no statistically significant difference compared with that in the monotherapy group (48.62%, p = 0.322). None of the patients had serious adverse events from caspofungin therapy. Conclusions For non-HIV-infected patients with severe PCP, initial combination therapy with caspofungin and TMP/SMZ is a promising first-line treatment option compared with TMP/SMZ monotherapy and combination therapy as salvage therapy. |
| first_indexed | 2024-03-13T04:52:27Z |
| format | Article |
| id | doaj.art-b1cab7ea530a49c29eaf5ad3de5ef515 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-13T04:52:27Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj.art-b1cab7ea530a49c29eaf5ad3de5ef5152023-06-18T11:07:48ZengBMCBMC Infectious Diseases1471-23342023-06-012311610.1186/s12879-023-08372-zEfficacy of initial caspofungin plus trimethoprim/sulfamethoxazole for severe PCP in patients without human immunodeficiency virus infectionHui Qi0Danjiang Dong1Ning Liu2Ying Xu3Mengzhi Qi4Qin Gu5Department of Intensive Care Unit, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical SchoolDepartment of Intensive Care Unit, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical SchoolDepartment of Intensive Care Unit, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical SchoolDepartment of Intensive Care Unit, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical SchoolDepartment of Intensive Care Unit, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical SchoolDepartment of Intensive Care Unit, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical SchoolAbstract Background The number of pneumocystis pneumonia (PCP) cases is increasing in immunocompromised patients without human immunodeficiency virus infection (HIV), causing serious morbidity with high mortality. Trimethoprim/sulfamethoxazole (TMP/SMZ) monotherapy has limited effectiveness in the treatment of PCP. Clinical data on whether initial caspofungin plus TMP/SMZ for this disease is superior to monotherapy in non-HIV-infected patients are limited. We aimed to compare the clinical effectiveness of these regimens for severe PCP in non-HIV patients. Methods A retrospective study reviewed 104 non-HIV-infected patients with confirmed PCP in the intensive care unit between January 2016 and December 2021. Eleven patients were excluded from the study because TMP/SMZ could not be used due to severe hematologic disorders or clinical data were missing. All enrolled patients were divided into three groups according to different treatment strategies: Group 1 received TMP/SMZ monotherapy, Group 2 received caspofungin combined with TMP/SMZ as first-line therapy, and Group 3 initially received TMP/SMZ monotherapy and later received caspofungin as salvage therapy. The clinical characteristics and outcomes were compared among the groups. Results A total of 93 patients met the criteria. The overall positive response rate of anti-PCP treatment was 58.06%, and the overall 90-day all-cause mortality rate was 49.46%. The median APACHE II score was 21.44. The concurrent infection rate was 74.19%, among whom 15.05% (n = 14) of those patients had pulmonary aspergillosis, 21.05% (n = 20) had bacteremia, and 23.65% (n = 22) had CMV infections. The patients who received initial caspofungin combination with TMP/SMZ had the best positive response rate (76.74%) compared to others (p = 0.001). Furthermore, the group that received initial caspofungin combined with TMP/SMZ had a 90-day all-cause mortality rate (39.53%) that was significantly different from that of the shift group (65.51%, p = 0.024), but this rate showed no statistically significant difference compared with that in the monotherapy group (48.62%, p = 0.322). None of the patients had serious adverse events from caspofungin therapy. Conclusions For non-HIV-infected patients with severe PCP, initial combination therapy with caspofungin and TMP/SMZ is a promising first-line treatment option compared with TMP/SMZ monotherapy and combination therapy as salvage therapy.https://doi.org/10.1186/s12879-023-08372-zPneumocystis pneumoniaTrimethoprim–sulfamethoxazoleCaspofunginCombination therapy |
| spellingShingle | Hui Qi Danjiang Dong Ning Liu Ying Xu Mengzhi Qi Qin Gu Efficacy of initial caspofungin plus trimethoprim/sulfamethoxazole for severe PCP in patients without human immunodeficiency virus infection BMC Infectious Diseases Pneumocystis pneumonia Trimethoprim–sulfamethoxazole Caspofungin Combination therapy |
| title | Efficacy of initial caspofungin plus trimethoprim/sulfamethoxazole for severe PCP in patients without human immunodeficiency virus infection |
| title_full | Efficacy of initial caspofungin plus trimethoprim/sulfamethoxazole for severe PCP in patients without human immunodeficiency virus infection |
| title_fullStr | Efficacy of initial caspofungin plus trimethoprim/sulfamethoxazole for severe PCP in patients without human immunodeficiency virus infection |
| title_full_unstemmed | Efficacy of initial caspofungin plus trimethoprim/sulfamethoxazole for severe PCP in patients without human immunodeficiency virus infection |
| title_short | Efficacy of initial caspofungin plus trimethoprim/sulfamethoxazole for severe PCP in patients without human immunodeficiency virus infection |
| title_sort | efficacy of initial caspofungin plus trimethoprim sulfamethoxazole for severe pcp in patients without human immunodeficiency virus infection |
| topic | Pneumocystis pneumonia Trimethoprim–sulfamethoxazole Caspofungin Combination therapy |
| url | https://doi.org/10.1186/s12879-023-08372-z |
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