Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis
Objectives:Pneumocystis jirovecii pneumonia (PCP) is an AIDS-defining illness. In patients with HIV, the benefit of PCP prophylaxis is well-defined when the CD4 T-cell count decreases below 200 cells/μL. In other immunocompromised patients, the value of PCP prophylaxis is not always as well-establis...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-05-01
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| Series: | Frontiers in Cellular and Infection Microbiology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fcimb.2020.00224/full |
| _version_ | 1811208285281320960 |
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| author | Albert Dunbar Alexander Schauwvlieghe Alexander Schauwvlieghe Alexander Schauwvlieghe Sheruna Algoe Jaap J. van Hellemond Marijke Reynders Stefaan Vandecasteele Jerina Boelens Pieter Depuydt Bart Rijnders |
| author_facet | Albert Dunbar Alexander Schauwvlieghe Alexander Schauwvlieghe Alexander Schauwvlieghe Sheruna Algoe Jaap J. van Hellemond Marijke Reynders Stefaan Vandecasteele Jerina Boelens Pieter Depuydt Bart Rijnders |
| author_sort | Albert Dunbar |
| collection | DOAJ |
| description | Objectives:Pneumocystis jirovecii pneumonia (PCP) is an AIDS-defining illness. In patients with HIV, the benefit of PCP prophylaxis is well-defined when the CD4 T-cell count decreases below 200 cells/μL. In other immunocompromised patients, the value of PCP prophylaxis is not always as well-established. This study aimed to describe the epidemiology of PCP in recent years and assess how many patients with PCP did or did not receive prophylaxis in the month preceding the infection.Material and Methods: A multicenter retrospective study was performed in 3 tertiary care hospital. A list of patients that underwent broncho-alveolar lavage sampling and Pneumocystis jirovecii (PJ) PCR testing was retrieved from the microbiology laboratories. An in-house PJ quantitative PCR (qPCR) was used in each center. A cycle threshold (Ct) value of ≤ 28.5–30 was considered a probable PCP. For patients with a positive PJ qPCR but above this threshold, a predefined case definition of possible PCP was defined as a qPCR Ct value ≤ 34–35 and both of the following criteria: 1. Clinical and radiological features compatible with PCP and 2. The patient died or received PCP therapy and survived. Patient files from those with a qPCR Ct value ≤ 35 were reviewed to determine whether the patient fulfilled the case definition and if PCP prophylaxis had been used in the weeks preceding the PCP. Disease-specific guidelines, as well as hospital-wide guidelines, were used to evaluate if prophylaxis could be considered indicated.Results: From 2012 to 2018, 482 BAL samples were tested. Two hundred and four had a qPCR Ct value ≤ 35 and were further evaluated: 90 fulfilled the definition of probable and 63 of possible PCP while the remaining 51 were considered colonized. Seventy-four percentages of the patients with PCP were HIV-negative. Only 11 (7%) of the 153 patients had received prophylaxis, despite that in 133 (87%) cases prophylaxis was indicated according to guidelines.Conclusion: In regions where HIV testing and treatment is available without restrictions, PCP is mainly diagnosed in non-HIV immunocompromised patients. More than four out of five patients with PCP had not received prophylaxis. Strategies to improve awareness of antimicrobial prophylaxis guidelines in immunocompromised patients are urgently needed. |
| first_indexed | 2024-04-12T04:19:16Z |
| format | Article |
| id | doaj.art-c58b7370a41f4dcc963918e2a5715353 |
| institution | Directory Open Access Journal |
| issn | 2235-2988 |
| language | English |
| last_indexed | 2024-04-12T04:19:16Z |
| publishDate | 2020-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cellular and Infection Microbiology |
| spelling | doaj.art-c58b7370a41f4dcc963918e2a57153532022-12-22T03:48:19ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882020-05-011010.3389/fcimb.2020.00224537826Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of ProphylaxisAlbert Dunbar0Alexander Schauwvlieghe1Alexander Schauwvlieghe2Alexander Schauwvlieghe3Sheruna Algoe4Jaap J. van Hellemond5Marijke Reynders6Stefaan Vandecasteele7Jerina Boelens8Pieter Depuydt9Bart Rijnders10Department of Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, NetherlandsDepartment of Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, NetherlandsDepartment of Hematology, Erasmus MC Cancer Institute, Rotterdam, NetherlandsDepartment of Hematology, Ghent University Hospital, Ghent, BelgiumDepartment of Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, NetherlandsDepartment of Medical Microbiology & Infectious Diseases, Erasmus University Medical Center, Rotterdam, NetherlandsDepartment of Laboratory Medicine, Medical Microbiology, AZ St-Jan Brugge-Oostende Hospital, Bruges, BelgiumDepartments of Nephrology and Infectious Diseases, AZ St-Jan Brugge-Oostende Hospital, Bruges, BelgiumDepartment of Laboratory Medicine, Ghent University Hospital, Ghent, BelgiumDepartment of Intensive Care Medicine, Ghent University Hospital, Ghent, BelgiumDepartment of Internal Medicine, Infectious Diseases, Erasmus University Medical Center, Rotterdam, NetherlandsObjectives:Pneumocystis jirovecii pneumonia (PCP) is an AIDS-defining illness. In patients with HIV, the benefit of PCP prophylaxis is well-defined when the CD4 T-cell count decreases below 200 cells/μL. In other immunocompromised patients, the value of PCP prophylaxis is not always as well-established. This study aimed to describe the epidemiology of PCP in recent years and assess how many patients with PCP did or did not receive prophylaxis in the month preceding the infection.Material and Methods: A multicenter retrospective study was performed in 3 tertiary care hospital. A list of patients that underwent broncho-alveolar lavage sampling and Pneumocystis jirovecii (PJ) PCR testing was retrieved from the microbiology laboratories. An in-house PJ quantitative PCR (qPCR) was used in each center. A cycle threshold (Ct) value of ≤ 28.5–30 was considered a probable PCP. For patients with a positive PJ qPCR but above this threshold, a predefined case definition of possible PCP was defined as a qPCR Ct value ≤ 34–35 and both of the following criteria: 1. Clinical and radiological features compatible with PCP and 2. The patient died or received PCP therapy and survived. Patient files from those with a qPCR Ct value ≤ 35 were reviewed to determine whether the patient fulfilled the case definition and if PCP prophylaxis had been used in the weeks preceding the PCP. Disease-specific guidelines, as well as hospital-wide guidelines, were used to evaluate if prophylaxis could be considered indicated.Results: From 2012 to 2018, 482 BAL samples were tested. Two hundred and four had a qPCR Ct value ≤ 35 and were further evaluated: 90 fulfilled the definition of probable and 63 of possible PCP while the remaining 51 were considered colonized. Seventy-four percentages of the patients with PCP were HIV-negative. Only 11 (7%) of the 153 patients had received prophylaxis, despite that in 133 (87%) cases prophylaxis was indicated according to guidelines.Conclusion: In regions where HIV testing and treatment is available without restrictions, PCP is mainly diagnosed in non-HIV immunocompromised patients. More than four out of five patients with PCP had not received prophylaxis. Strategies to improve awareness of antimicrobial prophylaxis guidelines in immunocompromised patients are urgently needed.https://www.frontiersin.org/article/10.3389/fcimb.2020.00224/fullPneumocystic jirovecii pneumoniaPneumocystis jiroveci (carinii) pneumoniaprophylaxisTrimetoprim- sulfamethoxazoleimmunocompromidsed patients |
| spellingShingle | Albert Dunbar Alexander Schauwvlieghe Alexander Schauwvlieghe Alexander Schauwvlieghe Sheruna Algoe Jaap J. van Hellemond Marijke Reynders Stefaan Vandecasteele Jerina Boelens Pieter Depuydt Bart Rijnders Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis Frontiers in Cellular and Infection Microbiology Pneumocystic jirovecii pneumonia Pneumocystis jiroveci (carinii) pneumonia prophylaxis Trimetoprim- sulfamethoxazole immunocompromidsed patients |
| title | Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis |
| title_full | Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis |
| title_fullStr | Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis |
| title_full_unstemmed | Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis |
| title_short | Epidemiology of Pneumocystis jirovecii Pneumonia and (Non-)use of Prophylaxis |
| title_sort | epidemiology of pneumocystis jirovecii pneumonia and non use of prophylaxis |
| topic | Pneumocystic jirovecii pneumonia Pneumocystis jiroveci (carinii) pneumonia prophylaxis Trimetoprim- sulfamethoxazole immunocompromidsed patients |
| url | https://www.frontiersin.org/article/10.3389/fcimb.2020.00224/full |
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