Pneumocystis jirovecii pneumonia in intensive care units: a multicenter study by ESGCIP and EFISG

Critical Care

Research

Enora Berti¹  Armand Mekontso-Dessap²  Luise Hänsel³  Philipp Koehler³  Giancarlo Icardi⁴  Antonio Vena⁵  Malgorzata Mikulska⁵  Silvia Dettori⁵  Daniele Roberto Giacobbe⁵  Matteo Bassetti⁵  Ola Blennow⁶  Anna Nordlander⁶  Mauro Giacomini⁷  Ignacio Martin-Loeches⁸  Tobias Lahmer⁹  Katrien Lagrou^1,10  Joost Wauters^1,11  Vincenzo Di Pilato^1,12  Lorenzo Ball^1,13  Paolo Pelosi^1,13  Anna Marchese^1,14  Joel Vargas^1,15  Gennaro De Pascale^1,16  Erika Asperges^1,17  Bianca Bruzzone^1,18  Carlo Tascini^1,19  Gabriele Di Meco^2,20  Laura Magnasco^2,20  Cristina Marelli^2,20  Sofia Choudaly^2,21  Julien Poissy^2,22  Anais Dartevel^2,23  Louis-Marie Galerneau^2,23  Louis-Maxime Vaconsin^2,24  Jean-Francois Timsit^2,25  Antonio Casabella^2,26  Melissa Fallon^2,27  P. Lewis White^2,28  Miguel Gallego^2,29  Alessio Signori^3,30  Laure Calvet^3,31  Adolfo González Sáez^3,32  Mercedes Marín-Arriaza^3,33  Federico Capra Marzani^3,34  Giovanna Russelli^3,35  Alessandra Mularoni^3,35 

[1]Assistance Publique - Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France

[2]Assistance Publique - Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France

[3]Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, IMRB, Creteil, Île-de-France, France

[4]INSERM, Creteil, Île-de-France, France

[5]Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany

[6]Medical Faculty and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany

[7]Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

[8]Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy

[9]Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

[10]Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy

[11]Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden

[12]Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden

[13]Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy

[14]Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland

[15]Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d’Investigacions Biomèdiques August Pi I Sunyer), University of Barcelona, CIBERES, Barcelona, Spain

[16]Department of Internal Medicine II, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany

[17]Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium

[18]Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium

[19]Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium

[20]Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium

[21]Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy

[22]Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy

[23]Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy

[24]Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy

[25]UO Microbiologia, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy

[26]Dipartimento di Scienze Dell’emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

[27]Dipartimento di Scienze Dell’emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

[28]Università Cattolica del Sacro Cuore, Rome, Italy

[29]Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

[30]Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy

[31]Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy

[32]Department of Medical Area (DAME), University of Udine, Udine, Italy

[33]Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy

[34]Inserm U1285, CHU Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale Et Fonctionnelle, University of Lille, 59000, Lille, France

[35]Inserm U1285, CHU Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale Et Fonctionnelle, University of Lille, 59000, Lille, France

[36]Department of Intensive Care Medicine, Critical Care Center, CHU Lille, 59000, Lille, France

[37]Medical Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France

[38]Medical and Infectious Diseases ICU, APHP, Bichat Hospital, Paris, France

[39]Medical and Infectious Diseases ICU, APHP, Bichat Hospital, Paris, France

[40]INSERM, IAME, Université Paris Cité, Paris, France

[41]Microbiology Unit, Laboratory Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain

[42]Public Health Wales Mycology Reference Laboratory, PHW Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK

[43]Public Health Wales Mycology Reference Laboratory, PHW Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK

[44]Division of Infection and Immunity, Cardiff University Centre for Trials Research, Heath Park, Cardiff, UK

[45]Respiratory Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain

[46]Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain

[47]Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy

[48]Service de Médecine Intensive Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France

[49]Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain

[50]Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

[51]Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain

[52]Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

[53]Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain

[54]Servizio di Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

[55]Unit of Infectious Diseases, ISMETT-IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy

关键词: Pneumocystis;    PCR;    Pneumonia;    ICU;    Diagnosis;    Biomarker;    Serum β-D-Glucan;   

DOI  :  10.1186/s13054-023-04608-1

 received in 2023-04-26, accepted in 2023-08-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPneumocystis jirovecii pneumonia (PJP) is an opportunistic, life-threatening disease commonly affecting immunocompromised patients. The distribution of predisposing diseases or conditions in critically ill patients admitted to intensive care unit (ICU) and subjected to diagnostic work-up for PJP has seldom been explored.Materials and methodsThe primary objective of the study was to describe the characteristics of ICU patients subjected to diagnostic workup for PJP. The secondary objectives were: (i) to assess demographic and clinical variables associated with PJP; (ii) to assess the performance of Pneumocystis PCR on respiratory specimens and serum BDG for the diagnosis of PJP; (iii) to describe 30-day and 90-day mortality in the study population.ResultsOverall, 600 patients were included in the study, of whom 115 had presumptive/proven PJP (19.2%). Only 8.8% of ICU patients subjected to diagnostic workup for PJP had HIV infection, whereas hematological malignancy, solid tumor, inflammatory diseases, and solid organ transplants were present in 23.2%, 16.2%, 15.5%, and 10.0% of tested patients, respectively. In multivariable analysis, AIDS (odds ratio [OR] 3.31; 95% confidence interval [CI] 1.13–9.64, p = 0.029), non-Hodgkin lymphoma (OR 3.71; 95% CI 1.23–11.18, p = 0.020), vasculitis (OR 5.95; 95% CI 1.07–33.22, p = 0.042), metastatic solid tumor (OR 4.31; 95% CI 1.76–10.53, p = 0.001), and bilateral ground glass on CT scan (OR 2.19; 95% CI 1.01–4.78, p = 0.048) were associated with PJP, whereas an inverse association was observed for increasing lymphocyte cell count (OR 0.64; 95% CI 0.42–1.00, p = 0.049). For the diagnosis of PJP, higher positive predictive value (PPV) was observed when both respiratory Pneumocystis PCR and serum BDG were positive compared to individual assay positivity (72% for the combination vs. 63% for PCR and 39% for BDG). Cumulative 30-day mortality and 90-day mortality in patients with presumptive/proven PJP were 52% and 67%, respectively.ConclusionPJP in critically ill patients admitted to ICU is nowadays most encountered in non-HIV patients. Serum BDG when used in combination with respiratory Pneumocystis PCR could help improve the certainty of PJP diagnosis.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 1

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