Epidemiology and Clinical Impact of Respiratory Coinfections at Diagnosis of <i>Pneumocystis jirovecii</i> Pneumonia
Romain Lécuyer, Nahéma Issa, Benoît Tessoulin, Rose‐Anne Lavergne, Florent Morio, Frédéric Gabriel, Emmanuel Canet, Céline Bressollette‐Bodin, A. Guillouzouic, David Boutoille, F. Raffi, R. Lecomte, Paul Le Turnier, Colin Deschanvres, Fabrice Camou, Benjamin Gaborit, PRONOCYSTIS Study Group, F. Raffi, David Boutoille, Charlotte Biron, M. Lefèbvre, Benjamin Gaborit, Paul Le Turnier, Colin Deschanvres, R. Lecomte, Marie Chauveau, Romain Lécuyer, Antoine Asquier-Khati, Patrice Le Pape, Florent Morio, Rose-Anne Lavergne, Fakhri Jeddi, Stéphane Corvec, Pascale Bémer, J. Caillon, A. Guillouzouic, Anne‐Gaëlle Leroy, Karim Lakhal, Raphaël Cinotti, Antoine Roquilly, Karim Asehnoune, Jean Reignier, Emmanuel Canet, Olivier Zambon, Amélie Seguin, Arnaud-Félix Miailhe, F.–X. Blanc, Cédric Bretonnière, P Morin, Fabrice Camou, Nahéma Issa, Olivier Guisset, Gaëlle Mourissoux, Laurence Delhaès, Isabelle Accoceberry, Frédéric Gabriel
Abstract
BACKGROUND: The role of respiratory coinfections at diagnosis of Pneumocystis jirovecii pneumonia (PcP) on clinical impact has been underestimated. METHODS: A retrospective observational study was conducted January 2011 to April 2019 to evaluate respiratory coinfections at diagnosis of PcP patients in 2 tertiary care hospitals. Coinfection was defined by identification of pathogens from P. jirovecii-positive samples. RESULTS: Of 7882 respiratory samples tested for P. jirovecii during the 8-year study, 328 patients with diagnosis of PcP were included. Mean age was 56.7 (SD 14.9) years, 193 (58.8%) were male, 74 (22.6%) had positive HIV serology, 125 (38.1%) had viral coinfection, 76 (23.2%) bacterial coinfection, and 90-day mortality was 25.3%. In the overall population, 90-day mortality was independently associated with solid tumor underlying disease (odds ratio [OR], 11.8; 95% confidence interval [CI], 1.90-78.0; P = .008), sepsis-related organ failure assessment score (SOFA) at admission (OR, 1.62; 95% CI, 1.34-2.05; P< .001), and cytomegalovirus (CMV) respiratory coinfection (OR, 3.44; 95% CI, 1.24-2.90; P = .02). Among HIV-negative patients, respiratory CMV coinfection was associated with worse prognosis, especially when treated with adjunctive corticosteroid therapy. CONCLUSIONS: Respiratory CMV coinfection at PcP diagnosis was independently associated with increased 90-day mortality, specifically in HIV-negative patients.