Mortality of <i>Pneumocystis jirovecii</i> pneumonia in intensive care units: a post-hoc analysis of an international multicenter study by ESGCIP and EFISG
Daniele Roberto Giacobbe, Silvia Dettori, Vincenzo Di Pilato, Erika Asperges, Lorenzo Ball, Enora Berti, Ola Blennow, Bianca Bruzzone, Laure Calvet, Federico Capra Marzani, Antonio Casabella, Sofia Choudaly, Anaïs Dartevel, Gennaro De Pascale, Gabriele Di Meco, Melissa Fallon, Louis-Marie Galerneau, Miguel Gallego, Mauro Giacomini, Adolfo González Saez, Luise Hänsel, Giancarlo Icardi, Philipp Koehler, Katrien Lagrou, Tobias Lahmer, P. Lewis White, Laura Magnasco, Anna Marchese, Cristina Marelli, Mercedes Marín, Ignacio Martín‐Loeches, Armand Mekontso Dessap, Małgorzata Mikulska, Marco Muccio, Alessandra Mularoni, Anna Nordlander, Julien Poissy, Giovanna Russelli, Alessio Signori, Carlo Tascini, Louis-Maxime Vaconsin, Joel Vargas, Antonio Vena, Joost Wauters, Paolo Pelosi, Jean‐François Timsit, Matteo Bassetti, on behalf of JIR-ICU Investigators (Collaborators), the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESGCIP), and the Fungal Infections Study Group of the European Society of Clinical Microbiology and Infectious Diseases (EFISG), Matteo Cerchiaro, Mario Zaccarelli, Chiara Robba, Denise Battaglini, Iole Brunetti, Filippo Del Puente, Sara Mora, Sofía de la Villa, Maricela Valerio, Patricia Muñoz, Gianmarco Lombardi, Melania Cesarano, Veronica Gennenzi, Philippe Meersseman, Greet Hermans, Alexander Wilmer, Keyvan Razazi, Guillaume Carteaux, Nicolas de Prost, Oliver A. Cornely, Danila Seidel, Ana Alastruey‐Izquierdo, Jorge Garcia Borrega, Christine Bonnal, Étienne de Montmollin, Julien Dessajan, Mariaelena Ceresini, Francesco Mojoli, Ambra Vola, Cécile Garnaud, Emili Dı́az, Oriol Gasch, Elena Prina, Sebastian Rasch, Miriam Dibos, Stefanie J. Haschka
Abstract
Background Pneumocystis jirovecii pneumonia (PJP) is a life-threatening disease. In the intensive care unit (ICU), PJP is most frequently observed among patients with several conditions not related to the human immunodeficiency virus (HIV) infection.Methods The primary objective of the present post-hoc analysis of a multicenter, multinational, retrospective study was to assess factors impacting prognosis in ICU patients with PJP through univariable and multivariable analyses.Results A total of 107 patients were included; 28 had proven PJP (26.2%), and 79 had presumptive PJP (73.8%). The overall 30-day mortality was 52.7% (95% confidence interval [CI] 42.1–62.2). In the multivariable analysis, metastatic solid tumor (hazard ratio [HR] 3.49; 95% CI 1.71–7.13, p < 0.001) and chronic liver disease (HR 2.44; 95% CI 1.03–5.80, p = 0.044) showed an independent association with 30-day mortality. The direction of effect remained consistent when center was added to the multivariable model as random effect.Conclusion PJP mortality remains high in ICU patients. Conditions other than HIV infection are emerging not only as non-classical risk factors for PJP development, but also as important mortality predictors. A better understanding of the reasons underlying this evolving landscape could be crucial to improve PJP management and survival.