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

Humans Pneumonia, Pneumocystis / complications Critical Illness HIV Infections Intensive Care Units Critical Care
Biomarker Diagnosis ICU PCR Pneumocystis Pneumonia Serum β-D-Glucan

Journal

Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902

Informations de publication

Date de publication:
24 08 2023
Historique:
received: 26 04 2023
accepted: 10 08 2023
medline: 28 8 2023
pubmed: 25 8 2023
entrez: 24 8 2023
Statut: epublish

Résumé

Pneumocystis 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. The 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. Overall, 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. PJP 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.

Sections du résumé

BACKGROUND
Pneumocystis 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 METHODS
The 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.
RESULTS
Overall, 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.
CONCLUSION
PJP 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.

Identifiants

DOI: 10.1186/s13054-023-04608-1 PMID: 37620828 PMC: PMC10464114
pubmed: 37620828
doi: 10.1186/s13054-023-04608-1
pii: 10.1186/s13054-023-04608-1
pmc: PMC10464114
doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

323

Investigateurs

Matteo Cerchiaro (M)
Mario Zaccarelli (M)
Chiara Robba (C)
Denise Battaglini (D)
Iole Brunetti (I)
Filippo Del Puente (F)
Sara Mora (S)
Sofía de la Villa (S)
Maricela Valerio (M)
Patricia Muñoz (P)
Gianmarco Lombardi (G)
Melania Cesarano (M)
Veronica Gennenzi (V)
Philippe Meersseman (P)
Greet Hermans (G)
Alexander Wilmer (A)
Keyvan Razazi (K)
Guillaume Carteaux (G)
Nicolas de Prost (N)
Oliver A Cornely (OA)
Danila Seidel (D)
Ana Alastruey-Izquierdo (A)
Jorge Garcia Borrega (J)
Christine Bonnal (C)
Etienne de Montmollin (E)
Julien Dessajan (J)
Mariaelena Ceresini (M)
Francesco Mojoli (F)
Ambra Vola (A)
Cécile Garnaud (C)
Emili Díaz (E)
Oriol Gasch (O)
Elena Prina (E)
Sebastian Rasch (S)
Miriam Dibos (M)
Stefanie Haschka (S)

Informations de copyright

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

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Auteurs

Daniele Roberto Giacobbe (DR)

Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. danieleroberto.giacobbe@unige.it.
Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy. danieleroberto.giacobbe@unige.it.

Silvia Dettori (S)

Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy.

Vincenzo Di Pilato (V)

Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.

Erika Asperges (E)

Division of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Lorenzo Ball (L)

Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.

Enora Berti (E)

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

Ola Blennow (O)

Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.

Bianca Bruzzone (B)

Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy.

Laure Calvet (L)

Service de Médecine Intensive Réanimation, CHU de Clermont-Ferrand, Clermont-Ferrand, France.

Federico Capra Marzani (F)

Servizio di Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Antonio Casabella (A)

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

Sofia Choudaly (S)

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

Anais Dartevel (A)

Medical Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France.

Gennaro De Pascale (G)

Dipartimento di Scienze Dell'emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.

Gabriele Di Meco (G)

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

Melissa Fallon (M)

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

Louis-Marie Galerneau (LM)

Medical Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France.

Miguel Gallego (M)

Respiratory Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.

Mauro Giacomini (M)

Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy.

Adolfo González Sáez (A)

Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

Luise Hänsel (L)

Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
Medical Faculty and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.

Giancarlo Icardi (G)

Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy.

Philipp Koehler (P)

Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
Medical Faculty and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.

Katrien Lagrou (K)

Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium.

Tobias Lahmer (T)

Department of Internal Medicine II, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.

P Lewis White (P)

Public Health Wales Mycology Reference Laboratory, PHW Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK.
Division of Infection and Immunity, Cardiff University Centre for Trials Research, Heath Park, Cardiff, UK.

Laura Magnasco (L)

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

Anna Marchese (A)

Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
UO Microbiologia, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.

Cristina Marelli (C)

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

Mercedes Marín-Arriaza (M)

Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.

Ignacio Martin-Loeches (I)

Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland.
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.

Armand Mekontso-Dessap (A)

Assistance Publique - Hôpitaux de Paris, DMU Médecine, Service de Médecine Intensive Réanimation, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor, Créteil, France.
Groupe de Recherche Clinique CARMAS, Faculté de Santé de Créteil, IMRB, Creteil, Île-de-France, France.
INSERM, Creteil, Île-de-France, France.

Malgorzata Mikulska (M)

Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy.

Alessandra Mularoni (A)

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

Anna Nordlander (A)

Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden.

Julien Poissy (J)

Inserm U1285, CHU Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale Et Fonctionnelle, University of Lille, 59000, Lille, France.
Department of Intensive Care Medicine, Critical Care Center, CHU Lille, 59000, Lille, France.

Giovanna Russelli (G)

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

Alessio Signori (A)

Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Carlo Tascini (C)

Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy.
Department of Medical Area (DAME), University of Udine, Udine, Italy.

Louis-Maxime Vaconsin (LM)

Medical and Infectious Diseases ICU, APHP, Bichat Hospital, Paris, France.

Joel Vargas (J)

Dipartimento di Scienze Dell'emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Antonio Vena (A)

Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy.

Joost Wauters (J)

Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Medical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.

Paolo Pelosi (P)

Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
Anesthesia and Intensive Care, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.

Jean-Francois Timsit (JF)

Medical and Infectious Diseases ICU, APHP, Bichat Hospital, Paris, France.
INSERM, IAME, Université Paris Cité, Paris, France.

Matteo Bassetti (M)

Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, L.go R. Benzi 10, 16132, Genoa, Italy.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Pneumocystis jirovecii pneumonia in intensive...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Pneumonie à Pneumocystis › Pneumocystis jirovecii pneumonia in intensive...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie grave › Pneumocystis jirovecii pneumonia in intensive...
questionsmedicales.fr › Maladies du système immunitaire › Déficits immunitaires › Infections à VIH › Pneumocystis jirovecii pneumonia in intensive...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › Pneumocystis jirovecii pneumonia in intensive...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins de réanimation › Pneumocystis jirovecii pneumonia in intensive...