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Войти в исследования The Journal of infection · 2025
Evolving risk factors and predisposing conditions of Pneumocystis pneumonia in non-HIV patients: A seven-year multicenter study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Kao Ting-Wei, Ruan Sheng-Yuan, Huang Yu-Tsung, Liu Wang-Da, Liu Chia-Jung, Chen You-Yi, Hsueh Po-Ren, Yu Chong-Jen, Chien Jung-Yien, TACTICS (TAiwan CollaboraTive Intensive Care Study) Group
Аннотация
OBJECTIVES: As Pneumocystis pneumonia (PCP) increasingly develops in non-HIV patients without established immunocompromising factors, the study examined the evolving predisposing factors and at-risk medications.
METHODS: This multicenter retrospective study included non-HIV PCP at seven clinical centers from 2016-2023. Patients were categorized by exposed medications and underlying predisposing diseases. Demographic characteristics, disease severity, treatment approaches, and outcomes were reported.
RESULTS: 470 non-HIV PCP were identified, and 420 probable cases were included for analysis. The proportion of PCP without established high-risk medications increased from 47% in 2016 to 61% by 2023. 209 (49.8%) received established high-risk medications, 106 (25.2%) with suspected at-risk medications, and 155 (36.9%) with no at-risk medications. Subjects with established high-risk medications were more likely to have hematological malignancies (50.2%, P<0.001). Those with suspected at-risk medications had higher rates of solid cancers (63.2%, P<0.001) and transplantation (24.5%, P<0.001). Overall mortality rates were 43.8% at 60-day, with comparable mortality across medication groups (log-rank P=0.08) but significant differences by disease category (log-rank P<0.001), with solid cancers exhibiting the worst outcome (58.0%).
CONCLUSIONS: The epidemiology of non-HIV PCP is evolving beyond traditional risk categories. Both emerging high-risk medications and predisposing comorbidities might require further investigation and addressed in prophylaxis guidelines.
METHODS: This multicenter retrospective study included non-HIV PCP at seven clinical centers from 2016-2023. Patients were categorized by exposed medications and underlying predisposing diseases. Demographic characteristics, disease severity, treatment approaches, and outcomes were reported.
RESULTS: 470 non-HIV PCP were identified, and 420 probable cases were included for analysis. The proportion of PCP without established high-risk medications increased from 47% in 2016 to 61% by 2023. 209 (49.8%) received established high-risk medications, 106 (25.2%) with suspected at-risk medications, and 155 (36.9%) with no at-risk medications. Subjects with established high-risk medications were more likely to have hematological malignancies (50.2%, P<0.001). Those with suspected at-risk medications had higher rates of solid cancers (63.2%, P<0.001) and transplantation (24.5%, P<0.001). Overall mortality rates were 43.8% at 60-day, with comparable mortality across medication groups (log-rank P=0.08) but significant differences by disease category (log-rank P<0.001), with solid cancers exhibiting the worst outcome (58.0%).
CONCLUSIONS: The epidemiology of non-HIV PCP is evolving beyond traditional risk categories. Both emerging high-risk medications and predisposing comorbidities might require further investigation and addressed in prophylaxis guidelines.