移植和非移植艾滋病毒阴性免疫功能低下患者的肺孢子虫肺炎治疗效果。

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2024-10-01 Epub Date: 2024-06-27 DOI:10.1111/tid.14321

Hanan Albasata, Francesca Gioia, Yidi Jiang, Susan M Poutanen, Seyed M Hosseini-Moghaddam

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引用次数: 0

摘要

背景：以往的研究表明，HIV 阴性的免疫功能低下患者易患肺孢子虫肺炎（PCP）。然而，尚未对 HIV 阴性免疫功能低下患者的 PCP 结果进行比较：在大学健康网络的这项回顾性队列研究中，我们纳入了 2018 年 12 月至 2019 年 12 月期间符合欧洲癌症研究和治疗组织（EORTC）PCP 诊断标准的所有 HIV 阴性免疫功能低下患者。我们比较了实体器官移植（SOT）和非实体器官移植患者的人口统计学、合并症、病程和 PCP 结局（28 天死亡率和综合结局[即死亡或入住重症监护室（ICU）]）：在 160 名确诊为 PCP 的非艾滋病毒患者中，118 名患者符合 EORTC 标准（76 名男性 [64.4%]，中位年龄 [范围]：65.5 [21-87] 岁）。与非 SOT 患者（104 人）相比，SOT 患者（14 人）的 PCP 表现更为严重：急性表现（发病时 2 饱和度（88% [75%, 99%] vs. 92%[70%, 99%]，P = .040）和补充氧气需求（12/14 [85.7%] vs. 59/104 [56.7%]，P = .044）。死亡率[4/14, (28.6%) vs. 15/104 (14.4%)，p = .176]、ICU 入院率（10/14 [71.4%] vs. 18/104 [17.3%]，p 结论：与非 SOT 患者相比，SOT 患者的 PCP 表现和预后更为严重。需要进一步研究探讨造成这种差异的生物学原因。

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Outcome of Pneumocystis pneumonia in transplant and non-transplant HIV-negative immunocompromised patients.

Background: Previous studies showed HIV-negative immunocompromised patients are susceptible to Pneumocystis pneumonia (PCP). However, the PCP outcome has not been compared among HIV-negative immunocompromised patients.

Methods: In this retrospective cohort study at the University Health Network, we included all HIV-negative immunocompromised patients who fulfilled the European Organization for Research and Treatment of Cancer (EORTC) PCP diagnosis criteria from December 2018 to December 2019. We compared the demographics, comorbidities, course of illness, and PCP outcome (28-day mortality and composite outcome [i.e., death or intensive care unit (ICU) admission]) between solid organ transplant (SOT) and non-SOT patients.

Results: Of 160 non-HIV patients with PCP diagnoses, 118 patients fulfilled EORTC criteria (76 males [64.4%], median [range] age: 65.5 [21-87] years). PCP presentation in SOT recipients (n = 14) was more severe than non-SOT patients (n = 104): acute presentation (onset <7 days before admission: 11/14 [78.6%] vs. 51/104 [56%], p = .037), shortness of breath (100% vs. 75/104 [74.3%], p = .037), median [range] O₂ saturation (88% [75%, 99%] vs. 92%[70%, 99%], p = .040), and supplemental O₂ requirement (12/14 [85.7%] vs. 59/104 [56.7%], p = .044). The mortality [4/14, (28.6%) vs. 15/104 (14.4%), p = .176], ICU admission (10/14 [71.4%] vs. 18/104 [17.3%], p < .0001), and mechanical ventilation (8/14 [57.1%] vs. 18/104 [17.3%], p = .0007) in SOT patients was different from non-SOT patients. In multivariable analysis, SOT recipients were at greater risk of composite outcome than non-SOT patients (aOR [CI95%]: 12.25 [3.08-48.62], p < .001).

Conclusion: PCP presentation and outcomes in SOT recipients are more severe than in non-SOT patients. Further studies are required to explore the biological reasons for this difference.

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.