非艾滋病毒肺孢子菌肺炎患者接受低剂量三甲双胍-磺胺甲噁唑治疗的疗效：日本全国性回顾性队列研究。

IF 2.9 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now Pub Date : 2024-10-04 DOI:10.1016/j.idnow.2024.104992

Jumpei Taniguchi , Shotaro Aso , Taisuke Jo , Hiroki Matsui , Kiyohide Fushimi , Hideo Yasunaga

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引用次数: 0

摘要

目的：低剂量三甲双胍-磺胺甲恶唑（TMP-SMX）可能是治疗肺孢子虫肺炎（PCP）患者的一种选择。然而，该疗法对未感染人类免疫缺陷病毒（HIV）患者的疗效还有待深入研究：这项回顾性队列研究使用了从日本诊断程序组合住院患者数据库中提取的数据。我们纳入了 2010 年 7 月至 2022 年 3 月期间确诊为 PCP 并开始接受 TMP-SMX 治疗的未感染 HIV 的免疫功能低下患者。我们将符合条件的患者分为常规剂量组（15.0-20.0 mg/kg/d）和低剂量组（7.5-15.0 mg/kg/d），并进行了倾向分数重叠加权分析。主要结果是院内死亡率。次要结果是完成初始治疗和在住院期间使用 TMP-SMX 替代品治疗 PCP：在 4449 名符合条件的患者中，分别有 1682 人（37.8%）和 2767 人（62.2%）接受了常规和低剂量 TMP-SMX 治疗。院内死亡率无明显差异（风险差异，-1.4%；95% CI，-4.5-1.7%；P = 0.388）。小剂量 TMP-SMX 与更多患者完成初始治疗有关（风险差异为 4.6%；95 % CI 为 2.3-6.9%；P 结论：小剂量 TMP-SMX 与更多患者完成初始治疗有关（风险差异为 4.6%；95 % CI 为 2.3-6.9%）：小剂量 TMP-SMX 可作为非艾滋病毒 PCP 患者的一种治疗选择。

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Outcomes of low-dose trimethoprim-sulfamethoxazole treatment in patients with non-HIV pneumocystis pneumonia: A nationwide Japanese retrospective cohort study

Objectives

Low-dose trimethoprim-sulfamethoxazole (TMP-SMX) may be a treatment option for patients with Pneumocystis jirovecii pneumonia (PCP). However, its effectiveness in patients without human immunodeficiency virus (HIV) infection has yet to be thoroughly investigated.

Methods

This retrospective cohort study used data extracted from the Japanese Diagnosis Procedure Combination inpatient database. We included immunocompromised patients without HIV having been diagnosed with PCP and had started TMP-SMX treatment between July 2010 and March 2022. We divided eligible patients into conventional-dose (15.0–20.0 mg/kg/d) and low-dose (7.5–15.0 mg/kg/d) groups and performed propensity-score overlap-weighting analysis. The primary outcome was in-hospital mortality rate. Secondary outcomes were completion of the initial treatment and use of alternatives to TMP-SMX for PCP treatment during hospitalization.

Results

Among 4449 eligible patients, 1682 (37.8 %) and 2767 (62.2 %) received conventional- and low-dose TMP-SMX treatments, respectively. No significant difference was observed in in-hospital mortality (risk difference, −1.4 %; 95 % CI, −4.5–1.7 %; P = 0.388). Low-dose TMP-SMX was associated with increased completion of initial treatment (risk difference, 4.6 %; 95 % CI, 2.3–6.9 %; P < 0.001), and reduced use of alternative agents (risk difference, −4.0 %; 95 % CI, −7.4 to −0.6 %; P = 0.020).