Adjunctive glucocorticoid therapy for Pneumocystis jirovecii pneumonia in solid organ transplant recipients: A multicenter cohort, 2015-2020

被引：6

作者：

Hosseini-Moghaddam, Seyed M. ^{[1
]}

Kothari, Sagar ^{[1
]}

Humar, Atul ^{[1
]}

Albasata, Hanan ^{[1
]}

Yetmar, Zachary A. ^{[2
]}

Razonable, Raymund R. ^{[2
]}

Neofytos, Dionysios ^{[3
]}

D'Asaro, Matilde ^{[3
]}

Boggian, Katia ^{[4
]}

Hirzel, Cedric ^{[5
]}

Khanna, Nina ^{[6
]}

Manuel, Oriol ^{[7
]}

Mueller, Nicolas J. ^{[8
]}

Imlay, Hannah ^{[9
]}

Kabbani, Dima ^{[1
,10
]}

Tyagi, Varalika ^{[1
,10
]}

Smibert, Olivia C. ^{[1
,2
,3
,4
,5
,11
,12
,13
,14
,15
]}

Nasra, Mohamed ^{[1
,2
,6
,11
,12
,16
]}

Fontana, Lauren ^{[1
,7
,17
]}

Obeid, Karam M. ^{[1
,7
,17
]}

Apostolopoulou, Anna ^{[1
,8
,18
]}

Zhang, Sean X. ^{[1
,19
]}

Permpalung, Nitipong ^{[2
,20
]}

Alhatimi, Hind ^{[1
,2
,21
]}

Silverman, Michael S. ^{[1
,2
,21
]}

Guo, Henry ^{[1
,6
,16
]}

Rogers, Benjamin A. ^{[1
,2
,6
,16
,22
]}

Mackenzie, Erica ^{[2
,3
,23
]}

Pisano, Jennifer ^{[2
,3
,23
]}

Gioia, Francesca ^{[2
,4
,24
]}

Rapi, Lindita ^{[2
,5
,25
]}

Prasad, G. V. Ramesh ^{[25
]}

Banegas, Marcela ^{[2
,6
,26
]}

Alonso, Carolyn D. ^{[2
,6
,26
]}

Doss, Kathleen ^{[2
,7
,27
]}

Rakita, Robert M. ^{[2
,7
,27
]}

Fishman, Jay A. ^{[1
,8
,18
,28
]}

机构：

[1] Univ Toronto, Univ Hlth Network, Ajmera Transplant Ctr, Transplant Infect Dis, Toronto, ON, Canada

[2] Mayo Clin, Div Publ Hlth Infect Dis & Occupat Med, Rochester, MN USA

[3] Geneva Univ Hosp, Div Infect Dis, Transplant Infect Dis Unit, Geneva, Switzerland

[4] Cantonal Hosp St Gallen, Div Infect Dis, St Gallen, Switzerland

[5] Univ Bern, Dept Infect Dis, Inselspital, Bern Univ Hosp, Bern, Switzerland

[6] Univ Hosp Basel, Hosp Epidemiol, Div Infect Dis, Basel, Switzerland

[7] Univ Hosp Ctr Canton Vaud, Div Infect Dis, Lausanne, Switzerland

[8] Univ Hosp Zurich, Div Infect Dis & Hosp Epidemiol, Zurich, Switzerland

[9] Univ Utah, Dept Internal Med, Salt Lake City, UT USA

[10] Univ Alberta, Dept Med, Edmonton, AB, Canada

[11] Austin Hlth, Dept Infect Dis, Heidelberg, Vic, Australia

[12] Univ Melbourne, Austin Hlth, Dept Med, Heidelberg, Vic, Australia

[13] Peter MacCallum Canc Ctr, Melbourne, Vic, Australia

[14] Univ Melbourne, Sir Peter MacCallum Dept Oncol, Parkville, Vic, Australia

[15] Peter MacCallum Canc Ctr, Natl Ctr Infect Canc, Parkville, Vic, Australia

[16] Monash Hlth, Melbourne, Vic, Australia

[17] Univ Minnesota, Div Infect Dis & Int Med, Minneapolis, MN USA

[18] Massachusetts Gen Hosp, Transplant Ctr, Harvard Med Sch, Transplant Infect Dis Program, Boston, MA USA

[19] Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD USA

[20] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD USA

[21] Western Univ, Schulich Sch Med & Dent, Dept Med, Div Infect Dis, London, ON, Canada

[22] Monash Univ, Sch Clin Sci Monash Hlth, Clayton, Vic, Australia

[23] Univ Chicago Med, Sect Infect Dis & Global Hlth, Dept Med, Chicago, IL USA

[24] Hosp Roman & Cajal, Dept Infect Dis, Madrid, Spain

[25] Univ Toronto, St Michaels Hosp, Kidney Transplant Program, Toronto, ON, Canada

[26] Beth Israel Deaconess Med Ctr, Div Infect Dis, Boston, MA USA

[27] Univ Washington, Dept Med, Div Allergy & Infect Dis, Seattle, WA USA

[28] Massachusetts Gen Hosp, MGH Transplantat Ctr, 55 Fruit St,WH510A, Boston, MA 02114 USA

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2024年 / 24卷 / 04期

关键词：

Pneumocystis jirovecii; Pneumocystis pneumonia; solid organ transplantation; PROPENSITY SCORE METHODS; CARINII-PNEUMONIA; NON-HIV; RISK-FACTORS; DOUBLE-BLIND; CORTICOSTEROIDS; INFECTION; OUTBREAK; OUTCOMES;

D O I：

10.1016/j.ajt.2023.11.003

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Solid organ transplant recipients (SOTRs) frequently receive adjunctive glucocorticoid therapy (AGT) for Pneumocystis jirovecii pneumonia (PJP). This multicenter cohort of SOTRs with PJP admitted to 20 transplant centers in Canada, the United States, Europe, and Australia, was examined for whether AGT was associated with a lower rate of all -cause intensive care unit (ICU) admission, 90 -day death, or a composite outcome (ICU admission or death). Of 172 SOTRs with PJP (median [IQR] age: 60 (51.5-67.0) years; 58 female [33.7%]), the ICU admission and death rates were 43.4%, and 20.8%, respectively. AGT was not associated with a reduced risk of ICU admission (adjusted odds ratio [aOR] [95% CI]: 0.49 [0.21-1.12]), death (aOR [95% CI]: 0.80 [0.30-2.17]), or the composite outcome (aOR [95% CI]: 0.97 [0.71-1.31]) in the propensity score -adjusted analysis. AGT was not significantly associated with at least 1 unit of the respiratory portion of the Sequential Organ Failure Assessment score improvement by day 5 (12/37 [32.4%] vs 39/111 [35.1%]; P = .78). We did not observe significant associations between AGT and ICU admission or death in SOTRs with PJP. Our findings should prompt a reevaluation of routine AGT administration in posttransplant PJP treatment and highlight the need for interventional studies.

引用

页码：653 / 668

页数：16

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