Patrick M Wieruszewski1, Jason N Barreto1, Erin Frazee1, Craig E Daniels2, Pritish K Tosh3, Ross A Dierkhising4, Kristin C Mara4, Andrew H Limper5. 1. Department of Pharmacy, Mayo Clinic, Rochester, MN. 2. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 3. Division of Infectious Diseases, Mayo Clinic, Rochester, MN. 4. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. 5. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: limper.andrew@mayo.edu.
Abstract
BACKGROUND: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis jirovecii pneumonia (PcP) in adults without HIV is minimal and controversial. METHODS: This retrospective cohort study included P jirovecii pneumonia-positive, hospitalized patients without HIV admitted to the Mayo Clinic from 2006 to 2016. Change from baseline in the respiratory component of the Sequential Organ Failure Assessment score (SOFAresp) at day 5 was compared between early (within 48 h) steroid recipients and nonrecipients by using multivariable logistic regression and in a propensity-matched analysis. RESULTS: Among the 323 included patients (early steroids, n = 258; no steroids, n = 65), the median (interquartile range) age was 65 (53, 73) years, 63% were male, and 92% were white. Severity-adjusted regression and propensity-matched analyses found that early administration of steroids was associated with less improvement in SOFAresp at day 5 compared with no steroids (P = .001 and P = .017, respectively). No differences were observed in the odds of having at least a one-point improvement in SOFAresp at day 5 compared with baseline between groups (adjusted OR, 0.76 [95% CI, 0.24-2.28]; P = .61). Overall 30-day mortality was 22.9% (95% CI, 18.2-27.4). No differences in mortality, length of stay, admission to the ICU, or need for mechanical ventilation were found between early steroid recipients and nonrecipients. CONCLUSIONS: The addition of early corticosteroids to anti-Pneumocystis therapy in patients without HIV was not associated with improved respiratory outcomes.
BACKGROUND: Evidence supporting adjunctive corticosteroids during the treatment of Pneumocystis jirovecii pneumonia (PcP) in adults without HIV is minimal and controversial. METHODS: This retrospective cohort study included P jirovecii pneumonia-positive, hospitalized patients without HIV admitted to the Mayo Clinic from 2006 to 2016. Change from baseline in the respiratory component of the Sequential Organ Failure Assessment score (SOFAresp) at day 5 was compared between early (within 48 h) steroid recipients and nonrecipients by using multivariable logistic regression and in a propensity-matched analysis. RESULTS: Among the 323 included patients (early steroids, n = 258; no steroids, n = 65), the median (interquartile range) age was 65 (53, 73) years, 63% were male, and 92% were white. Severity-adjusted regression and propensity-matched analyses found that early administration of steroids was associated with less improvement in SOFAresp at day 5 compared with no steroids (P = .001 and P = .017, respectively). No differences were observed in the odds of having at least a one-point improvement in SOFAresp at day 5 compared with baseline between groups (adjusted OR, 0.76 [95% CI, 0.24-2.28]; P = .61). Overall 30-day mortality was 22.9% (95% CI, 18.2-27.4). No differences in mortality, length of stay, admission to the ICU, or need for mechanical ventilation were found between early steroid recipients and nonrecipients. CONCLUSIONS: The addition of early corticosteroids to anti-Pneumocystis therapy in patients without HIV was not associated with improved respiratory outcomes.
Authors: Julio A Ramirez; Daniel M Musher; Scott E Evans; Charles Dela Cruz; Kristina A Crothers; Chadi A Hage; Stefano Aliberti; Antonio Anzueto; Francisco Arancibia; Forest Arnold; Elie Azoulay; Francesco Blasi; Jose Bordon; Steven Burdette; Bin Cao; Rodrigo Cavallazzi; James Chalmers; Patrick Charles; Jean Chastre; Yann-Erick Claessens; Nathan Dean; Xavier Duval; Muriel Fartoukh; Charles Feldman; Thomas File; Filipe Froes; Stephen Furmanek; Martin Gnoni; Gustavo Lopardo; Carlos Luna; Takaya Maruyama; Rosario Menendez; Mark Metersky; Donna Mildvan; Eric Mortensen; Michael S Niederman; Mathias Pletz; Jordi Rello; Marcos I Restrepo; Yuichiro Shindo; Antoni Torres; Grant Waterer; Brandon Webb; Tobias Welte; Martin Witzenrath; Richard Wunderink Journal: Chest Date: 2020-06-16 Impact factor: 9.410
Authors: François Barbier; Mervin Mer; Piotr Szychowiak; Robert F Miller; Éric Mariotte; Lionel Galicier; Lila Bouadma; Pierre Tattevin; Élie Azoulay Journal: Intensive Care Med Date: 2020-02-03 Impact factor: 17.440
Authors: Zachary Hoy; Terry W Wright; Michael Elliott; Jane Malone; Samir Bhagwat; Jing Wang; Francis Gigliotti Journal: Infect Immun Date: 2020-01-22 Impact factor: 3.441