Pneumocystis pneumonia in intensive care: clinical spectrum, prophylaxis patterns, antibiotic treatment delay impact, and role of corticosteroids. A French multicentre prospective cohort study
Authors' conclusion
This study showed that few patients with PJP admitted to intensive care received prophylactic antibiotic therapy, that delay in curative antibiotic treatment was common and that both delay in curative antibiotic treatment and adjunctive corticosteroids for PJP were associated with accelerated mortality.
Study context
- Population
- Adults with severe Pneumocystis jirovecii pneumonia (PJP) admitted to 49 intensive care units (ICUs) in France, September 2020 to August 2022
- Participants
- 158 adults · 49 ICUs
- Exposure
- Curative antibiotic treatment started after vs within 96 h of ICU admission; adjunctive corticosteroids vs none
- Outcome
- Mortality (association of delayed curative antibiotic treatment and adjunctive corticosteroids with mortality)
Methodological detailsmulticentre, observational, propensity score-based inverse probability of treatment weighting, time-to-event analysis
- Multicentre
- Observational
- Propensity score-based inverse probability of treatment weighting
- Time-to-event analysis
Main finding
As reported in the abstract
Time ratio
6.75
95% CI 1.48–30.82P = 0.014
Antibiotics after 96 h vs Antibiotics within 96 h
Time ratio
2.48
95% CI 1.01–6.08P = 0.048
Corticosteroids vs No corticosteroids
Observational data: associations, not effects.
Further findings
ICU, hospital and 6-month mortality (whole cohort)
- ICU mortality
- 31.6%
- Hospital mortality
- 35.4%
- 6-month mortality
- 40.5%
Acute respiratory failure as main reason for admission
- Acute respiratory failure
- n = 150, 94.9%
PJP antibiotic prophylaxis before ICU admission
- Received prophylaxis
- 12%
Original publication
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