883. Outcome of Moderate-to-Severe Pneumocystis Pneumonia Treated with Adjunctive Steroid in Non-HIV-Infected Patients
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Background: While it is well-known that adjunctive corticosteroid use improves the outcome of moderate-to-severe Pneumocystis jirovecii pneumonia (PCP) in patients with human immunodeficiency virus (HIV), there is limited data on the efficacy of adjunctive corticosteroid use in non-HIV-infected patients with PCP.

Methods: Patients undergoing fiberoptic bronchoscopy with bronchoalveolar lavage for suspected PCP from January 2007 through December 2010 were reviewed retrospectively. We compared demographics, clinical characteristics, and outcome in non-HIV infected patient with moderate-to-severe PCP with (n=59) and without (n=29) adjunctive corticosteroid use. Outcome of PCP was assessed by respiratory failure and 30-day and 90-day all-cause mortality. Survival curve was analyzed by Kaplan-Meier method and estimated by log-rank test.

Results: All cause mortality of moderate-to-severe PCP at 90-day was lower in the solid organ transplant recipients (6/26 [23%] vs. 34/62 [55%]; P=.006) and mortality at 30-day was lower in patients with hematologic malignancies (4/26 [15%] vs. 24/62 [39%]; P=.03) than all others, respectively. The outcomes (respiratory failure rate and mortality) of PCP were not significantly different in moderate-to-severe PCP patients with and without adjunctive corticosteroid use, regardless of recent corticosteroid use. Survival analysis of PCP patients with and without corticosteroid use by Kaplan-Meier method also did not show the difference (log-rank test, P=.81). Analyzing the solid organ transplant recipients with PCP, we did not find any significant differences of outcomes between those with and without adjunctive corticosteroid use.

Conclusion: Our results suggest that adjunctive corticosteroid use might not improve the outcome of moderate-to-severe PCP in non-HIV infected patients.

Table 1. Comparison of outcome of Moderate-to-Severe Pneumocystis jirovecii Pneumonia with and without Adjunctive Steroid Therapy

Adjunctive Steroid Therapy (n=59)

   No adjunctive Steroid Therapy (n=29)

P value

Respiratory failure

37 (62.7)

17 (58.6)

.71

30-day all-cause mortality

18 (30.5)

10 (34.5)

.71

90-day all-cause mortality

28 (47.5)

12 (41.4)

.59


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Song Mi Moon, MD1,2, Tark Kim, MD1, Hyun Jung Park, MD1, So-Youn Park, MD1, Heungsup Sung, MD, PhD3, Mi-Na Kim, MD, PhD3, Sung-Han Kim, MD, PhD1, Sang-Ho Choi, MD, PhD1, Jin-Yong Jeong, PhD1, Jun Hee Woo, MD, PhD1, Yang Soo Kim, MD, PhD1 and Sang-Oh Lee, MD1, (1)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, (2)Graduate School, Kyung Hee University, Seoul, South Korea, (3)Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

S. M. Moon, None

T. Kim, None

H. J. Park, None

S. Y. Park, None

H. Sung, None

M. N. Kim, None

S. H. Kim, None

S. H. Choi, None

J. Y. Jeong, None

J. H. Woo, None

Y. S. Kim, None

S. O. Lee, None

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