958. Morbidity and Mortality of Non-HIV-Infected Patients with Pneumocystis Pneumonia and Concomitant Pulmonary Cytomegalovirus Infection
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: The pathogenic role of concomitant pulmonary cytomegalovirus (CMV) infection on morbidity and mortality of Pneumocystis pneumonia (PCP) has been questioned in non-HIV-infected patients with PCP.

Methods: We compared retrospectively demographics, clinical characteristics, morbidity, and mortality between the groups of PCP with (n = 31) and without (n = 75) pulmonary CMV infection in non-HIV-infected patients. Morbidity of PCP was assessed by length of hospital stay, admission to intensive care unit, and use of mechanical ventilation. Mortality of PCP was defined as 30-day and 90-day all-cause mortality. Cox proportional hazard model was performed to determine covariates associated with 90-day all-cause mortality after PCP. 

Results: The morbidity and mortality of PCP were not significantly different between PCP patients with and without CMV infection, regardless of initial severity of PCP. There was a trend toward an increased 90-day all-cause mortality in PCP patients without CMV (42.7%) compared to those with CMV (22.6%; P = .051). In multivariate analysis using Cox proportional hazard model, solid organ transplant recipient (RR, 0.17; 95% CI, 0.05–0.56; P = .004) and use of mechanical ventilation (RR, 6.49; 95% CI, 2.84–14.83; P < .001) were independently associated with 90-day all-cause mortality. However, concomitant pulmonary CMV infection was not associated with mortality of PCP.

Conclusion: Our result suggests that concomitant pulmonary CMV infection do not significantly increase the severity of PCP, as indicated by morbidity and mortality, in non-HIV-infected patients with PCP.

Table 1. Comparison of outcome of Pneumocystis jirovecii pneumonia with and without cytomegalovirus infection in non-HIV-infected patients

 

PCP with CMV (n=31)

PCP without CMV (n=75)

P value

Morbidity

  Length of hospital stay, median days (IQR)

28 (17–47)

24 (14–42)

.15

  Admission to intensive care unit (%)

19 (61.3)

42 (56.0)

.62

  Mechanical ventilation (%)

14 (45.2)

37 (49.3)

.70

30-day all-cause mortality (%)

6 (19.4)

20 (26.7)

.43

90-day all-cause mortality (%)

7 (22.6)

32 (42.7)

.051

 


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

Tark Kim, MD1, Song Mi Moon, MD1, Hyun Jung Park, MD1, So-Youn Park, MD1, Heungsup Sung, MD, PhD2, Mi-Na Kim, MD, PhD2, 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)Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

T. Kim, None

S. M. Moon, 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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