Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection. The increasing use of corticosteroids, chemotherapy and immunosuppressive drugs may lead to an outbreak of PCP in patients not affected by HIV and sometimes their admission to an intensive care unit (ICU) for acute respiratory distress.
The aim of this study was to evaluate the diagnostic contribution of quantitative real-time PCR (rtPCR) in P. jirovecii patients having acute respiratory distress in the ICU. All patients with a positive rtPCR in the ICU were included in this prospective 3 year study. Patients were classified as having retained PCP (positive direct microscopic examination), possible PCP or colonization according to clinical, radiological and microbiological data. Treatment and outcome of patients were also analyzed.
Seventy-five patients were included and 68% were men. The median age was 61 years. Risk factors were identified in 96% of patients: 53% had corticosteroid therapy, 28% onco- hematological malignancy, 23% transplantation and 21% HIV. Dyspnea and fever were the most frequent clinical manifestations. Overall, 97% of patients were not receiving PCP prophylaxis. Typical radiological results were found in 83% of patients. Direct microscopic examination (DME) of the respiratory secretions (BAL and or sputum) was positive in 88% of HIV patients and 27% of non-HIV patients. Among the 45 patients with negative DME, 34 (75%) had a possible PCP and 11 were colonized. Cotrimoxazole was the first-line treatment in 85% of patients. Steroid therapy was used in 69% of patients and 45% of the patients needed mechanical ventilation. The in-hospital mortality was 39% and attributable PCP mortality was 52%.
This study confirms that quantitative rtPCR is a useful tool to diagnose PCP in the ICU, especially in non-HIV patients of whom 73% had a negative direct microbiologic examination.
G. Baulier, None
I. Accoceberry, None
G. Mourissoux, None
O. Guisset, None
F. Camou, None
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