Affiliation:
1. Infectious Diseases Department Rashid Hospital Dubai Academic Health Corporation Dubai United Arab Emirates
2. Transplant Infectious Diseases Program, Ajmera Transplant Centre, Division of Infectious Diseases, Department of Medicine University of Toronto University Health Network Toronto Ontario Canada
3. Infectious Diseases Department Hospital Ramón y Cajal IRYCIS (Instituto Ramón y Cajal de Investigación Sanitaria) Universidad de Alcalá Madrid Spain
4. Biostatistics Research Unit University Health Network Toronto Canada
5. Department of Laboratory Medicine & Pathobiology University Health Network/Sinai Health Department of Microbiology University of Toronto Toronto Canada
Abstract
AbstractBackgroundPrevious studies showed HIV‐negative immunocompromised patients are susceptible to Pneumocystis pneumonia (PCP). However, the PCP outcome has not been compared among HIV‐negative immunocompromised patients.MethodsIn this retrospective cohort study at the University Health Network, we included all HIV‐negative immunocompromised patients who fulfilled the European Organization for Research and Treatment of Cancer (EORTC) PCP diagnosis criteria from December 2018 to December 2019. We compared the demographics, comorbidities, course of illness, and PCP outcome (28‐day mortality and composite outcome [i.e., death or intensive care unit (ICU) admission]) between solid organ transplant (SOT) and non‐SOT patients.ResultsOf 160 non‐HIV patients with PCP diagnoses, 118 patients fulfilled EORTC criteria (76 males [64.4%], median [range] age: 65.5 [21–87] years). PCP presentation in SOT recipients (n = 14) was more severe than non‐SOT patients (n = 104): acute presentation (onset <7 days before admission: 11/14 [78.6%] vs. 51/104 [56%], p = .037), shortness of breath (100% vs. 75/104 [74.3%], p = .037), median [range] O2 saturation (88% [75%, 99%] vs. 92%[70%, 99%], p = .040), and supplemental O2 requirement (12/14 [85.7%] vs. 59/104 [56.7%], p = .044). The mortality [4/14, (28.6%) vs. 15/104 (14.4%), p = .176], ICU admission (10/14 [71.4%] vs. 18/104 [17.3%], p < .0001), and mechanical ventilation (8/14 [57.1%] vs. 18/104 [17.3%], p = .0007) in SOT patients was different from non‐SOT patients. In multivariable analysis, SOT recipients were at greater risk of composite outcome than non‐SOT patients (aOR [CI95%]: 12.25 [3.08–48.62], p < .001).ConclusionPCP presentation and outcomes in SOT recipients are more severe than in non‐SOT patients. Further studies are required to explore the biological reasons for this difference.
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