Outcomes of moderate-to-severe Pneumocystis pneumonia treated with adjunctive steroid in non-HIV-infected patients
Antimicrobial Agents and Chemotherapy, 55 (10):
4613--4618 (2011)Abstract
While it is well-known that adjunctive corticosteroid use improves the outcome of moderate-to-severe <i>Pneumocystis jirovecii</i> pneumonia (PcP) in patients with human immunodeficiency virus (HIV), there are limited data on its efficacy in non-HIV-infected patients with PcP. Patients undergoing fiber-optic bronchoscopy with bronchoalveolar lavage for suspected PcP from January 2007 through December 2010 were reviewed retrospectively. We compared demographics, clinical characteristics, and outcomes in 88 non-HIV-infected patients with moderate-to-severe PcP with (<i>n</i>=59) and without (<i>n</i>=29) adjunctive corticosteroid use. Outcomes of PcP were assessed by respiratory failure and 30-day and 90-day all-cause mortality. Survival curves were analyzed by the Kaplan-Meier method and estimated by the log rank test. All-cause mortality of moderate-to-severe PcP at 90 days was lower in the solid-organ transplant recipients than in all other patients (6/26 23\$\backslash$\%\ versus 34/62 55\$\backslash$\%\, respectively; <i>P</i>=0.006), and mortality at 30 days was lower in patients with hematologic malignancies than in all other patients (4/26 15\$\backslash$\%\ versus 24/62 39\$\backslash$\%\, respectively; <i>P</i>=0.03). The outcomes 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 the Kaplan-Meier method also did not reveal any difference (log rank test; <i>P</i>=0.81). There again was no difference within the subgroup of PcP patients with solid-organ transplants. Adjunctive corticosteroid use may not improve the outcome of moderate-to-severe PcP in non-HIV-infected patients.