Pneumocystis pneumonia in intensive care: clinical spectrum, prophylaxis patterns, antibiotic treatment delay impact, and role of corticosteroids. A French multicentre prospective cohort study - Infection et Inflammation
Article Dans Une Revue Intensive Care Medicine Année : 2024

Pneumocystis pneumonia in intensive care: clinical spectrum, prophylaxis patterns, antibiotic treatment delay impact, and role of corticosteroids. A French multicentre prospective cohort study

Xavier Valette
  • Fonction : Auteur
Minh-Pierre Le
  • Fonction : Auteur
Remi Coudroy
  • Fonction : Auteur
Thierry Boulain
Auchabie Johann
  • Fonction : Auteur
Beuret Pascal
  • Fonction : Auteur
Darreau Cédric
  • Fonction : Auteur
Desmeulles Isabelle
  • Fonction : Auteur
Guervilly Christophe
  • Fonction : Auteur
Hong Tuan Ha Vivien
  • Fonction : Auteur
Jochmans Sébastien
  • Fonction : Auteur
Jozwiak Mathieu
  • Fonction : Auteur
Louis Guillaume
  • Fonction : Auteur
Navellou Jean-Christophe
  • Fonction : Auteur
Neuville Mathilde
  • Fonction : Auteur
Pichon Nicolas
  • Fonction : Auteur
Sagnier Anne
  • Fonction : Auteur
Schnell David
  • Fonction : Auteur

Résumé

Purpose Severe Pneumocystis jirovecii pneumonia (PJP) requiring intensive care has been the subject of few prospective studies. It is unclear whether delayed curative antibiotic therapy may impact survival in these severe forms of PJP. The impact of corticosteroid therapy combined with antibiotics is also unclear. Methods This multicentre, prospective observational study involving 49 adult intensive care units (ICUs) in France was designed to evaluate the severity, the clinical spectrum, and outcomes of patients with severe PJP, and to assess the association between delayed curative antibiotic treatment and adjunctive corticosteroid therapy with mortality. Results We included 158 patients with PJP from September 2020 to August 2022. Their main reason for admission was acute respiratory failure (n = 150, 94.9%). 12% of them received antibiotic prophylaxis for PJP before ICU admission. The ICU, hospital, and 6-month mortality were 31.6%, 35.4%, and 40.5%, respectively. Using time-to-event analysis with a propensity score-based inverse probability of treatment weighting, the initiation of curative antibiotic treatment after 96 h of ICU admission was associated with faster occurrence of death [time ratio: 6.75; 95% confidence interval (95% CI): 1.48–30.82; P = 0.014]. The use of corticosteroids for PJP was associated with faster occurrence of death (time ratio: 2.48; 95% CI 1.01–6.08; P = 0.048). Conclusion This study showed that few patients with PJP admitted to intensive care received prophylactic antibiotic therapy, that delay in curative antibiotic treatment was common and that both delay in curative antibiotic treatment and adjunctive corticosteroids for PJP were associated with accelerated mortality.
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hal-04671908 , version 1 (04-09-2024)

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Toufik Kamel, Ralf Janssen-Langenstein, Quentin Quelven, Jonathan Chelly, Xavier Valette, et al.. Pneumocystis pneumonia in intensive care: clinical spectrum, prophylaxis patterns, antibiotic treatment delay impact, and role of corticosteroids. A French multicentre prospective cohort study. Intensive Care Medicine, 2024, 50 (8), pp.1228-1239. ⟨10.1007/s00134-024-07489-2⟩. ⟨hal-04671908⟩
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