An analysis of the utilisation of chemoprophylaxis against Pneumocystis jirovecii pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospital.
Pneumocystis jirovecii pneumonia (PCP) is associated with high mortality in immunocompromised patients without human immunodeficiency virus infection. However, chemoprophylaxis is highly effective. In patients with solid tumours or haematologic malignancy, several risk factors for developing PCP have been identified, predominantly corticosteroid therapy. The aims of this study were to identify the potentially preventable cases of PCP in patients receiving corticosteroid therapy at a tertiary care cancer centre and to estimate the frequency of utilisation of chemoprophylaxis in these patients. Two retrospective reviews were performed. Over a 10-year period, 14 cases of PCP were identified: no cases were attributable to failed chemoprophylaxis, drug allergy or intolerance. During a 6-month period, 73 patients received high-dose corticosteroid therapy (> or =25 mg prednisolone or > or =4 mg dexamethasone daily) for > or =4 weeks. Of these, 22 (30%) had haematologic malignancy, and 51 (70%) had solid tumours. Fewer patients with solid tumours received prophylaxis compared to patients with haematologic malignancy (3.9 vs 63.6%, P<0.0001). Guidelines for PCP chemoprophylaxis in patients with haematologic malignancy or solid tumours who receive corticosteroid therapy are proposed. Successful primary prevention of PCP in this population will require a multifaceted approach targeting the suboptimal prescribing patterns for chemoprophylaxis.
Worth
L J
LJ
Victorian Infectious Diseases Service, Centre for Clinical Research Excellence in Infectious Diseases, Grattan Street, Parkville, Victoria 3050, Australia. leon.worth@petermac.org
Dooley
M J
MJ
Seymour
J F
JF
Mileshkin
L
L
Slavin
M A
MA
Thursky
K A
KA
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D016720:Pneumocystis Infections / Q000517:prevention & control*; D045363:Pneumocystis carinii
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
Clin Infect Dis. 2002 Oct 15;35(8):929-34
12355379
Eur J Cancer Clin Oncol. 1987 Nov;23(11):1679-82
3501375
AIDS. 1997 Aug;11(10):1263-8
9256945
Arch Intern Med. 2003 Feb 24;163(4):402-10
12588198
Mayo Clin Proc. 1996 Jan;71(1):102-3
8538221
Clin Infect Dis. 1993 Nov;17 Suppl 2:S416-22
8274607
Clin Infect Dis. 2001 Jul 15;33(2):139-44
11418871
Health Policy. 1994 Mar;27(3):253-9
10134582
Bone Marrow Transplant. 1995 Feb;15(2):267-70
7773216
Biol Blood Marrow Transplant. 2000;6(1):35-43
10707997
Clin Exp Dermatol. 1990 Sep;15(5):358-60
2225539
Cancer Treat Rev. 2003 Apr;29(2):105-19
12670453
Clin Infect Dis. 1993 Sep;17(3):323-32
8218671
Clin Microbiol Rev. 2004 Oct;17(4):770-82, table of contents
15489347
Arch Intern Med. 1992 Mar;152(3):523-8
1546914
Am J Med Qual. 2003 Sep-Oct;18(5):197-203
14604272
Am J Pediatr Hematol Oncol. 1981 Summer;3(2):115-9
6975580
J Rheumatol. 2004 Mar;31(3):550-6
14994404
N Engl J Med. 1987 Jun 25;316(26):1627-32
3495732
Mayo Clin Proc. 1996 Jan;71(1):5-13
8538233
JAMA. 1992 Feb 12;267(6):832-7
1732656
Clin Infect Dis. 1996 Oct;23(4):718-22
8909833
J Clin Oncol. 1994 Apr;12(4):671-8
7512125
Clin Infect Dis. 2002 Apr 15;34(8):1098-107
11914999
Medicine (Baltimore). 1997 Nov;76(6):415-22
9413427
Eur Respir J. 1996 Nov;9(11):2318-22
8947078
Cancer. 1975 Dec;36(6):2004-9
1081905
Am J Med. 2003 Apr 15;114(6):463-9
12727579
Am J Med. 1993 Feb;94(2):216-9
8381584
N Engl J Med. 1977 Dec 29;297(26):1419-26
412099
Acta Haematol. 1998;99(1):54-6
9490570
J Pediatr. 1984 Oct;105(4):639-44
6332893
J Infect Dis. 1984 Feb;149(2):143-7
6321606
Ann Intern Med. 1992 Nov 15;117(10):877-8
1416570
Chest. 1993 Jun;103(6):1923
8280237
Ann Intern Med. 1974 Jan;80(1):83-93
4589515
Clin Lymphoma. 2004 Mar;4(4):220-7
15072613
Arch Intern Med. 1995 Jun 12;155(11):1125-8
7763117
Chest. 2000 Sep;118(3):712-20
10988193
Bone Marrow Transplant. 1999 Oct;24(8):897-902
10516703
Pharmacotherapy. 1996 Nov-Dec;16(6):1030-8
8947975
N Engl J Med. 1998 Dec 24;339(26):1889-95
9862944
Br J Rheumatol. 1998 Jan;37(1):105-6
9487262
Eur J Haematol. 2003 Oct;71(4):315-6
12950246
J Pediatr. 1990 Nov;117(5):823-6
2231218
Clin Infect Dis. 1997 Aug;25(2):215-8
9332513
J Clin Oncol. 2000 Feb;18(3):547-61
10653870
Am J Hematol. 2000 Mar;63(3):125-30
10679801
Clin Infect Dis. 1999 Dec;29(6):1467-71
10585797
N Engl J Med. 1984 May 24;310(21):1353-6
6546971
Eur J Cancer. 1991;27(5):671
1711356
J Natl Med Assoc. 1987 Nov;79(11):1205-9
3501015