title: An analysis of the utilisation of chemoprophylaxis against Pneumocystis jirovecii pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospital.
abstract: 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.
authors.affiliation: Victorian Infectious Diseases Service, Centre for Clinical Research Excellence in Infectious Diseases, Grattan Street, Parkville, Victoria 3050, Australia. leon.worth@petermac.org
authors.forename: L J
authors.initials: LJ
authors.lastname: Worth
authors.forename: M J
authors.initials: MJ
authors.lastname: Dooley
authors.forename: J F
authors.initials: JF
authors.lastname: Seymour
authors.forename: L
authors.initials: L
authors.lastname: Mileshkin
authors.forename: M A
authors.initials: MA
authors.lastname: Slavin
authors.forename: K A
authors.initials: KA
authors.lastname: Thursky
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
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