title: Outcomes of moderate-to-severe Pneumocystis pneumonia treated with adjunctive steroid in non-HIV-infected patients.
abstract: While it is well-known that adjunctive corticosteroid use improves the outcome of moderate-to-severe Pneumocystis jirovecii 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 (n = 59) and without (n = 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%] versus 34/62 [55%], respectively; P = 0.006), and mortality at 30 days was lower in patients with hematologic malignancies than in all other patients (4/26 [15%] versus 24/62 [39%], respectively; P = 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; P = 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.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Song Mi
authors.initials: SM
authors.lastname: Moon
authors.forename: Tark
authors.initials: T
authors.lastname: Kim
authors.forename: Heungsup
authors.initials: H
authors.lastname: Sung
authors.forename: Mi-Na
authors.initials: MN
authors.lastname: Kim
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin-Yong
authors.initials: JY
authors.lastname: Jeong
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D045363:Pneumocystis carinii / Q000187:drug effects*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D013419:Sulfamethizole / Q000627:therapeutic use*; D016896:Treatment Outcome; D014295:Trimethoprim / Q000627:therapeutic use*; D000096926:Benzenesulfonamides
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D004338:Drug Combinations; D013419:Sulfamethizole; D014295:Trimethoprim; C029078:trimethoprim sulfamethizole; D000096926:Benzenesulfonamides