title: Pneumocystis pneumonia in hospitalized patients: a detailed examination of symptoms, management, and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected persons.
abstract: BACKGROUND
  Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection for immunocompromised individuals. Robust data and clear guidelines are available for prophylaxis and treatment of human immunodeficiency virus (HIV)-related PCP (HIV-PCP), yet few data and no guidelines are available for non-HIV-related PCP (NH-PCP). We postulated that prevention and inpatient management of HIV-PCP differed from NH-PCP.
  
  
  METHODS
  We performed a retrospective case review of all pathologically confirmed cases of PCP seen at the University of Alabama Medical Center from 1996 to 2008. Data on clinical presentation, hospital course, and outcome were collected using a standardized data collection instrument. Bivariate analysis compared prophylaxis, adjunctive corticosteroids, and clinical outcomes between patients with HIV-PCP and NH-PCP.
  
  
  RESULTS
  Our analysis of the cohort included 97 cases of PCP; 65 HIV and 32 non-HIV cases. Non-HIV cases rarely received primary prophylaxis (4% vs. 38%, P = 0.01) and received appropriate antibiotics later in the course of hospitalization (5.2 days vs. 1.1 days, P < 0.005). Among transplant patients, NH-PCP was diagnosed a mean of 1066 days after transplantation and most patients were on low-dose corticosteroids (87%) at the time of disease onset. No significant differences in adjunctive corticosteroid use (69% vs. 77%, P = 0.39) and 90-day mortality (41% vs. 28%, P = 0.20) were detected.
  
  
  CONCLUSIONS
  Patients who have undergone organ or stem cell transplant remain at risk for PCP for many years after transplantation. In our cohort, patients who developed NH-PCP were rarely given prophylaxis, and initiation of appropriate antibiotics was significantly delayed compared to cases of HIV-PCP. Medical providers should be aware of the ongoing risk for NH-PCP, even late after transplantation, and consider more aggressive approaches to both prophylaxis and earlier empirical therapy for PCP.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: McKinnell
authors.forename: A P
authors.initials: AP
authors.lastname: Cannella
authors.forename: D F
authors.initials: DF
authors.lastname: Kunz
authors.forename: E W
authors.initials: EW
authors.lastname: Hook
authors.forename: S A
authors.initials: SA
authors.lastname: Moser
authors.forename: L G
authors.initials: LG
authors.lastname: Miller
authors.forename: J W
authors.initials: JW
authors.lastname: Baddley
authors.forename: P G
authors.initials: PG
authors.lastname: Pappas
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology / Q000821:virology; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018890:Chemoprevention; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000821:virology; D015497:HIV-1; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000150:complications* / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D033581:Stem Cell Transplantation / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents