title: Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients.
abstract: BACKGROUND
  Pneumocystis jiroveci pneumonia in human immunodeficiency virus (HIV)-negative immunocompromised patients is associated with high mortality rates. Although trimethoprim-sulfamethoxazole provides a very effective prophylaxis, pneumocystosis still occurs and may even be emerging due to suboptimal characterization of patients most at risk, hence precluding targeted prophylaxis.
  
  
  METHODS
  We retrospectively analyzed all cases of documented pneumocystosis in HIV-negative patients admitted in our institution, a referral center in the area, from January 1990 to June 2010, and extracted data on their underlying condition(s). To estimate incidence rates within each condition, we estimated the number of patients followed-up in our area for each condition by measuring the number of patients admitted with the corresponding international classification diagnostic code, through the national hospital discharge database (Program of Medicalization of the Information System [PMSI]).
  
  
  RESULTS
  From 1990 to 2010, 293 cases of pneumocystosis were documented, of which 154 (52.6%) tested negative for HIV. The main underlying conditions were hematological malignancies (32.5%), solid tumors (18.2%), inflammatory diseases (14.9%), solid organ transplant (12.3%), and vasculitis (9.7%). Estimated incidence rates could be ranked in 3 categories: 1) high risk (incidence rates >45 cases per 100,000 patient-year): polyarteritis nodosa, granulomatosis with polyangiitis, polymyositis/dermatopolymyositis, acute leukemia, chronic lymphocytic leukemia, and non-Hodgkin lymphoma; 2) intermediate risk (25-45 cases per 100,000 patient-year): Waldenström macroglobulinemia, multiple myeloma, and central nervous system cancer; and 3) low risk (<25 cases per 100,000 patient-year): other solid tumors, inflammatory diseases, and Hodgkin lymphoma.
  
  
  CONCLUSIONS
  These estimates may be used as a guide to better target pneumocystosis prophylaxis in the groups most at risk.
authors: Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France.
authors: Pierre
authors: P
authors: Fillatre
authors: Médecine Interne, Hôpital Sud, Rennes, France.
authors: Olivier
authors: O
authors: Decaux
authors: Pneumologie, Hôpital Pontchaillou, Rennes, France; IRSET, UMR-INSERM 1085, Université Rennes 1, Rennes, France.
authors: Stéphane
authors: S
authors: Jouneau
authors: Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France.
authors: Matthieu
authors: M
authors: Revest
authors: Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France.
authors: Arnaud
authors: A
authors: Gacouin
authors: IRSET, UMR-INSERM 1085, Université Rennes 1, Rennes, France; Parasitologie-Mycologie, Hôpital Pontchaillou, Rennes, France.
authors: Florence
authors: F
authors: Robert-Gangneux
authors: Medical Information Department, Hôpital Pontchaillou, Rennes, France.
authors: Annie
authors: A
authors: Fresnel
authors: IRSET, UMR-INSERM 1085, Université Rennes 1, Rennes, France; Parasitologie-Mycologie, Hôpital Pontchaillou, Rennes, France.
authors: Claude
authors: C
authors: Guiguen
authors: Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France.
authors: Yves
authors: Y
authors: Le Tulzo
authors: Médecine Interne, Hôpital Sud, Rennes, France.
authors: Patrick
authors: P
authors: Jégo
authors: Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France; INSERM U835, Faculté de Médecine, Université Rennes 1, Rennes, France. Electronic address: pierre.tattevin@chu-rennes.fr.
authors: Pierre
authors: P
authors: Tattevin
mesh_terms: D005602:France / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology* / Q000276:immunology; D016015:Logistic Models; D009369:Neoplasms / Q000453:epidemiology* / Q000276:immunology; D016017:Odds Ratio; D016377:Organ Transplantation / Q000534:rehabilitation*; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology* / Q000276:immunology; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000453:epidemiology* / Q000276:immunology; D014657:Vasculitis / Q000453:epidemiology* / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents
keywords: HIV-negative; Hematological malignancy; Inflammatory diseases; Organ transplant; Pneumocystis jiroveci; Vasculitis