論文No4053
Clinical Characteristics and Prognosis of Patients With Severe Pneumonia With Pneumocystis jirovecii Colonization
A Multicenter, Retrospective Study
Yongpo Jiang,Xiaohan Huang,Huili Zhou,...Shengwei Jin,Hongyu Wang,Lingtong Huang
CHEST, Volume 167, Issue 1, p54-66, January 2025.
要約
この研究は、重症肺炎患者におけるニューモシスチス・ジロベチーという菌の定着が、患者の予後にどのような影響を与えるのかを調査しました。その結果、ニューモシスチス・ジロベチーが定着している患者は、免疫力が低下していることが多く、他のウイルス感染を併発している傾向が見られました。また、この菌の定着は、患者の死亡リスクを高める独立した要因であることが明らかになりました。
Take Home Message
ニューモシスチス・ジロベチーの定着は重症肺炎患者の死亡リスクを高める: 免疫力が低下している患者や、他のウイルスに感染している患者では、特に注意が必要です。
免疫抑制や他のウイルス感染は、ニューモシスチス・ジロベチーの定着リスクを高める: これらの患者に対しては、早期の診断と治療が重要です。
ニューモシスチス・ジロベチーの定着は、重症肺炎の予後を悪化させる可能性がある: 肺炎の治療において、ニューモシスチス・ジロベチーの存在を考慮する必要があります。
Background
For decades, the incidence and clinical characteristics of Pneumocystis jirovecii colonization in patients with severe pneumonia was unclear.
Research Question
What are the clinical features and outcomes associated with P jirovecii colonization in individuals diagnosed with severe pneumonia?
Study Design and Methods
In this multicenter, retrospective, matched study, patients with severe pneumonia who underwent bronchoalveolar lavage clinical metagenomics from 2019 to 2023 in the ICUs of 17 medical centers were enrolled. Patients were diagnosed based on clinical metagenomics, pulmonary CT scans, and clinical presentations. Clinical data were collected retrospectively, and according to propensity score matching and Cox multivariate regression analysis, the prognosis of patients with P jirovecii colonization was compared with that of patients who were P jirovecii-negative.
Results
A total of 40% of P jirovecii-positive patients are considered to have P jirovecii colonization. The P jirovecii colonization group had a higher proportion of patients with immunosuppression and a lower lymphocyte count than the P jirovecii-negative group. More frequent detection of cytomegalovirus, Epstein-Barr virus, human herpesvirus-6B, human herpesvirus-7, and torque teno virus in the lungs was associated with P jirovecii colonization than with P jirovecii negativity. By constructing two cohorts through propensity score matching, we incorporated codetected microorganisms and clinical features into a Cox proportional hazards model and revealed that P jirovecii colonization was an independent risk factor for mortality in patients with severe pneumonia. According to sensitivity analyses, which included or excluded codetected microorganisms, and patients not receiving trimethoprim-sulfamethoxazole treatment, similar conclusions were reached.
Interpretation
Immunosuppression and a reduced lymphocyte count were identified as risk factors for P jirovecii colonization in patients with non-Pneumocystis pneumonia. More frequent detection of various viruses was observed in patients colonized with P jirovecii, and P jirovecii colonization was associated with an increased 28-day mortality in patients with severe pneumonia.