PMID- 34763703
OWN - NLM
STAT- MEDLINE
DCOM- 20220110
LR  - 20220110
IS  - 1476-0711 (Electronic)
IS  - 1476-0711 (Linking)
VI  - 20
IP  - 1
DP  - 2021 Nov 11
TI  - Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis 
      jiroveci pneumonia among rheumatic patients: a territory-wide study.
PG  - 78
LID - 10.1186/s12941-021-00483-2 [doi]
LID - 78
AB  - BACKGROUND: Pneumocystis jiroveci pneumonia (PJP) is an opportunistic infection 
      affecting immunocompromised individuals. However, evidence regarding the burden 
      and effectiveness of prophylaxis among rheumatic patients remains limited. 
      Delineating the epidemiology and efficacy of prophylaxis among rheumatic patients 
      is urgently needed. METHODS: We performed a territory-wide cohort study of 
      rheumatic patients in Hong Kong. All patients with a diagnosis of anti-neutrophil 
      cytoplasmic antibody-associated vasculitis (AAV), immune-mediated myositis (IMM), 
      rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis 
      (SSc), or spondyloarthritis (SpA) between 2015 and 2019 were included. 
      Prevalence, frequency of prophylaxis and mortality of PJP were calculated. Number 
      needed to treat (NNT) analysis was also performed. RESULTS: Out of 21,587 
      patients (54% RA, 25% SLE, 13% SpA, 5% IMM, 2% AAV and 1% SSc), 1141 (5.3%) 
      patients were prescribed PJP prophylaxis. 48/21,587 (0.2%) developed PJP. No 
      patients who developed PJP received prophylaxis prior to infection. The incidence 
      of PJP was highest among SSc, AAV, and IMM patients. Among these diseases, the 
      majority of PJP occurred while patients were on glucocorticoids at daily 
      prednisolone-equivalent doses of 15 mg/day (P15) or above. PJP prophylaxis was 
      effective with NNT for SSc, AAV and IIM being 36, 48 and 114 respectively. There 
      were 19 PJP-related mortalities and the mortality rate was 39.6%. CONCLUSION: PJP 
      is an uncommon but important infection among rheumatic patients, PJP prophylaxis 
      is effective and should be considered in patients with SSc, AAV and IMM, 
      especially those receiving glucocorticoid doses above P15.
CI  - (c) 2021. The Author(s).
FAU - Chan, Shirley Chiu Wai
AU  - Chan SCW
AD  - Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen 
      Mary Hospital, The University of Hong Kong, Hong Kong, China.
FAU - Chung, Ho Yin
AU  - Chung HY
AD  - Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen 
      Mary Hospital, The University of Hong Kong, Hong Kong, China.
FAU - Lau, Chak Sing
AU  - Lau CS
AD  - Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen 
      Mary Hospital, The University of Hong Kong, Hong Kong, China.
FAU - Li, Philip Hei
AU  - Li PH
AUID- ORCID: 0000-0002-9155-9162
AD  - Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen 
      Mary Hospital, The University of Hong Kong, Hong Kong, China. liphilip@hku.hk.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20211111
PL  - England
TA  - Ann Clin Microbiol Antimicrob
JT  - Annals of clinical microbiology and antimicrobials
JID - 101152152
RN  - 0 (Glucocorticoids)
SB  - IM
MH  - Aged
MH  - Cohort Studies
MH  - Female
MH  - Glucocorticoids/*administration & dosage/therapeutic use
MH  - Humans
MH  - Immunocompromised Host
MH  - Incidence
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Opportunistic Infections/*complications/immunology
MH  - Pneumocystis carinii/*drug effects/isolation & purification
MH  - Pneumonia, Pneumocystis/diagnosis/*mortality/*prevention & control
MH  - Rheumatic Diseases/*complications/epidemiology
PMC - PMC8582139
OTO - NOTNLM
OT  - Epidemiology
OT  - Fungal
OT  - Mortality
OT  - Pneumonia
OT  - Prophylaxis
OT  - Rheumatology
COIS- The authors declare that they have no competing interests.
EDAT- 2021/11/13 06:00
MHDA- 2022/01/11 06:00
PMCR- 2021/11/11
CRDT- 2021/11/12 05:35
PHST- 2021/08/03 00:00 [received]
PHST- 2021/10/29 00:00 [accepted]
PHST- 2021/11/12 05:35 [entrez]
PHST- 2021/11/13 06:00 [pubmed]
PHST- 2022/01/11 06:00 [medline]
PHST- 2021/11/11 00:00 [pmc-release]
AID - 10.1186/s12941-021-00483-2 [pii]
AID - 483 [pii]
AID - 10.1186/s12941-021-00483-2 [doi]
PST - epublish
SO  - Ann Clin Microbiol Antimicrob. 2021 Nov 11;20(1):78. doi: 
      10.1186/s12941-021-00483-2.