PMID- 38297200
OWN - NLM
STAT- MEDLINE
DCOM- 20240202
LR  - 20240206
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 24
IP  - 1
DP  - 2024 Jan 31
TI  - A regimen based on the combination of trimethoprim/sulfamethoxazole with 
      caspofungin and corticosteroids as a first-line therapy for patients with severe 
      non-HIV-related pneumocystis jirovecii pneumonia: a retrospective study in a 
      tertiary hospital.
PG  - 152
LID - 10.1186/s12879-024-09031-7 [doi]
LID - 152
AB  - BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening and 
      severe disease in immunocompromised hosts. A synergistic regimen based on the 
      combination of sulfamethoxazole-trimethoprim (SMX-TMP) with caspofungin and 
      glucocorticosteroids (GCSs) may be a potential first-line therapy for PJP. 
      Therefore, it is important to explore the efficacy and safety of this synergistic 
      therapy for treating non-HIV-related PJP patients. METHODS: We retrospectively 
      analysed the data of 38 patients with non-HIV-related PJP at the First Affiliated 
      Hospital of Xi'an Jiaotong University. Patients were divided into two groups: the 
      synergistic therapy group (ST group, n = 20) and the monotherapy group (MT group, 
      n = 18). All patients were from the ICU and were diagnosed with severe PJP. In 
      the ST group, all patients were treated with SMX-TMP (TMP 15-20 mg/kg per day) 
      combined with caspofungin (70 mg as the loading dose and 50 mg/day as the 
      maintenance dose) and a GCS (methylprednisolone 40-80 mg/day). Patients in the MT 
      group were treated only with SMX-TMP (TMP 15-20 mg/kg per day). The clinical 
      response, adverse events and mortality were compared between the two groups. 
      RESULTS: The percentage of patients with a positive clinical response in the ST 
      group was significantly greater than that in the MT group (100.00% vs. 66.70%, 
      P = 0.005). The incidence of adverse events in the MT group was greater than that 
      in the ST group (50.00% vs. 15.00%, P = 0.022). Furthermore, the dose of TMP and 
      duration of fever in the ST group were markedly lower than those in the MT group 
      (15.71 mg/kg/day vs. 18.35 mg/kg/day (P = 0.001) and 7.00 days vs. 11.50 days 
      (P = 0.029), respectively). However, there were no significant differences in 
      all-cause mortality or duration of hospital stay between the MT group and the ST 
      group. CONCLUSIONS: Compared with SMZ/TMP monotherapy, synergistic therapy 
      (SMZ-TMP combined with caspofungin and a GCS) for the treatment of 
      non-HIV-related PJP can increase the clinical response rate, decrease the 
      incidence of adverse events and shorten the duration of fever. These results 
      indicate that synergistic therapy is effective and safe for treating severe 
      non-HIV-related PJP.
CI  - (c) 2024. The Author(s).
FAU - Li, Hao
AU  - Li H
AD  - Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
AD  - Shaanxi Provincial Key Laboratory of Sepsis in Critical Care Medicine, Xi'an, 
      Shaanxi, China.
FAU - Lu, Yihe
AU  - Lu Y
AD  - Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
AD  - Shaanxi Provincial Key Laboratory of Sepsis in Critical Care Medicine, Xi'an, 
      Shaanxi, China.
FAU - Tian, Guoxin
AU  - Tian G
AD  - Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
AD  - Shaanxi Provincial Key Laboratory of Sepsis in Critical Care Medicine, Xi'an, 
      Shaanxi, China.
FAU - Wu, Yongxing
AU  - Wu Y
AD  - Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
AD  - Shaanxi Provincial Key Laboratory of Sepsis in Critical Care Medicine, Xi'an, 
      Shaanxi, China.
FAU - Chen, Tianjun
AU  - Chen T
AD  - Department of Respiratory and Critical Care Medicine, the First Affiliated 
      Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 
      China.
FAU - Zhang, Jiangwei
AU  - Zhang J
AD  - Department of Kideny Transplant, Hospital of Nephrology, the First Affiliated 
      Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 
      China.
FAU - Hu, Nan
AU  - Hu N
AD  - Department of Rheumatology, the First Affiliated Hospital of Xi'an Jiaotong 
      University, 277 Yanta West Road, Xi'an, Shaanxi, China.
FAU - Wang, Xiaoning
AU  - Wang X
AD  - Department of Hematology, the First Affiliated Hospital of Xi'an Jiaotong 
      University, 277 Yanta West Road, Xi'an, Shaanxi, China.
FAU - Wang, Yang
AU  - Wang Y
AD  - Department of Cardiovascular Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
FAU - Gao, Lan
AU  - Gao L
AD  - Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
AD  - Shaanxi Provincial Key Laboratory of Sepsis in Critical Care Medicine, Xi'an, 
      Shaanxi, China.
FAU - Yan, Jinqi
AU  - Yan J
AD  - Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
AD  - Shaanxi Provincial Key Laboratory of Sepsis in Critical Care Medicine, Xi'an, 
      Shaanxi, China.
FAU - Zhou, Linjing
AU  - Zhou L
AD  - Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
AD  - Shaanxi Provincial Key Laboratory of Sepsis in Critical Care Medicine, Xi'an, 
      Shaanxi, China.
FAU - Shi, Qindong
AU  - Shi Q
AD  - Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an 
      Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China. 
      shiqindong@163.com.
AD  - Shaanxi Provincial Key Laboratory of Sepsis in Critical Care Medicine, Xi'an, 
      Shaanxi, China. shiqindong@163.com.
LA  - eng
GR  - No. 2022JM-477/Natural Science Basic Research Program of Shaanxi Province/
GR  - 82070549/National Nature Science Foundation of China/
GR  - No. LJS-201801A/the Dr Li Jieshou (Academician of CAS) Research Fund for 
      Intestinal Barrier/
GR  - XJTU1AF-CRF-2019-016/the clinical research award of the first affiliated hospital 
      of Xi'an Jiaotong university/
GR  - No. 81460287/National Natural Science Foundation of China/
GR  - No. 81600327/the National Nature Science Foundation of China/
PT  - Journal Article
DEP - 20240131
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
RN  - 8064-90-2 (Trimethoprim, Sulfamethoxazole Drug Combination)
RN  - F0XDI6ZL63 (Caspofungin)
RN  - 0 (Adrenal Cortex Hormones)
SB  - IM
MH  - Humans
MH  - *Pneumonia, Pneumocystis/drug therapy
MH  - Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects
MH  - Caspofungin/therapeutic use
MH  - Retrospective Studies
MH  - Tertiary Care Centers
MH  - *Pneumocystis carinii
MH  - Adrenal Cortex Hormones/therapeutic use
PMC - PMC10829312
OTO - NOTNLM
OT  - Adverse event
OT  - Caspofungin
OT  - Clinical response
OT  - Glucocorticosteroid
OT  - Pneumocystis Jirovecii pneumonia
OT  - Sulfamethoxazole-trimethoprim
COIS- The authors declare no competing interests.
EDAT- 2024/02/01 00:42
MHDA- 2024/02/02 06:43
PMCR- 2024/01/31
CRDT- 2024/01/31 23:38
PHST- 2023/07/08 00:00 [received]
PHST- 2024/01/18 00:00 [accepted]
PHST- 2024/02/02 06:43 [medline]
PHST- 2024/02/01 00:42 [pubmed]
PHST- 2024/01/31 23:38 [entrez]
PHST- 2024/01/31 00:00 [pmc-release]
AID - 10.1186/s12879-024-09031-7 [pii]
AID - 9031 [pii]
AID - 10.1186/s12879-024-09031-7 [doi]
PST - epublish
SO  - BMC Infect Dis. 2024 Jan 31;24(1):152. doi: 10.1186/s12879-024-09031-7.