共感染
医学
耶氏肺孢子虫
内科学
肺炎
优势比
流行病学
肺孢子虫肺炎
免疫学
人类免疫缺陷病毒(HIV)
作者
Romain Lécuyer,Nahema Issa,Benoit Tessoulin,Rose-Anne Lavergne,Florent Morio,Frédéric Gabriel,Emmanuel Canet,Céline Bressollette-Bodin,Aurélie Guillouzouic,David Boutoille,François Raffi,Raphaël Lecomte,Paul Le Turnier,Colin Deschanvres,Fabrice Camou,Benjamin Gaborit
标识
DOI:10.1093/infdis/jiab460
摘要
The role of respiratory coinfections at diagnosis of Pneumocystis jirovecii pneumonia (PcP) on clinical impact has been underestimated.A retrospective observational study was conducted January 2011 to April 2019 to evaluate respiratory coinfections at diagnosis of PcP patients in 2 tertiary care hospitals. Coinfection was defined by identification of pathogens from P. jirovecii-positive samples.Of 7882 respiratory samples tested for P. jirovecii during the 8-year study, 328 patients with diagnosis of PcP were included. Mean age was 56.7 (SD 14.9) years, 193 (58.8%) were male, 74 (22.6%) had positive HIV serology, 125 (38.1%) had viral coinfection, 76 (23.2%) bacterial coinfection, and 90-day mortality was 25.3%. In the overall population, 90-day mortality was independently associated with solid tumor underlying disease (odds ratio [OR], 11.8; 95% confidence interval [CI], 1.90-78.0; P = .008), sepsis-related organ failure assessment score (SOFA) at admission (OR, 1.62; 95% CI, 1.34-2.05; P< .001), and cytomegalovirus (CMV) respiratory coinfection (OR, 3.44; 95% CI, 1.24-2.90; P = .02). Among HIV-negative patients, respiratory CMV coinfection was associated with worse prognosis, especially when treated with adjunctive corticosteroid therapy.Respiratory CMV coinfection at PcP diagnosis was independently associated with increased 90-day mortality, specifically in HIV-negative patients.
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