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Epidemiology of Pneumocystis jirovecii pneumonia and (non-)use of prophylaxis

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Abstract
Objectives: Pneumocystis jirovecii pneumonia (PCP) is an AIDS-defining illness. In patients with HIV, the benefit of PCP prophylaxis is well-defined when the CD4 T-cell count decreases below 200 cells/μL. In other immunocompromised patients, the value of PCP prophylaxis is not always as well-established. This study aimed to describe the epidemiology of PCP in recent years and assess how many patients with PCP did or did not receive prophylaxis in the month preceding the infection. Material and Methods: A multicenter retrospective study was performed in 3 tertiary care hospital. A list of patients that underwent broncho-alveolar lavage sampling and Pneumocystis jirovecii (PJ) PCR testing was retrieved from the microbiology laboratories. An in-house PJ quantitative PCR (qPCR) was used in each center. A cycle threshold (Ct) value of ≤ 28.5–30 was considered a probable PCP. For patients with a positive PJ qPCR but above this threshold, a predefined case definition of possible PCP was defined as a qPCR Ct value ≤ 34–35 and both of the following criteria: 1. Clinical and radiological features compatible with PCP and 2. The patient died or received PCP therapy and survived. Patient files from those with a qPCR Ct value ≤ 35 were reviewed to determine whether the patient fulfilled the case definition and if PCP prophylaxis had been used in the weeks preceding the PCP. Disease-specific guidelines, as well as hospital-wide guidelines, were used to evaluate if prophylaxis could be considered indicated. Results: From 2012 to 2018, 482 BAL samples were tested. Two hundred and four had a qPCR Ct value ≤ 35 and were further evaluated: 90 fulfilled the definition of probable and 63 of possible PCP while the remaining 51 were considered colonized. Seventy-four percentages of the patients with PCP were HIV-negative. Only 11 (7%) of the 153 patients had received prophylaxis, despite that in 133 (87%) cases prophylaxis was indicated according to guidelines. Conclusion: In regions where HIV testing and treatment is available without restrictions, PCP is mainly diagnosed in non-HIV immunocompromised patients. More than four out of five patients with PCP had not received prophylaxis. Strategies to improve awareness of antimicrobial prophylaxis guidelines in immunocompromised patients are urgently needed.
Keywords
Immunology, Microbiology (medical), Microbiology, Infectious Diseases, Pneumocystic jiroveciipneumonia, Pneumocystis jiroveci(carinii) pneumonia, prophylaxis, Trimetoprim, sulfamethoxazole, immunocompromidsed patients, TIME PCR ASSAY, PNEUMOCYSTIS-JIROVECII, ECIL GUIDELINES, PNEUMONIA, COLONIZATION, DIAGNOSIS

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MLA
Dunbar, Albert, et al. “Epidemiology of Pneumocystis Jirovecii Pneumonia and (Non-)Use of Prophylaxis.” FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY, vol. 10, 2020, doi:10.3389/fcimb.2020.00224.
APA
Dunbar, A., Schauwvlieghe, A., Algoe, S., van Hellemond, J. J., Reynders, M., Vandecasteele, S., … Rijnders, B. (2020). Epidemiology of Pneumocystis jirovecii pneumonia and (non-)use of prophylaxis. FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY, 10. https://doi.org/10.3389/fcimb.2020.00224
Chicago author-date
Dunbar, Albert, Alexander Schauwvlieghe, Sheruna Algoe, Jaap J. van Hellemond, Marijke Reynders, Stefaan Vandecasteele, Jerina Boelens, Pieter Depuydt, and Bart Rijnders. 2020. “Epidemiology of Pneumocystis Jirovecii Pneumonia and (Non-)Use of Prophylaxis.” FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY 10. https://doi.org/10.3389/fcimb.2020.00224.
Chicago author-date (all authors)
Dunbar, Albert, Alexander Schauwvlieghe, Sheruna Algoe, Jaap J. van Hellemond, Marijke Reynders, Stefaan Vandecasteele, Jerina Boelens, Pieter Depuydt, and Bart Rijnders. 2020. “Epidemiology of Pneumocystis Jirovecii Pneumonia and (Non-)Use of Prophylaxis.” FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY 10. doi:10.3389/fcimb.2020.00224.
Vancouver
1.
Dunbar A, Schauwvlieghe A, Algoe S, van Hellemond JJ, Reynders M, Vandecasteele S, et al. Epidemiology of Pneumocystis jirovecii pneumonia and (non-)use of prophylaxis. FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY. 2020;10.
IEEE
[1]
A. Dunbar et al., “Epidemiology of Pneumocystis jirovecii pneumonia and (non-)use of prophylaxis,” FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY, vol. 10, 2020.
@article{8669861,
  abstract     = {Objectives: Pneumocystis jirovecii pneumonia (PCP) is an AIDS-defining illness. In patients with HIV, the benefit of PCP prophylaxis is well-defined when the CD4 T-cell count decreases below 200 cells/μL. In other immunocompromised patients, the value of PCP prophylaxis is not always as well-established. This study aimed to describe the epidemiology of PCP in recent years and assess how many patients with PCP did or did not receive prophylaxis in the month preceding the infection.

Material and Methods: A multicenter retrospective study was performed in 3 tertiary care hospital. A list of patients that underwent broncho-alveolar lavage sampling and Pneumocystis jirovecii (PJ) PCR testing was retrieved from the microbiology laboratories. An in-house PJ quantitative PCR (qPCR) was used in each center. A cycle threshold (Ct) value of ≤ 28.5–30 was considered a probable PCP. For patients with a positive PJ qPCR but above this threshold, a predefined case definition of possible PCP was defined as a qPCR Ct value ≤ 34–35 and both of the following criteria: 1. Clinical and radiological features compatible with PCP and 2. The patient died or received PCP therapy and survived. Patient files from those with a qPCR Ct value ≤ 35 were reviewed to determine whether the patient fulfilled the case definition and if PCP prophylaxis had been used in the weeks preceding the PCP. Disease-specific guidelines, as well as hospital-wide guidelines, were used to evaluate if prophylaxis could be considered indicated.

Results: From 2012 to 2018, 482 BAL samples were tested. Two hundred and four had a qPCR Ct value ≤ 35 and were further evaluated: 90 fulfilled the definition of probable and 63 of possible PCP while the remaining 51 were considered colonized. Seventy-four percentages of the patients with PCP were HIV-negative. Only 11 (7%) of the 153 patients had received prophylaxis, despite that in 133 (87%) cases prophylaxis was indicated according to guidelines.

Conclusion: In regions where HIV testing and treatment is available without restrictions, PCP is mainly diagnosed in non-HIV immunocompromised patients. More than four out of five patients with PCP had not received prophylaxis. Strategies to improve awareness of antimicrobial prophylaxis guidelines in immunocompromised patients are urgently needed.},
  articleno    = {224},
  author       = {Dunbar, Albert and Schauwvlieghe, Alexander and Algoe, Sheruna and van Hellemond, Jaap J. and Reynders, Marijke and Vandecasteele, Stefaan and Boelens, Jerina and Depuydt, Pieter and Rijnders, Bart},
  issn         = {2235-2988},
  journal      = {FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY},
  keywords     = {Immunology,Microbiology (medical),Microbiology,Infectious Diseases,Pneumocystic jiroveciipneumonia,Pneumocystis jiroveci(carinii) pneumonia,prophylaxis,Trimetoprim,sulfamethoxazole,immunocompromidsed patients,TIME PCR ASSAY,PNEUMOCYSTIS-JIROVECII,ECIL GUIDELINES,PNEUMONIA,COLONIZATION,DIAGNOSIS},
  language     = {eng},
  pages        = {7},
  title        = {Epidemiology of Pneumocystis jirovecii pneumonia and (non-)use of prophylaxis},
  url          = {http://dx.doi.org/10.3389/fcimb.2020.00224},
  volume       = {10},
  year         = {2020},
}

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