Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study

Abstract 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...

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Autores principales:	Shirley Chiu Wai Chan, Ho Yin Chung, Chak Sing Lau, Philip Hei Li
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Epidemiology Prophylaxis Rheumatology Fungal Pneumonia Mortality Therapeutics. Pharmacology RM1-950 Infectious and parasitic diseases RC109-216 Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/f53189effe32485b9f30bfae591e4901
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spelling	oai:doaj.org-article:f53189effe32485b9f30bfae591e49012021-11-14T12:11:38ZEpidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study10.1186/s12941-021-00483-21476-0711https://doaj.org/article/f53189effe32485b9f30bfae591e49012021-11-01T00:00:00Zhttps://doi.org/10.1186/s12941-021-00483-2https://doaj.org/toc/1476-0711Abstract 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.Shirley Chiu Wai ChanHo Yin ChungChak Sing LauPhilip Hei LiBMCarticleEpidemiologyProphylaxisRheumatologyFungalPneumoniaMortalityTherapeutics. PharmacologyRM1-950Infectious and parasitic diseasesRC109-216MicrobiologyQR1-502ENAnnals of Clinical Microbiology and Antimicrobials, Vol 20, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Epidemiology Prophylaxis Rheumatology Fungal Pneumonia Mortality Therapeutics. Pharmacology RM1-950 Infectious and parasitic diseases RC109-216 Microbiology QR1-502
spellingShingle	Epidemiology Prophylaxis Rheumatology Fungal Pneumonia Mortality Therapeutics. Pharmacology RM1-950 Infectious and parasitic diseases RC109-216 Microbiology QR1-502 Shirley Chiu Wai Chan Ho Yin Chung Chak Sing Lau Philip Hei Li Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study
description	Abstract 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.
format	article
author	Shirley Chiu Wai Chan Ho Yin Chung Chak Sing Lau Philip Hei Li
author_facet	Shirley Chiu Wai Chan Ho Yin Chung Chak Sing Lau Philip Hei Li
author_sort	Shirley Chiu Wai Chan
title	Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study
title_short	Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study
title_full	Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study
title_fullStr	Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study
title_full_unstemmed	Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study
title_sort	epidemiology, mortality and effectiveness of prophylaxis for pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/f53189effe32485b9f30bfae591e4901
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Epidemiology, mortality and effectiveness of prophylaxis for Pneumocystis jiroveci pneumonia among rheumatic patients: a territory-wide study

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