| Title: |
Prognostic impact and safety of early adjunctive corticosteroid therapy in HIV-negative severe pneumocystis pneumonia: a propensity-matched multicentre study |
| Authors: |
Reizine, Florian; Stiegler, Vicky; Lecuyer, Romain; Tessoulin, Benoit; Rieul, Guillaume; Camou, Fabrice; Morio, Florent; Cady, Anne; Gabriel, Frederic; Canet, Emmanuel; Raffi, François; Boutoille, David; Issa, Nahéma; Gaborit, Benjamin Jean |
| Contributors: |
Centre Hospitalier Bretagne Atlantique (Vannes-Auray) (CHBA); Service des maladies infectieuses et tropicales CHU Nantes; Centre Hospitalier Universitaire de Nantes = Nantes University Hospital (CHU Nantes); Laboratoire d'Hematologie CHU Nantes; Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux); Cibles et Médicaments des Infections et de l'Immunité - UR 1155 (IICiMed); Nantes Université - UFR des Sciences Pharmaceutiques et Biologiques (Nantes Univ - UFR Pharmacie); Nantes Université - pôle Santé; Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé; Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ); CHU de Bordeaux Pellegrin Bordeaux; Service de Médecine Intensive CHU Nantes; Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology (U1064 Inserm - CR2TI); Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE); Team 6 : Impact of acute inflammation on host pathogen interactions and lung homeostasis (Team 6 - U1064 Inserm - CR2TI); Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Nantes Université - UFR de Médecine et des Techniques Médicales (Nantes Univ - UFR MEDECINE); pronocystis study group: Francois Raffi, David Boutoille, Charlotte Biron, Maeva Lefebvre, Benjamin Jean Gaborit, Paul Le Turnier, Colin Deschanvres, Raphael Lecomte, Marie Chauveau, Romain Lécuyer, Antoine Asquier-Khati, Patrice Le Pape, Florent Morio, Rose-Anne Lavergne, Fakhri Jeddi, Stéphane Corvec, Pascale Bemer, Jocelyne Caillon, Aurélie Guillouzouic, Anne-Gaëlle Leroy, Karim Lakhal, Raphaël Cinotti, Antoine Roquilly, Jean Reignier, Emmanuel Canet, François Xavier Blanc, Cédric Bretonniere, Jean Morin, Fabrice Camou, Nahéma Issa, Olivier Guisset, Gaelle Mourissoux, Isabelle Accoceberry, Frederic Gabriel, Noémie Coron, Laurence Delhaes, Sébastien Imbert, Maxime Lefranc, Florian Lussac-Sorton, Amandine Rougeron, Marie Gousseff, Yoann Crabol, Grégory Corvaisier, Florent Lautredoux, Romain Lécuyer, Anne Cady, Myriam Auger, Pascal Pouedras |
| Source: |
ISSN: 0040-6376 ; Thorax ; https://inserm.hal.science/inserm-05509714 ; Thorax, 2025, pp.thorax-2025-223504. ⟨10.1136/thorax-2025-223504⟩. |
| Publisher Information: |
CCSD; BMJ Publishing Group |
| Publication Year: |
2025 |
| Collection: |
Université de Nantes: HAL-UNIV-NANTES |
| Subject Terms: |
Respiratory Infection; Pneumonia; Immunodeficiency; Hypoxemia; Critical Care; [SDV]Life Sciences [q-bio] |
| Description: |
International audience ; Background : Pneumocystis jirovecii pneumonia (PcP) in HIV-negative patients is associated with high mortality rates. While early adjunctive corticosteroid (AC) therapy benefits HIV-positive patients with severe PcP, its efficacy and safety in HIV-negative patients remain poorly investigated. Methods : This multicentre retrospective observational study included consecutive patients diagnosed with proven or probable PcP, from January 2011 to January 2021. This study assessed the prognostic impact and safety of early AC in HIV-negative patients with PcP. To address baseline characteristic imbalances between patients, a non-parsimonious propensity matching analysis was performed with a 1/1 ratio. Survival analysis, day-90 mortality rate and healthcare-associated infections (HCAI) were compared using Cox and logistic regressions. Results : 350 consecutive HIV-negative patients with proven or probable PcP were included. Of these, 116 (33.1%) received early AC within 5 days of anti-PcP therapy initiation. The median arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 /FiO 2 ) ratio was 224 (114–229). The 90-day mortality rate was 29.4% (103/350). There was no significant difference in 90-day mortality according to AC, both in overall and matched populations (OR 1.27 (0.78–2.05); p=0.336 and 0.92 (0.52–1.62); p=0.772, respectively). HCAI incidences appeared similar between groups. In the matched population, a higher proportion of AC patients required high-flow oxygen therapy (OR 2.15 (1.17–4.05); p=0.015) and mechanical ventilation duration was higher in corticosteroid recipients (OR 1.04 (1.01–1.09); p=0.048). Conclusion : Early AC therapy was not associated with reduced 90-day mortality in HIV-negative PcP patients. Although recommended in hypoxemic HIV-positive PcP patients, the benefit of this strategy in HIV-negative patients remains to be proven. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/41371766; PUBMED: 41371766 |
| DOI: |
10.1136/thorax-2025-223504 |
| Availability: |
https://inserm.hal.science/inserm-05509714; https://doi.org/10.1136/thorax-2025-223504 |
| Accession Number: |
edsbas.B05FF662 |
| Database: |
BASE |