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Severe Pneumocystis jirovecii pneumonia PJP requiring intensive care has been the subject of few prospective studies. It is unclear whether delayed curative antibiotic therapy may impact survival in these severe forms of PJP. The impact of corticosteroid therapy combined with antibiotics is also unclear.
This multicentre, prospective observational study involving 49 adult intensive care units ICUs in France was designed to evaluate the severity, the clinical spectrum, and outcomes of patients with severe PJP, and to assess the association between delayed curative antibiotic treatment and adjunctive corticosteroid therapy with mortality.
The ICU, hospital, and 6-month mortality were Using time-to-event analysis with a propensity score-based inverse probability of treatment weighting, the initiation of curative antibiotic treatment after 96 h of ICU admission was associated with faster occurrence of death [time ratio: 6. The use of corticosteroids for PJP was associated with faster occurrence of death time ratio: 2.
This study showed that few patients with PJP admitted to intensive care received prophylactic antibiotic therapy, that delay in curative antibiotic treatment was common and that both delay in curative antibiotic treatment and adjunctive corticosteroids for PJP were associated with accelerated mortality. Keywords: Pneumocystis jirovecii , Prophylaxis, Delayed treatment, Adjunctive corticosteroid therapy, Mortality, Intensive care.
