Kim Tark, Moon Song Mi, Sung Heungsup, Kim Mi-Na, Kim Sung-Han, Choi Sang-Ho, Jeong Jin-Yong, Woo Jun Hee, Kim Yang Soo, Lee Sang-Oh
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Scand J Infect Dis. 2012 Sep;44(9):670-7. doi: 10.3109/00365548.2011.652665. Epub 2012 Jan 21.
The pathogenic effect of concomitant pulmonary cytomegalovirus (CMV) infection on morbidity and mortality of Pneumocystis jirovecii pneumonia (PCP) has been questioned in the case of non-HIV-infected patients.
We conducted a retrospective cross-sectional study of patients who were diagnosed with PCP by bronchoalveolar lavage. We compared demographics, clinical characteristics, morbidity, and mortality in non-HIV-infected PCP patients with (n = 31) and without (n = 75) pulmonary CMV infection. Morbidity was assessed by length of hospital stay, admission to the intensive care unit, and use of mechanical ventilation. Mortality was defined as 30-day and 90-day all-cause mortality.
Morbidity and mortality did not differ between PCP patients with and without pulmonary CMV infection. In multivariate analysis using the Cox proportional hazard model, haematological malignancy (relative risk (RR) 0.20, 95% confidence interval (95% CI) 0.06-0.71), PCP treatment duration (RR 0.81, 95% CI 0.75-0.88), changing to a second-line regimen due to treatment failure (RR 4.51, 95% CI 1.61-12.64), and mechanical ventilation (RR 17.99, 95% CI 4.83-67.04) were independently associated with 30-day all-cause mortality. Being a solid organ transplant recipient (RR 0.17, 95% CI 0.05-0.56) and the use of mechanical ventilation (RR 6.49, 95% CI 2.84-14.83) were independently associated with 90-day all-cause mortality. However, concomitant pulmonary CMV infection was not associated with either 30-day or 90-day mortality.
Our results suggest that concomitant pulmonary CMV infection does not significantly affect the prognosis of PCP, as indicated by morbidity and mortality in non-HIV-infected patients with PCP. Based on this result, we propose that it is not essential to administer an anti-CMV regimen when CMV is co-isolated from the bronchoalveolar lavage in patients with PCP.
对于非HIV感染患者，合并肺巨细胞病毒（CMV）感染对耶氏肺孢子菌肺炎（PCP）发病率和死亡率的致病作用存在疑问。
我们对通过支气管肺泡灌洗诊断为PCP的患者进行了一项回顾性横断面研究。我们比较了合并（n = 31）和未合并（n = 75）肺CMV感染的非HIV感染PCP患者的人口统计学、临床特征、发病率和死亡率。发病率通过住院时间、入住重症监护病房情况和机械通气使用情况进行评估。死亡率定义为30天和90天全因死亡率。
合并和未合并肺CMV感染的PCP患者的发病率和死亡率没有差异。在使用Cox比例风险模型的多变量分析中，血液系统恶性肿瘤（相对风险（RR）0.20，95%置信区间（95%CI）0.06 - 0.71）、PCP治疗持续时间（RR 0.81，95%CI 0.75 - 0.88）、因治疗失败改用二线方案（RR 4.51，95%CI 1.61 - 12.64）和机械通气（RR 17.99，95%CI 4.83 - 67.04）与30天全因死亡率独立相关。实体器官移植受者（RR 0.17，95%CI 0.05 - 0.56）和机械通气的使用（RR 6.49，95%CI 2.84 - 14.83）与90天全因死亡率独立相关。然而，合并肺CMV感染与30天或90天死亡率均无关。
我们的结果表明，如非HIV感染PCP患者的发病率和死亡率所示，合并肺CMV感染不会显著影响PCP的预后。基于这一结果，我们建议当PCP患者支气管肺泡灌洗中共分离出CMV时，给予抗CMV方案并非必要。
