时间治疗与 HIV 阴性患者呼吸衰竭相关的卡氏肺孢子虫肺炎结局的关系。
Association of time-to-treatment with outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients.
机构信息
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
Respir Res. 2019 Sep 26;20(1):213. doi: 10.1186/s12931-019-1188-6.
BACKGROUND
The prevalence of pneumocystis pneumonia (PCP) and associated hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, no prior studies have evaluated the effect of early anti-PCP treatment on clinical outcomes in HIV-negative patient with severe PCP. Therefore, this study investigated the association between the time to anti-PCP treatment and the clinical outcomes in HIV-negative patients with PCP who presented with hypoxemic respiratory failure.
METHODS
A retrospective observational study was performed involving 51 HIV-negative patients with PCP who presented in respiratory failure and were admitted to the intensive care unit between October 2005 and July 2018. A logistic regression model was used to adjust for potential confounding factors in the association between the time to anti-PCP treatment and in-hospital mortality.
RESULTS
All patients were treated with appropriate anti-PCP treatment, primarily involving trimethoprim/sulfamethoxazole. The median time to anti-PCP treatment was 58.0 (28.0-97.8) hours. Thirty-one (60.8%) patients were treated empirically prior to confirmation of the microbiological diagnosis. However, the hospital mortality rates were not associated with increasing quartiles of time until anti-PCP treatment (P = 0.818, test for trend). In addition, hospital mortality of patients received early empiric treatment was not better than those of patients received definitive treatment after microbiologic diagnosis (48.4% vs. 40.0%, P = 0.765). In a multiple logistic regression model, the time to anti-PCP treatment was not associated with increased mortality. However, age (adjusted OR 1.07, 95% CI 1.01-1.14) and failure to initial treatment (adjusted OR 13.03, 95% CI 2.34-72.65) were independently associated with increased mortality.
CONCLUSIONS
There was no association between the time to anti-PCP treatment and treatment outcomes in HIV-negative patients with PCP who presented in hypoxemic respiratory failure.
背景
人类免疫缺陷病毒（HIV）阴性患者中，肺囊虫肺炎（PCP）和相关低氧性呼吸衰竭的患病率正在增加。然而，此前尚无研究评估早期抗 PCP 治疗对 HIV 阴性患者重度 PCP 合并低氧性呼吸衰竭的临床结局的影响。因此，本研究旨在探讨 HIV 阴性合并低氧性呼吸衰竭的 PCP 患者接受抗 PCP 治疗的时间与临床结局之间的相关性。
方法
回顾性观察性研究，纳入 2005 年 10 月至 2018 年 7 月因呼吸衰竭入住重症监护病房的 51 例 HIV 阴性 PCP 患者。采用逻辑回归模型调整抗 PCP 治疗时间与住院死亡率之间的潜在混杂因素。
结果
所有患者均接受了适当的抗 PCP 治疗，主要是复方磺胺甲噁唑。抗 PCP 治疗的中位时间为 58.0（28.0-97.8）小时。31 例（60.8%）患者在获得微生物学诊断之前接受了经验性治疗。然而，随着抗 PCP 治疗时间的增加，死亡率并未呈递增趋势（P=0.818，趋势检验）。此外，接受早期经验性治疗的患者的住院死亡率并不优于接受微生物学诊断后进行明确治疗的患者（48.4% vs. 40.0%，P=0.765）。在多变量逻辑回归模型中，抗 PCP 治疗时间与死亡率的增加无关。然而，年龄（校正 OR 1.07，95% CI 1.01-1.14）和初始治疗失败（校正 OR 13.03，95% CI 2.34-72.65）与死亡率的增加独立相关。
结论
在 HIV 阴性合并低氧性呼吸衰竭的 PCP 患者中，抗 PCP 治疗的时间与治疗结局之间无相关性。
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