Zalmanovich Anat, Ben-Ami Ronen, Rahav Galia, Alon Danny, Moses Allon, Olshtain-Pops Karen, Weinberger Miriam, Shitrit Pnina, Katzir Michal, Gottesman Bat-Sheva, Chowers Michal
Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel.
Department of Infectious Disease, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2021 May;23(5):312-317.
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection in immunocompromised patients. Clusters of PJP, especially among organ transplant recipients in clinic settings were described. Data regarding nosocomial PJP infection among inpatients are limited.
To assess the magnitude and characteristics of inpatient healthcare-associated PJP infection (HCA-PJP) in HIV-negative patients.
A retrospective chart review of hospitalized PJP patients was performed to identify HCA-PJP. The study was performed at six medical centers in Israel from 2006 to 2016. HCA-PJP was defined as cases of hospital-onset or those with documented contact with a PJP patient. We reviewed and cross-matched temporal and spatial co-locations of patients. Clinical laboratory characteristics and outcomes were compared.
Seventy-six cases of PJP were identified. Median age was 63.7 years; 64% men; 44% hematological malignancies; 18% inflammatory diseases; and 61% steroid usage. Thirty-two patients (42%) were defined as HCA-PJP: 18/32 (23.6%) were hospitalized at onset and 14/32 (18.4%) had a previous encounter with a PJP patient. Time from onset of symptoms to diagnosis was shorter in HCA-PJP vs. community-PJP (3.25 vs. 11.23 days, P = 0.009). In multivariate analysis, dyspnea at presentation (odds ratio [OR] 16.79, 95% confidence interval [95%CI] 1.78-157.95) and a tendency toward higher rate of ventilator support (72% vs. 52%, P = 0.07, OR 5.18, 95%CI 0.7-30.3) were independently associated with HCA-PJP, implying abrupt disease progression in HCA-PJP.
HCA-PJP was common. A high level of suspicion for PJP among selected patients with nosocomial respiratory infection is warranted. Isolation of PJP patients should be considered.
耶氏肺孢子菌肺炎（PJP）是免疫功能低下患者的一种机会性感染。已描述了PJP聚集性病例，尤其是在临床环境中的器官移植受者中。关于住院患者医院获得性PJP感染的数据有限。
评估HIV阴性患者住院医疗相关PJP感染（HCA-PJP）的规模和特征。
对住院的PJP患者进行回顾性病历审查以确定HCA-PJP。该研究于2006年至2016年在以色列的六个医疗中心进行。HCA-PJP被定义为医院发病病例或有记录显示与PJP患者有接触的病例。我们审查并交叉匹配了患者的时间和空间共定位情况。比较了临床实验室特征和结局。
共识别出76例PJP病例。中位年龄为63.7岁；男性占64%；血液系统恶性肿瘤患者占44%；炎症性疾病患者占18%；使用类固醇的患者占61%。32例患者（42%）被定义为HCA-PJP：18/32（23.6%）起病时住院，14/32（18.4%）曾与PJP患者接触过。HCA-PJP患者从症状出现到诊断的时间比社区获得性PJP患者短（3.25天对11.23天，P = 0.009）。在多变量分析中，就诊时呼吸困难（比值比[OR] 16.79，95%置信区间[95%CI] 1.78 - 157.95）以及呼吸机支持率有升高趋势（72%对52%，P = 0.07，OR 5.18，95%CI 0.7 - 30.3）与HCA-PJP独立相关，这意味着HCA-PJP疾病进展迅速。
HCA-PJP很常见。对于选定的医院获得性呼吸道感染患者，有必要高度怀疑PJP。应考虑隔离PJP患者。
