Taniguchi Jumpei, Aso Shotaro, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Infect Chemother. 2025 Jan;31(1):102489. doi: 10.1016/j.jiac.2024.08.004. Epub 2024 Aug 6.
Although combination therapy of echinocandins with trimethoprim-sulfamethoxazole (TMP-SMX) has been reported for patients with Pneumocystis jirovecii pneumonia (PCP), the effectiveness of this combination therapy in patients with PCP without human immunodeficiency virus (HIV) infection remains unknown.
Data from the Japanese Diagnosis Procedure Combination inpatient database was used to identify non-HIV patients who underwent their first hospitalisation for PCP between April 2012 and March 2022. The patients were divided into those treated with TMP-SMX alone and those treated with TMP-SMX combined with echinocandins. We performed propensity-score overlap-weighting analysis to estimate in-hospital mortality.
Among the 1324 eligible patients, 122 received TMP-SMX plus echinocandins, while 1202 received TMP-SMX alone. The propensity-score overlap-weighting analysis showed that the combination therapy was not associated with reduced in-hospital mortality in comparison with TMP-SMX alone (22.2 % vs. 26.9 %; risk difference, 4.6 %; 95 % confidence interval, -6.1 %-15.3 %; P = 0.398).
Echinocandins combined with TMP-SMX may not improve in-hospital mortality due to PCP in patients without HIV infection.
尽管已有报告称棘白菌素与甲氧苄啶-磺胺甲恶唑（TMP-SMX）联合治疗用于耶氏肺孢子菌肺炎（PCP）患者，但这种联合疗法在无人类免疫缺陷病毒（HIV）感染的PCP患者中的有效性仍不清楚。
利用日本诊断流程组合住院患者数据库的数据，确定2012年4月至2022年3月期间因PCP首次住院的非HIV患者。患者分为单独接受TMP-SMX治疗的患者和接受TMP-SMX联合棘白菌素治疗的患者。我们进行倾向评分重叠加权分析以估计住院死亡率。
在1324例符合条件的患者中，122例接受了TMP-SMX加棘白菌素治疗，而1202例仅接受TMP-SMX治疗。倾向评分重叠加权分析显示，与单独使用TMP-SMX相比，联合治疗与降低住院死亡率无关（22.2%对26.9%；风险差异为4.6%；95%置信区间为-6.1%-15.3%；P=0.398）。
棘白菌素联合TMP-SMX可能无法改善无HIV感染的PCP患者因PCP导致的住院死亡率。
