Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Pneumocystis jirovecii is a fungal pathogen that causes pneumonia in immunocompromized hosts. Prednisone is frequently suggested as a risk factor for developing pneumocystis pneumonia (PCP) in patients with rheumatic diseases. If prednisone use is a risk factor indeed, targeted preventive measures can be taken. The aim of this study was to analyze whether prednisone is a risk factor for developing PCP in patients with rheumatic diseases.
Methods:
In this case-control study all cases with a rheumatic disease who developed PCP from 2005 to 2012 in one of two clinics were included. Clinical and laboratory results were compared with controls with rheumatic disease without PCP in the same period, matched for disease duration. At least four controls were included for every PCP patient. Confounders were selected using existing literature, including concomitant medication, comorbidity and laboratory results. Logistic regression was used for analysis.
Results :
Thirty-six patients with a variety of rheumatic diseases were diagnosed with PCP in the 8-year study period and 167 controls were matched to these cases. Forty-two percent of the patients with PCP required admission to the intensive care unit (ICU), and 28% died in the course of PCP. In the 6 months before PCP onset, 75% of the patients with PCP used prednisone, which was 25% for controls in the corresponding period, with an OR (95%CI) of 20 (5-85) while corrected for confounders (model 3 in the table). Especially also receiving i.v. corticosteroids (25% vs. 0,6% in the PCP group and control group, p < 0,05) was a risk for developing PCP, with an OR (95%CI) of 60(2-1627).
Table 1. Logistic regression models
|
Characteristic |
OR (95% CI) |
P-value |
|
Model 1 |
|
|
|
Use of prednisone |
23,84 (6,98-81,46) |
0,000 |
|
Model 2 |
|
|
|
Use of prednisone |
26,52 (7,32-96,10) |
0,000 |
|
Age |
1,04 (1,01-1,08) |
0,024 |
|
Sex |
1,05 (0,43-2,55) |
0,923 |
|
Use of methotrexate |
2,90 (1,19-7,03) |
0,019 |
|
Model 3 |
|
|
|
Use of prednisone |
20,18 (4,82-84,53) |
0,000 |
|
Age |
1,04 (0,99-1,08) |
0,105 |
|
Sex |
0,55 (0,18-1,68) |
0,295 |
|
Use of methotrexate |
8,67 (2,36-31,86) |
0,001 |
|
Diabetes mellitus |
2,98 (0,60-14,92) |
0,184 |
|
Pre-existing lung disease |
3,52 (1,06-11,76) |
0,041 |
|
Pneumonia |
9,92 (1,78-55,45) |
0,009 |
|
Leukopenia |
13,96 (2,15-90,59) |
0,006 |
OR odds ratio; use of prednisone: during 6 months prior to PCP; 95% CI: 95% confidence interval
Conclusion:
Pneumocystis jirovecii pneumonia remains a challenging infection with often severe consequences. Confirmative arguments for prednisone as a strong independent risk factor for development of PCP were found. Prophylaxis with trimethoprim-sulfamethoxazole might be considered in patients using corticosteroids, and particularly during 2 to 6 months in patients receiving high dose corticosteroids (orally or intravenously).
Disclosure:
W. van den Hombergh,
None;
A. van Ede,
None;
J. Fransen,
None;
F. B. lamers-Karnebeek,
None;
S. Kuipers,
None;
M. Janssen,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prednisone-is-a-risk-factor-for-pneumocystis-jirovecii-pneumonia-in-patients-with-rheumatic-diseases-a-case-control-study-with-36-cases/