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Evaluation of Pneumocystis pneumonia Prevalence and Risk Factors in Patients With Positive Polymerase Chain Reaction in Bronchoalveolar Lavage or Washing Fluid FREE TO VIEW

Hea Yeon Lee*, MD; Chin Kook Rhee, MD; Jae Cheol Kwon, MD; Ah Young Shin, MD; Jick Hwan Ha, MD; Sook Young Lee, MD; Seok Chan Kim, MD; Seung Joon Kim, MD; Young Kyoon Kim, MD; Sung Hak Park, MD; Ji Young Kang, MD
Author and Funding Information

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea

Chest. 2012;142(4_MeetingAbstracts):219A. doi:10.1378/chest.1387317
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SESSION TYPE: Respiratory Infections Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Pneumocystis jirovecii (Pj) polymerase chain reaction (PCR) is useful for diagnosing Pneumocystis pneumonia (PCP) in the clinical setting, however its use is limited by Pj colonization causing lower specificity. We conducted a retrospective, clinical evaluation of patients who were tested positive for Pj PCR in either bronchoalveolar lavage or bronchial washing fluid.

METHODS: Between May 2009 and October 2011, Pj PCR was performed in 961 adult patients with a high index of clinical suspicion for PCP. Only patients who were tested positive for Pj PCR were enrolled in this study. We defined definitive PCP as the trimethoprim-sulfamethoxazole treatment group. Retrospective chart review of the patients were performed.

RESULTS: One hundred twenty one patients (12.6%) with a positive Pj PCR result were enrolled. 57 patients were identified as a definitive PCP group (47.1%) and 64 patients were in the non-treatment group (52.9%). The underlying conditions included HIV (n = 6, 5%), hematological malignancies (n = 35, 28.9%), solid organ transplantation (n = 10, 8.3%), solid tumors (n = 29, 24%), autoimmune diseases (n = 13, 10.7%), and others (n = 28, 23.1%). The overall mortality rate for patients in the definitive PCP group was 38.6% (n = 22). Univariable analysis showed that age, underlying conditions, use of systemic steroid, and symptoms of dyspnea differed significantly between two groups. Independent risk factors for definitive PCP by binary logistic regression analysis were underlying conditions- HIV, hematological malignancies, or solid organ transplantation (odds ratio [OR], 5.904; 95% confidence interval [CI], 2.240-15.563, P = 0.000), and systemic use of steroids (OR, 2.666; 95% CI, 1.006-7.066, P = 0.049).

CONCLUSIONS: This study shows that patients with underlying HIV, hematological malignancies or solid organ transplantation, and with systemic steroid use display a higher risk of definitive PCP when tested positive for Pj PCR.

CLINICAL IMPLICATIONS: Further prospective study regarding the utility of Pj PCP is needed.

DISCLOSURE: The following authors have nothing to disclose: Hea yeon Lee, Chin Kook Rhee, Jae Cheol Kwon, Ah Young Shin, Jick Hwan Ha, Sook Young Lee, Seok Chan Kim, Seung Joon Kim, Young Kyoon Kim, Sung Hak Park, Ji Young Kang

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Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea




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