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Chest Infections |

Re-examination of Pneumocystis jirovecii Pneumonia During a Shortage of Parenteral Trimethoprim-Sulfamethoxazole

Purba Gupta, MD; Takashi Shinha, MD; Ramin Pirouz, MD; Yu Shia Lin, MD; Louis Gerolemou, DO; Dourglas Sepkowitz, MD
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Maimonides Medical Center, Brooklyn, NY


Chest. 2013;144(4_MeetingAbstracts):252A. doi:10.1378/chest.1704538
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Abstract

SESSION TITLE: AIDS/ Immunocompromised Patients Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Trimethoprim-sulfamethoxazole (TMP-SMX) is the treatment of choice for Pneumocystis jirovecii pneumonia (PCP). However, there was a severe shortage of parenteral TMP-SMX from July 2008-June 2011and only 29% of patients were treated with the parental drug during this time period. The remainder of PCP patients were treated with pentamidine, a combination of clindamycin and primaquine, or oral TMP-SMX. This led us to compare our experience from 2003-2005 to determine if there were any changes in diagnosis and outcome of HIV patients with suspected PCP.

METHODS: A retrospective study was conducted on all patients admitted with PCP and AIDS from July 2008 to June 2011. Patients were categorized as confirmed cases of PCP if they had respiratory symptoms and cytological evidence of P. jirovecii in their bronchoalveolar lavage specimen. Probable cases of PCP required meeting all 3 of the following criteria: (1) presence of respiratory symptoms; (2) abnormal chest imaging or hypoxemia; and (3) specific anti-pneumocystis therapy. We then compared these findings to our results from 2003-2005.

RESULTS: Out of a total of 56 cases, the majority (77%) were probable cases of PCP. Only 23% patients underwent bronchoscopy, compared with 46% during 2003-2005. Computerized tomography (CT) of chest was done in 66% patients. Mean lactate dehydrogenase (LDH) level was 1208 IU/L. 18% of patients required ICU admission as compared to only 10% during the 2003-2005 period. This was not, however, statistically significant (p=.211). Mortality rate was actually lower in comparison to the previous years—7% as opposed to 10%.

CONCLUSIONS: Lack of parenteral TMP-SMX did not result in increased mortality or a statistically significant difference in the number of ICU admissions. The increased use of CT scans has resulted in fewer bronchoscopies being performed in the management of PCP cases.

CLINICAL IMPLICATIONS: This change in clinical practice—using less invasive diagnostic methods--has not affected the outcomes adversely. It has, however, resulted in a marked shift in the categorization of PCP patients from definite to probable.

DISCLOSURE: The following authors have nothing to disclose: Purba Gupta, Takashi Shinha, Ramin Pirouz, Yu Shia Lin, Louis Gerolemou, Dourglas Sepkowitz

No Product/Research Disclosure Information


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