High initial (1, 3) Beta-D-Glucan concentration may be a predictor of satisfactory caspofungin combined with TMP/SMZ response to HIV-negative patients with moderate to severe pneumocystis jirovecii pneumonia.
Int J Infect Dis. 2019 Aug 20;:
Authors: Jin F, Liu XH, Chen WC, Fan ZL, Wang HL
OBJECTIVES: The aim of this study was to investigate the efficacy of combination therapy of caspofungin and TMP/SMZ (trimethoprim/sulfamethoxazole) in moderate to severe pneumocystis jirovecii pneumonia (PJP) in patients without human immunodeficiency virus infection (HIV) and the relationship between therapeutic effect and plasma (1, 3) Beta-D-Glucan (BDG) levels.
METHODS: We retrospectively reviewed HIV-negative patients with PJP diagnosed in our department, who were treated with combination therapy of caspofungin and TMP/SMZ or monotherapy of TMP/SMZ during six and a half years period.
RESULTS: A total of 126 moderate to severe PJP patients were enrolled in the study. In the multivariate analysis, low lymphocyte counts, high serum lactate dehydrogenase levels at the diagnosis of PJP and progression to shock were significant risk factors for death. In all patients, there was no significant difference in risk of death at 3 months. In the group of BDG≥800 pg/m, patients received combination therapy was associated with a significant decreased risk of death at 3 months. Whereas, in the group of BDG<800 pg/ml, there were no statistically significant difference in survival rate between two treatment regimens.
CONCLUSION: High initial plasma (1, 3) Beta-D-Glucan concentration may be a predictor of satisfactory caspofungin response to HIV-negative patients with PJP. Based on our findings, we suggest the choice of combination therapy with caspofungin and TMP/SMZ as initial treatment when BDG≥800 pg/ml in moderate to severe HIV-negative patients with PJP.
PMID: 31442630 [PubMed - as supplied by publisher]