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Low Lymphocyte Proportion in Bronchoalveolar Lavage Fluid as a Risk Factor Associated with the Change from Trimethoprim/sulfamethoxazole used as First-Line Treatment for Pneumocystis jirovecii Pneumonia

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Background: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. Materials and Methods: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). Results: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. Conclusion: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.

Abstract

Background: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients. Materials and Methods: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group). Results: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8–40%] vs. 47% [IQR, 15–62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20–18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08–18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47–34.58) were independently associated with the case group in multivariate analysis. Conclusion: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.

참고문헌 (28)

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관련 논문AI추천

Reply: Correspondence Regarding the Article Titled “Low Lymphocyte Proportion in Bronchoalveolar Lavage Fluid as a Risk Factor Associated with the Change from Trimethoprim/sulfamethoxazole Used as First-Line Treatment for Pneumocystis jirovecii Pneumonia”김탁, 이상오대한감염학회 · Infection and Chemotherapy2018 · 제50권 제3호Correspondence Regarding the Article Titled “Low Lymphocyte Proportion in Bronchoalveolar Lavage Fluid as a Risk Factor Associated with the Change from Trimethoprim/sulfamethoxazole Used as First-Line Treatment for Pneumocystis jirovecii Pneumonia”이창훈대한감염학회 · Infection and Chemotherapy2018 · 제50권 제3호인간면역결핍바이러스 비감염자에서 발생한 주폐포자충 폐렴 환자군에서 trimethoprim-sulfamethoxazole의 투여 경로에 따른 효과 및 안전성 분석김재송, 박무석, 손은선, 오주영, 이경아한국병원약사회 · 병원약사회지2017 · 제34권 제3호Clinical significance of positive Pneumocystis jirovecii polymerase chain reaction in non-human immunodeficiency virus immunocompromised patients in a real practice강지영, 강혜선, 김석찬, 김승준, 김영균, 박연준, 이숙영, 이진국, 이혜연, 이화영대한내과학회 · The Korean Journal of Internal Medicine2017 · 제32권 제3호Comparison of Clinical Characteristics of Pneumocystis Pneumonia with or without Human Immunodeficiency Virus: A Prognosis Contrary to Initial Clinical Features박윤선, 시혜진, 엄중식, 이주영, 홍신희연세대학교의과대학 · Yonsei Medical Journal2025 · 제66권 제11호Diagnosis of Pneumocystis jirovecii Pneumonia in Non-HIV Immunocompromised Patient in Korea: A Review and Algorithm Proposed by Expert Consensus GroupHuh Kyungmin, Jung Jongtak, Kang Chang Kyung, Kim Chung-Jong, Kim Hyungjin, Kim Jung Ho, Kim Yong Chan, Lee Raeseok, Park Jeong Su, Park Ji Young, Song Kyoung-Ho, Sung Heungsup대한감염학회 · Infection and Chemotherapy2025 · 제57권 제1호

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