679 Epidemiology and Impact of Pneumocystis jirovecii Pneumonia in Hospitalized Patients With Inflammatory Bowel Disease

Abstract

INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) is rare opportunistic infection that is most often associated with human immunodeficiency virus (HIV) but is also a reported complication in patients with inflammatory bowel disease (IBD). Treatment for IBD often include systemic corticosteroids and immunosuppressive agents that render these patients to opportunistic infections. Despite this, prophylaxis against PJP remains a topic of debate among providers with no clear consensus. Furthermore, data regarding the burden of PJP in patients with IBD and its impact on healthcare utilization remains limited. We aim to explore the epidemiology and impact of PJP on outcomes in hospitalized patients with IBD. METHODS: We queried the National Inpatient Sample (NIS) for all hospitalizations with a primary or secondary diagnosis of IBD [Crohn's disease (CD) or ulcerative colitis (UC)] with or without a diagnosis of PJP using the International Classification of Diseases 9th Edition Clinical Modification codes from 2003-2014. We conducted a retrospective analysis using SPSS (version 25.0). The primary outcome was in-hospital mortality and secondary outcomes included length of stay (LOS) and average total hospital charges. Associations were assessed using multivariable adjustment accounting for age, sex, income, region, hospital characteristics and the Elixhauser comorbidity index. Trend analysis was tested using Cochran Armitage trend test. RESULTS: From 2003-2014, there were a total of 840 hospitalizations for PJP in patients with IBD. The patients were primarily white (81%), aged between 41-60 (41.8%) and male (63.2%). Patients with PJP had a greater proportion of in-hospital mortality (10.8% vs 1.6%. P < 0.0001) and were more likely to die while hospitalized (OR 6.2, CI 4.8-7.9, P < 0.0001). PJP was associated with increased mean LOS (13 days vs. 6) and greater total hospital charges ($32,716.12 vs. $14,329.83). Patients with PJP had greater rates of comorbid HIV infection (36.4% vs. 0.30%) and comorbid HIV was associated with a significant risk of PJP infection (OR 232, CI 192-280, P < 0.0001). Cochran-Armitage test did not show a statistically significant increase in the disease incidence over the study period (P = 0.580). CONCLUSION: The incidence of PJP in hospitalized IBD patients is low and rates of disease remain stable. Disease is most likely related to comorbid HIV. Overall, PJP in IBD patients is associated with great mortality risk and significantly higher healthcare utilization costs.