Abstract
SESSION TITLE: Outcomes of Respiratory Infections in the Immunocompromised Host SESSION TYPE: Original Investigations PRESENTED ON: 10/20/2019 2:15 PM - 3:15 PM PURPOSE: Pneumocystis jirovecii pneumonia (PCP) is a highly morbid respiratory infection that affects immune-suppressed hosts with and without HIV. Presence or absence of HIV impacts the degree of immune response observed. Non-HIV patients with PCP exhibit a greater degree of lung inflammation, despite lower Pneumocystis organism burden. Studies have examined the utility of 1,3-β-D glucan (BDG), a cellular component of Pneumocystis, as a diagnostic tool in PCP. The purpose of this study is to describe the association of BDG assay and degree of hypoxemia in non-HIV adults presenting with PCP. METHODS: This was a single-center, retrospective cohort study of non-HIV adults who presented with microbiologic-confirmed PCP at Mayo Clinic in Rochester, MN between 2011 and 2017. Patients were included if they had an available BDG concentration on PCP presentation prior to treatment initiation. The primary objective was to determine the relationship between BDG concentration and degree of hypoxemia at the time of PCP presentation. BDG concentrations were categorized as negative (500 pg/ml) based on the bounds of detection of the assay and the median observed. Wilcoxon rank sum test was used to compare PaO2/FiO2 (PF) and SaO2/FiO2 (SF) between the BDG groups at PCP presentation. RESULTS: The 38 included patients had a median (IQR) age of 65 (54, 72) years, 25 (66%) were male, and the most common immune-suppressive condition was hematologic malignancy (N = 27; 71%). BDG concentrations were negative in 7 (18%), mild positive in 8 (21%), moderate positive in 8 (21%), and strong positive in 15 (40%). Among the patients with available arterial blood gases for assessment (N = 24), the median PF ratio was 156 (103, 189). The median SF ratio was 223 (157, 320). Non-invasive positive pressure or mechanical ventilation was required in 9 (24%) cases. Compared to negative BDG, strong positive BDG concentrations were associated with worse PF (211 vs. 138, p = 0.043) and SF (332 vs. 195, p = 0.003) ratios. Compared to negative BDG, mild positive BDG concentrations were associated with worse SF ratios (332 vs. 241, p = 0.024). CONCLUSIONS: Among non-HIV patients presenting with PCP, higher pre-treatment BDG concentrations were associated with a greater degree of hypoxemia. CLINICAL IMPLICATIONS: PCP is on the rise among non-HIV immune-suppressed individuals and mortality rates are significant. With an association between higher BDG concentrations and lower PF and SF ratios, our study reveals a potential approach for prognosticating severity of respiratory failure at the time of PCP presentation. With lysis of Pneumocystis organisms on initiation of antimicrobial therapy, our study opens further investigations to explore the association of BDG and severity of hypoxemia over the course of PCP treatment. DISCLOSURES: Advisory Committee Member relationship with Fast Biomedical Please note: $1-$1000 Added 03/13/2019 by Erin Barreto, source=Web Response, value=Consulting fee No relevant relationships by Jason Barreto, source=Web Response No relevant relationships by Andrew Limper, source=Web Response No relevant relationships by Kristin Mara, source=Web Response No relevant relationships by Patrick Wieruszewski, source=Web Response No relevant relationships by Hemang Yadav, source=Web Response
Published Version
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