• Daniele Roberto Giacobbe, Silvia Dettori, Vincenzo Di Pilato, Erika Asperges, Lorenzo Ball, Enora Berti, Ola Blennow, Bianca Bruzzone, Laure Calvet, Federico Capra Marzani, Antonio Casabella, Sofia Choudaly, Anais Dartevel, Gennaro De Pascale, Gabriele Di Meco, Melissa Fallon, Louis-Marie Galerneau, Miguel Gallego, Mauro Giacomini, Adolfo González Sáez, Luise Hänsel, Giancarlo Icardi, Philipp Koehler, Katrien Lagrou, Tobias Lahmer, Lewis WhitePPPublic Health Wales Mycology Reference Laboratory, PHW Microbiology Cardiff, University Hospital of Wales, Heath Park, Cardiff, UK.Division of Infection and Immunity, Cardiff University Centre for Trials Research, Heath Park, Cardiff, UK., Laura Magnasco, Anna Marchese, Cristina Marelli, Mercedes Marín-Arriaza, Ignacio Martin-Loeches, Armand Mekontso-Dessap, Malgorzata Mikulska, Alessandra Mularoni, Anna Nordlander, Julien Poissy, Giovanna Russelli, Alessio Signori, Carlo Tascini, Louis-Maxime Vaconsin, Joel Vargas, Antonio Vena, Joost Wauters, Paolo Pelosi, Jean-Francois Timsit, Matteo Bassetti, JIR-ICU investigators (collaborators), and Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESGCIP), and the Fungal Infection Study Group of the European Society of Clinical Microbiology and Infectious Diseases (EFISG).
• Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. danieleroberto.giacobbe@unige.it.
• Crit Care. 2023 Aug 24; 27 (1): 323323.

BackgroundPneumocystis jirovecii pneumonia (PJP) is an opportunistic, life-threatening disease commonly affecting immunocompromised patients. The distribution of predisposing diseases or conditions in critically ill patients admitted to intensive care unit (ICU) and subjected to diagnostic work-up for PJP has seldom been explored.Materials And MethodsThe primary objective of the study was to describe the characteristics of ICU patients subjected to diagnostic workup for PJP. The secondary objectives were: (i) to assess demographic and clinical variables associated with PJP; (ii) to assess the performance of Pneumocystis PCR on respiratory specimens and serum BDG for the diagnosis of PJP; (iii) to describe 30-day and 90-day mortality in the study population.ResultsOverall, 600 patients were included in the study, of whom 115 had presumptive/proven PJP (19.2%). Only 8.8% of ICU patients subjected to diagnostic workup for PJP had HIV infection, whereas hematological malignancy, solid tumor, inflammatory diseases, and solid organ transplants were present in 23.2%, 16.2%, 15.5%, and 10.0% of tested patients, respectively. In multivariable analysis, AIDS (odds ratio [OR] 3.31; 95% confidence interval [CI] 1.13-9.64, p = 0.029), non-Hodgkin lymphoma (OR 3.71; 95% CI 1.23-11.18, p = 0.020), vasculitis (OR 5.95; 95% CI 1.07-33.22, p = 0.042), metastatic solid tumor (OR 4.31; 95% CI 1.76-10.53, p = 0.001), and bilateral ground glass on CT scan (OR 2.19; 95% CI 1.01-4.78, p = 0.048) were associated with PJP, whereas an inverse association was observed for increasing lymphocyte cell count (OR 0.64; 95% CI 0.42-1.00, p = 0.049). For the diagnosis of PJP, higher positive predictive value (PPV) was observed when both respiratory Pneumocystis PCR and serum BDG were positive compared to individual assay positivity (72% for the combination vs. 63% for PCR and 39% for BDG). Cumulative 30-day mortality and 90-day mortality in patients with presumptive/proven PJP were 52% and 67%, respectively.ConclusionPJP in critically ill patients admitted to ICU is nowadays most encountered in non-HIV patients. Serum BDG when used in combination with respiratory Pneumocystis PCR could help improve the certainty of PJP diagnosis.© 2023. BioMed Central Ltd., part of Springer Nature.

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