The following is a summary of “Pneumocystis pneumonia in French intensive care units in 2013–2019: mortality and immunocompromised conditions,” published in the May 2024 issue of Critical Care by Kamel et al.

The recent surge of PCP (Pneumocystis Pneumonia) in French ICUs demands a deeper understanding of the underlying immunodeficiency conditions leading to life-threatening infections.

Researchers conducted a retrospective study determining if a changing spectrum of immunosuppression beyond HIV is contributing to the increase in severe cases of PCP requiring admission to the ICU.

They utilized the French national healthcare database system, PMSI, to identify all adult patients admitted to ICUs with a PCP diagnosis in 2013 and 2019.

The result showed a significant rise in PCP admissions, with patients requiring ICU care increasing from 17.8% in 2014 to 21.3% in 2019 (P<0.001). A rise in the incidence of severe PCP cases was observed, increasing from 0.85 to 1.32 per 100,000 adults (P<0.0001) (2013 to 2019). The incidence of severe PCP increased from 0.85 per 100,000 adults to 1.32 per 100,000 (P<0.0001), mainly driven by a rise in the proportion of HIV-negative patients from 60.6% to 74.4% (P<0.0001). The number of severe cases of PCP in patients with HIV-positive remained stable throughout the years. Mortality rates also differed between the groups, with in-hospital mortality for severe cases of PCP being 28.5% for patients with HIV infection and a significantly higher 49.7% for patients without HIV infection. Further analysis revealed that patients with HIV infection had a significantly lower risk of death than those without HIV infection(OR: 0.30, 95% CI [95CI]: 0.17–0.55)). Several factors were associated with higher mortality, including older age, a more severe illness score measured by Simplified Acute Physiologic Score II, and underlying health conditions such as congestive heart failure (HF), blood clotting problems, organ cancers, and liver cirrhosis. Among patients who are HIV-negative, a significant proportion (19.9%) suffer from various autoimmune inflammatory diseases.

Investigators concluded that French ICUs were experiencing a concerning rise in admissions in PCP, particularly among cancer and patients with autoimmune disease, while cases of HIV-positive remained stable, suggesting a shift in the underlying immunosuppression landscape.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01309-y