Background

The decision to administer prophylaxis to patients receiving immunosuppression against pneumocystosis remains a dilemma.

Objective

To determine overall and age-specific 5-year pneumocystosis incidence within a population exposed to immunosuppressants.

Methods

Retrospective cohort analysis identifying incident pneumocystosis cases among adults without HIV, AIDS, or cancer exposed to immunosuppressant, corticosteroid therapy, or both.

Results

We identified 406 new cases among patients prescribed an immunosuppressant, corticosteroid, or both. Overall incidence of pneumocystosis was 0.012% (406/3,366,086). Incidence was highest in those exposed to immunosuppressant and corticosteroid medications (0.199%), followed by those exposed to immunosuppressant alone (0.012%), corticosteroid alone (0.008%), and neither medication (0.001%) (P < .001). The greatest risk differences were noted between groups exposed to immunosuppressant and corticosteroid compared with neither (0.198%, 95% confidence interval [CI] 0.166%-0.230%) or immunosuppressant alone (0.188%, 95% CI 0.155%-0.221%). The greatest relative risks (RRs) were noted among those receiving immunosuppressant and corticosteroid compared with those exposed to neither (RR 122.5, 95% CI 100.9-148.8) or immunosuppressant alone (RR 16.5, 95% CI 7.3-37.4).

Limitations

We could not confirm dose and duration of exposures.

Conclusion

Incidence of pneumocystosis among patients exposed to immunosuppressants is very low. Prophylaxis for patients receiving combination immunosuppressant and corticosteroid therapy, the group at highest risk, might be warranted.

中文翻译：

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暴露于免疫抑制的患者中肺囊肿的发生率

背景

对接受针对肺囊肿的免疫抑制的患者进行预防治疗的决定仍然是一个难题。

客观的

在暴露于免疫抑制剂的人群中确定总体和特定年龄的5年性肺囊病的发病率。

方法

回顾性队列分析确定了在没有HIV，AIDS或未接受免疫抑制剂，糖皮质激素治疗或两者的癌症的成年人中发生的肺气肿病病例。

结果

我们在开具免疫抑制剂和/或皮质类固醇激素或两者同时使用的患者中确定了406例新病例。肺囊肿的总发病率为0.012％（406 / 3,366,086）。暴露于免疫抑制剂和皮质类固醇药物的发生率最高（0.199％），其次是仅接受免疫抑制剂（0.012％），仅皮质类固醇（0.008％）和两种药物（0.001％）的发生率（P <.001）。与单独使用免疫抑制剂（0.198％，95％置信区间[CI] 0.166％-0.230％）或单独使用免疫抑制剂（0.188％，95％CI 0.155％-0.221％）相比，暴露于免疫抑制剂和皮质类固醇的组之间存在最大的风险差异。与既未接触过（RR 122.5，95％CI 100.9-148.8）也未接触过免疫抑制剂（RR 16.5，95％CI 7.3-37.4）的患者相比，接受免疫抑制剂和皮质类固醇激素的患者的最大相对风险（RRs）最高。

局限性

我们无法确定暴露的剂量和持续时间。

结论

暴露于免疫抑制剂的患者中肺囊肿的发生率很低。对于有最高风险的人群，可能需要对接受免疫抑制剂和糖皮质激素联合治疗的患者进行预防。