{
  "abstract": "Background Pneumocystis jirovecii pneumonia (PcP) in HIV-negative patients is associated with high mortality rates. While early adjunctive corticosteroid (AC) therapy benefits HIV-positive patients with severe PcP, its efficacy and safety in HIV-negative patients remain poorly investigated.Methods This multicentre retrospective observational study included consecutive patients diagnosed with proven or probable PcP, from January 2011 to January 2021. This study assessed the prognostic impact and safety of early AC in HIV-negative patients with PcP. To address baseline characteristic imbalances between patients, a non-parsimonious propensity matching analysis was performed with a 1/1 ratio. Survival analysis, day-90 mortality rate and healthcare-associated infections (HCAI) were compared using Cox and logistic regressions.Results 350 consecutive HIV-negative patients with proven or probable PcP were included. Of these, 116 (33.1%) received early AC within 5 days of anti-PcP therapy initiation. The median arterial oxygen partial pressure to fractional inspired oxygen (PaO 2/FiO2) ratio was 224 (114–229). The 90-day mortality rate was 29.4% (103/350). There was no significant difference in 90-day mortality according to AC, both in overall and matched populations (OR 1.27 (0.78–2.05); p=0.336 and 0.92 (0.52–1.62); p=0.772, respectively). HCAI incidences appeared similar between groups. In the matched population, a higher proportion of AC patients required high-flow oxygen therapy (OR 2.15 (1.17–4.05); p=0.015) and mechanical ventilation duration was higher in corticosteroid recipients (OR 1.04 (1.01–1.09); p=0.048).Conclusion Early AC therapy was not associated with reduced 90-day mortality in HIV-negative PcP patients. Although recommended in hypoxemic HIV-positive PcP patients, the benefit of this strategy in HIV-negative patients remains to be proven.",
  "authors": [
    {
      "affiliations": [
        "Service de Réanimation Polyvalente, Groupement Hospitalier Broceliande Atlantique, Brittany, France"
      ],
      "name": "Florian Reizine"
    },
    {
      "affiliations": [
        "Service de Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France"
      ],
      "name": "Vicky Stiegler"
    },
    {
      "affiliations": [
        "Service de Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France"
      ],
      "name": "Romain Lecuyer"
    },
    {
      "affiliations": [
        "Service d’Hématologie, CHU Nantes, Nantes, France"
      ],
      "name": "Benoit Tessoulin"
    },
    {
      "affiliations": [
        "Service de Réanimation Polyvalente, Groupement Hospitalier Broceliande Atlantique, Brittany, France"
      ],
      "name": "Guillaume Rieul"
    },
    {
      "affiliations": [
        "Intensive Care and Infectious Disease Unit, CHU de Bordeaux, Bordeaux, France"
      ],
      "name": "Fabrice Camou"
    },
    {
      "affiliations": [
        "Laboratoire de Mycologie-Parasitologie, Hôtel-Dieu, CHU Nantes, Nantes, France"
      ],
      "name": "Florent Morio"
    },
    {
      "affiliations": [
        "Laboratoire de Microbiologie, Groupement Hospitalier Broceliande Atlantique, Brittany, France"
      ],
      "name": "Anne Cady"
    },
    {
      "affiliations": [
        "Laboratoire de Mycologie, CHU de Bordeaux, Bordeaux, France"
      ],
      "name": "Frederic Gabriel"
    },
    {
      "affiliations": [
        "Service de Médecine Intensive-Réanimation, CHU Nantes, Nantes, France"
      ],
      "name": "Emmanuel Canet"
    },
    {
      "affiliations": [
        "Service de Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France"
      ],
      "name": "François Raffi"
    },
    {
      "affiliations": [
        "Service de Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France"
      ],
      "name": "David Boutoille"
    },
    {
      "affiliations": [
        "Service de Maladies Infectieuses, CHU Bordeaux GH Pellegrin, Bordeaux, France"
      ],
      "name": "Nahéma Issa"
    },
    {
      "affiliations": [
        "Service de Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France",
        "Université de Nantes, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France"
      ],
      "name": "Benjamin Jean Gaborit"
    },
    {
      "affiliations": [],
      "name": "on behalf of the pronocystis study group"
    }
  ],
  "title": "Prognostic impact and safety of early adjunctive corticosteroid therapy in HIV-negative severe pneumocystis pneumonia: a propensity-matched multicentre study",
  "uid": "c2a6ba7f-4f21-5524-a082-81a9fdfe5a66"
}