Management and Outcome Patterns for Adult Pneumocystis carinii Pneumonia, 1985 to 1995 : Comparison of HIV-Associated Cases to Other Immunocompromised States

摘要

Study objectives: Encompassing periods preceding and following major advances in the diagnosisnand management of HIV-related Pneumocystis carinii pneumonia (PCP), the purpose of this studynwas to determine whether management and outcome patterns of non-HIV PCP parallel thenmanagement and outcomes of AIDS-related PCP.nDesign: Retrospective review of medical records.nSetting: A 375-bed tertiary-care urban teaching hospital and referral center.nPatients: All adult patients with morphologically confirmed PCP from 1985 to 1995.nMeasurements and results: From 1985 to 1995, 638 confirmed cases of PCP were identified,nincluding 605 cases in 442 HIV-positive persons (HIV 1 PCP), and 33 cases in 33 non-HIVnpatients (non-HIV PCP). For HIV 1 PCP cases, a peak of 104 cases occurred in 1987, with angradual decline to 23 in 1995. The proportion of cases requiring hospitalization declined from anpeak of 91.6% in 1987 to a low of 51.6% in 1992. ICU admission was required for 6.3 to 8.2%, andnmechanical ventilation for 4.7 to 5.7%. Overall mortality improved from 11.7 to 6.6%, althoughnmortality for intubated patients remained at 50 to 60%. For the non-HIV PCP cases, 97%noccurred from 1989 to 1995 with similar annual frequency, 97% required hospitalization, 69%nrequired ICU admission, and 66% required intubation. Overall mortality was 39%, and mortalitynfor intubated patients was 59%.nConclusions: Despite major advances in diagnosis and management, PCP remains a significantnproblem in non-HIV-infected patients, and respiratory failure remains associated with a highnmortality rate for patients with both HIV 1 PCP and non-HIV PCP