Clinical Characteristics and Outcomes of Severe Non-HIV Related Pneumocystis jirovecii Pneumonia in the Pediatric Intensive Care Unit

Abstract

Background: Pneumocystis jirovecii is an important cause of opportunistic pneumonia in immunocompromised patients. The aim of this study was to investigate the clinical, laboratory, imaging characteristics, and prognosis of Pneumocystis jirovecii pneumonia (PJP) in immunocompromised non-HIV pediatric patients. Methods: This was a retrospective, observational study. Continuous variables were expressed as median and interquartile range and evaluated by Mann Whitney U test. Risk factors associated with 90-day all-cause mortality were evaluated by a logistic regression model. Results: Twenty-two patients (55%) had previously undergone transplantation; 19 (47.5%) liver transplants and 3 (7.5%) allogeneic hematopoietic stem cell transplants. The remaining 18 patients included 12 with acute lymphoblastic leukemia (30%) with 6 others (15%). Eight patients (20%) presented with shock on admission. Fifteen patients (37.5%) had received PJP prophylaxis before PJP onset. The median duration of hospitalization was 26 (20–34) days with a median saty of 18 (11–25) days in the pediatric intensive care unit (PICU). The 30 day all-cause mortality was 12.5% (5/40). The 90 day all-cause mortality was 22.5% (9/40). Compared with survivors, non-survivors had a significantly higher Pediatric Sequential Organ Failure Assessment Score (pSOFA) (11 vs 4; p < 0.01) and lower SpO2 at presentation (88% vs 90%; p = 0.046). Multivariate analysis showed that the pSOFA [95% CI 1.983 (1.183–3.325); p = 0.009)] was the only significant risk factor for mortality. Although there was no statistically significant difference, patients who received adjunctive glucocorticoid therapy had a shorter duration of mechanical ventilation compared to those who did not (12 vs. 15 days; p = 0.26). Conclusions: PJP remains life-threatening in immunocompromised pediatric patients. pSOFA was a significant risk factor for mortality.