333. EVALUATING THE RISK OF PNEUMOCYSTIS JIROVECII PNEUMONIA (PCP) IN RENAL AND NON-RENAL VASCULITIS PATIENTS

Abstract

Background: Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection that can be life- threatening to immunocompromised patients. Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for management of glomerulonephritis recommend that patients receiving immunosuppression should be given prophylactic Co-Trimoxazole (trimethoprim- sulfamethoxazole) 1.Objectives: We aim to compare the incidence of Pneumocystis jirovecii pneumonia in renal and non-renal vasculitis patients. We aim to identify indicators of risk for PCP, to help guide therapeutic choices in the future. Method: Vasculitis patients under the care of Wirral University Teaching Hospital or kip to Main Content Countess of Chester Hospital were split into renal or non-renal vasculitis by the pattern of organ involvement. Electronic notes and clinic letters were reviewed prior to inter-cohort analysis. Results: 41 renal and 14 non-renal vasculitis patients were identified. Mean follow-up was 50.8 months (range 2 - 173 months). 97.6% of renal patients had positive immunology (C-ANCA, P-ANCA or ANTI-GBM) whilst 71.4% of non-renal patients were positive. 56.4% of patients were male, 43.6% were female; the average age at diagnosis was 60.7 years. All patient induction regimes included 10-60mg daily Prednisolone. Cyclophosphamide was the main induction agent (73.2% of renal, 64.3% of non- renal) with Rituximab the second most frequent (24.4% of renal, 7.1% of non-renal). In combination with steroids, Azathioprine was the most popular maintenance therapy (30.3% renal, 58.3% non-renal). Rituximab was the most popular treatment for relapse in both. Prophylactic Co-trimoxazole was given in 78.0% of renal patients and 85.7% of non-renal patients. Mean treatment duration was 6.6 months (5.9 months renal, 8.4 months non-renal), ranging from 2 months - 24 months. Infection rates were 28.2% in renal patients and 42.8% in non-renal patients. PCP incidence was 16.7% in non-renal patients, 5.1% incidence in renal patients - see Graph 1. Of the cases with PCP, 2 patients hadn't received Co- trimoxazole (1 case due to allergy), 1 patient was minimally compliant with therapy and 1 patient had previously completed a 2-month course. Pentamidine was used as an alternative agent in 1 patient. All 4 patients with PCP had received recent Rituximab therapy. Conclusion: Vasculitis patients on immunosuppression (IS), the risk of PCP pneumonia appears greatest in non-renal patients. Course duration may need to be prolonged while on IS and IV pentamidine can be used if allergic to Septrin.