Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs
| Autor: | Jinoos Yazdany, Urmimala Sarkar, Gabriela Schmajuk, Michael J. Evans, Ishita Aggarwal, Stephen Shiboski, Zara Izadi, Sarah L. Patterson, R. Adams Dudley, Milena A. Gianfrancesco, Kashif Jafri |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Cyclophosphamide medicine.drug_class Opportunistic infection medicine.medical_treatment Antibiotics Opportunistic Infections Pneumocystis carinii Article Immunocompromised Host Young Adult 03 medical and health sciences 0302 clinical medicine Rheumatology Rheumatic Diseases Internal medicine Electronic Health Records Humans Medicine 030212 general & internal medicine Practice Patterns Physicians' Antibiotic prophylaxis Adverse effect Aged Aged 80 and over 030203 arthritis & rheumatology business.industry Pneumonia Pneumocystis Immunosuppression Antibiotic Prophylaxis Middle Aged medicine.disease Anesthesiology and Pain Medicine Female business Vasculitis Risk assessment Immunosuppressive Agents medicine.drug |
| Zdroj: | Semin Arthritis Rheum |
| ISSN: | 0049-0172 |
| DOI: | 10.1016/j.semarthrit.2018.10.018 |
| Popis: | Introduction/objectives Pneumocystis jirovecii pneumonia (PJP) is a rare but potentially fatal opportunistic infection; however, consensus varies around which conditions or medications confer a level of risk sufficient to justify antibiotic prophylaxis for PJP. We used electronic health record (EHR) data to assess the current patterns of PJP prophylaxis, PJP outcomes, and prophylaxis-related adverse events among patients with rheumatic diseases who were receiving high-risk immunosuppressant drugs. Methods Data derive from the EHR of a large health system. We included new immunosuppressant users with diagnoses of vasculitis, myositis, or systemic lupus erythematosus. We calculated the proportion of patients who received PJP prophylaxis for each diagnosis and drug combination. We also calculated the number of PJP infections and the number of antibiotic adverse drug events (ADEs) per patient-year of exposure. Results We followed 316 patients for 23.2 + /- 14.2 months. Overall, 124 (39%) of patients received prophylactic antibiotics for PJP. At least 25% of patients with the highest risk conditions (e.g. vasculitis) or highest risk immunosuppressants (e.g. cyclophosphamide) did not receive PJP prophylaxis. We found no cases of PJP infection over 640 patient-years of follow up, including among those not receiving prophylaxis, and an overall incidence rate of ADEs of 2.2% per patient-year. Conclusions PJP prophylaxis for patients with rheumatic conditions is inconsistent, with one quarter of patients who have high risk conditions or high risk immunosuppressants not receiving prophylaxis. However, given extremely low rates of PJP infection, but detectable ADEs to prophylactic antibiotics, our findings suggest that evidence to guide more personalized risk assessments are needed to inform PJP prophylaxis. |
| Databáze: | OpenAIRE |
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