Pneumocystis jirovecii pneumonia (PJP)prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs

Gabriela Schmajuk, Kashif Jafri, Michael Evans, Stephen Shiboski, Milena Gianfrancesco, Zara Izadi, Sarah L. Patterson, Ishita Aggarwal, Urmimala Sarkar, R. Adams Dudley, Jinoos Yazdany

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1087-1092
Number of pages6
JournalSeminars in Arthritis and Rheumatism
Volume48
Issue number6
DOIs
StatePublished - Jun 2019
Externally publishedYes

Bibliographical note

Funding Information:
This work is supported by AHRQ R01 HS024412 and K23 AR063770 (GS). Drs. Yazdany and Schmajuk are also supported by the Russell/Engleman Medical Research Center for Arthritis. Dr. Sarkar is supported by AHRQ P30HS023558. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or National Institutes of Health.

Publisher Copyright:
© 2018 Elsevier Inc.

Keywords

  • Immunosuppression
  • Infection
  • Vasculitis

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