| Objective:Pneumocystis Pneumonia(PCP)is a potentially life-threatening invasive fungal infection that occurs in immunocompromised individuals.The time from the onset of symptom to treatment is a main risk factor for PCP mortality.Waiting for pathogenic evidence without treatment will result in respiratory failure,or even multiple organ failure.Preemptive therapy is to conduct antifungal treatment for patients with high risk of fungal infection,which may be beneficial to probable PCP patients.The purpose of our study was to investigate the effect of this therapy.Methods:We retrospectively collected the information of the patients who diagnosed as PCP after renal transplantation from January 2014 to December 2019,including age,gender,symptoms,CT performance,blood indicators,oxygen saturation,mechanical ventilation rates,drug adverse reactions,treatment endings,hospitalization days and hospitalization costs.Results:A total of 53 patients were enrolled in the study,including 42 males and 11females,with a mean age of 37±8 years old,ranging from 23 to 60.The mean time from the appearance of symptoms to the beginning of the target therapy was 5.57±2.83 days.The most common comorbidity among patients was hypertension(17/53,32.08%),followed by diabetes(2/53,3.77%)and coronary heart disease(1/53,1.89%).Forty-two patients(42/53,79.25%)developed PCP within six months after transplantation,and the median time of onset was 3.23(2.93,4.24)months.The most common symptoms were fever(50/53,94.34%),followed by progressive dyspnea(39/53,73.58%),dry cough(26/53,49.06%),and expectoration(18/53,33.96%).After admission,the level of 1,3-β-glucan in single serum was increased in 20 patients,and that in double serum was increased in 17 patients.The mean level was 215.84±371.91pg/ml.The proportion of CD4~+T cells was lower than the normal level in 11 patients(11/45,24.44%),with a mean value of 38.64±11.39%.CRP levels were elevated in 45 patients(45/49,91.84%),with an average of 41.02±26.56 mg/L.While PCT levels were elevated in 7 patients(7/46,15.22%),with a median level of 0.15(0.10,0.41)ng/m L.In addition to diffused ground-glass opacity,the most common imaging features were air bronchogram(5/53,9.43%)and gaseous cyst(5/53,9.43%),followed by pleural effusion(4/53,7.55%),pleural thickening(3/53,5.66%),aerothorax(2/53,3.77%)and pulmonary consolidation(1/53,1.89%).There were 49 patients reached clinical recovery,the cure rate was 92.45%,while the all-cause mortality was 7.55%.Two patients(3.77%)received non-invasive assisted ventilation and one(1.89%)received endotracheal intubation.There was no readmission of PCP during the follow-up in one year.The average hospitalization days was 14.75±10.01 days.The mean hospitalization cost was15665.44±16327.99 RMB.Conclusion:Once renal transplant recipients were diagnosed as probable PCP,preemptive therapy should be applied immediately while waiting for the results of etiological examination.Based on our study,the therapy appears to be effective,but the economic benefits need further evaluated. |
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