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Low prevalence of Pneumocystis pneumonia in hospitalized patients with systemic lupus erythematosus: review of a clinical data warehouse.
Lupus 2017; 26(14):1473-1482L

Abstract

Objective In the era of powerful immunosuppression, opportunistic infections are an increasing concern in systemic lupus erythematosus. One of the best-studied opportunistic infections is Pneumocystis pneumonia; however, the prevalence of Pneumocystis pneumonia in systemic lupus erythematosus is not clearly defined. This study evaluates the prevalence of Pneumocystis pneumonia in hospitalized systemic lupus erythematosus patients, with a focus on validating the Pneumocystis pneumonia and systemic lupus erythematosus diagnoses with clinical information. Methods This retrospective cohort study evaluates the prevalence of Pneumocystis pneumonia in all systemic lupus erythematosus patients treated at Columbia University Medical Center-New York Presbyterian Hospital between January 2000 and September 2014, using electronic medical record data. Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and patients with renal transplants (including both early and late post-transplant patients) represented immunocompromised control groups. Patients with systemic lupus erythematosus, Pneumocystis pneumonia, HIV/AIDS, or renal transplant were identified using diagnostic codes from the International Classification of Diseases, Ninth Revision (ICD-9). Results Out of 2013 hospitalized systemic lupus erythematosus patients, nine had presumed Pneumocystis pneumonia, yielding a low prevalence of Pneumocystis pneumonia in systemic lupus erythematosus of 0.45%. Three of the nine Pneumocystis pneumonia cases were patients with concomitant systemic lupus erythematosus and HIV/AIDS. Only one of these nine cases was histologically confirmed as Pneumocystis pneumonia, in a patient with concomitant systemic lupus erythematosus and HIV/AIDS and a CD4 count of 13 cells/mm3. The prevalence of Pneumocystis pneumonia in renal transplant patients and HIV/AIDS patients was 0.61% and 5.98%, respectively. Conclusion Given the reported high rate of adverse effects to trimethoprim-sulfamethoxazole in systemic lupus erythematosus and the low prevalence of Pneumocystis pneumonia in hospitalized systemic lupus erythematosus patients, our data do not substantiate the need for Pneumocystis pneumonia prophylaxis in systemic lupus erythematosus patients, except in those with concurrent HIV/AIDS.

Authors+Show Affiliations

1 Division of Rheumatology, Columbia University School of Physicians and Surgeons, USA.1 Division of Rheumatology, Columbia University School of Physicians and Surgeons, USA.1 Division of Rheumatology, Columbia University School of Physicians and Surgeons, USA.2 Department of Endocrine, Columbia University School of Physicians and Surgeons, USA.3 Department of Cardiology, Rutgers-New Jersey Medical School, USA.1 Division of Rheumatology, Columbia University School of Physicians and Surgeons, USA.1 Division of Rheumatology, Columbia University School of Physicians and Surgeons, USA.1 Division of Rheumatology, Columbia University School of Physicians and Surgeons, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28399687

Citation

Kapoor, T M., et al. "Low Prevalence of Pneumocystis Pneumonia in Hospitalized Patients With Systemic Lupus Erythematosus: Review of a Clinical Data Warehouse." Lupus, vol. 26, no. 14, 2017, pp. 1473-1482.
Kapoor TM, Mahadeshwar P, Nguyen S, et al. Low prevalence of Pneumocystis pneumonia in hospitalized patients with systemic lupus erythematosus: review of a clinical data warehouse. Lupus. 2017;26(14):1473-1482.
Kapoor, T. M., Mahadeshwar, P., Nguyen, S., Li, J., Kapoor, S., Bathon, J., ... Askanase, A. (2017). Low prevalence of Pneumocystis pneumonia in hospitalized patients with systemic lupus erythematosus: review of a clinical data warehouse. Lupus, 26(14), pp. 1473-1482. doi:10.1177/0961203317703494.
Kapoor TM, et al. Low Prevalence of Pneumocystis Pneumonia in Hospitalized Patients With Systemic Lupus Erythematosus: Review of a Clinical Data Warehouse. Lupus. 2017;26(14):1473-1482. PubMed PMID: 28399687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low prevalence of Pneumocystis pneumonia in hospitalized patients with systemic lupus erythematosus: review of a clinical data warehouse. AU - Kapoor,T M, AU - Mahadeshwar,P, AU - Nguyen,S, AU - Li,J, AU - Kapoor,S, AU - Bathon,J, AU - Giles,J, AU - Askanase,A, Y1 - 2017/04/11/ PY - 2017/4/13/pubmed PY - 2018/6/16/medline PY - 2017/4/13/entrez KW - HIV KW - Pneumocystis carinii pneumonia KW - Pneumocystis jirovecii KW - Systemic lupus erythematosus (SLE) KW - electronic medical records database KW - opportunistic infections SP - 1473 EP - 1482 JF - Lupus JO - Lupus VL - 26 IS - 14 N2 - Objective In the era of powerful immunosuppression, opportunistic infections are an increasing concern in systemic lupus erythematosus. One of the best-studied opportunistic infections is Pneumocystis pneumonia; however, the prevalence of Pneumocystis pneumonia in systemic lupus erythematosus is not clearly defined. This study evaluates the prevalence of Pneumocystis pneumonia in hospitalized systemic lupus erythematosus patients, with a focus on validating the Pneumocystis pneumonia and systemic lupus erythematosus diagnoses with clinical information. Methods This retrospective cohort study evaluates the prevalence of Pneumocystis pneumonia in all systemic lupus erythematosus patients treated at Columbia University Medical Center-New York Presbyterian Hospital between January 2000 and September 2014, using electronic medical record data. Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and patients with renal transplants (including both early and late post-transplant patients) represented immunocompromised control groups. Patients with systemic lupus erythematosus, Pneumocystis pneumonia, HIV/AIDS, or renal transplant were identified using diagnostic codes from the International Classification of Diseases, Ninth Revision (ICD-9). Results Out of 2013 hospitalized systemic lupus erythematosus patients, nine had presumed Pneumocystis pneumonia, yielding a low prevalence of Pneumocystis pneumonia in systemic lupus erythematosus of 0.45%. Three of the nine Pneumocystis pneumonia cases were patients with concomitant systemic lupus erythematosus and HIV/AIDS. Only one of these nine cases was histologically confirmed as Pneumocystis pneumonia, in a patient with concomitant systemic lupus erythematosus and HIV/AIDS and a CD4 count of 13 cells/mm3. The prevalence of Pneumocystis pneumonia in renal transplant patients and HIV/AIDS patients was 0.61% and 5.98%, respectively. Conclusion Given the reported high rate of adverse effects to trimethoprim-sulfamethoxazole in systemic lupus erythematosus and the low prevalence of Pneumocystis pneumonia in hospitalized systemic lupus erythematosus patients, our data do not substantiate the need for Pneumocystis pneumonia prophylaxis in systemic lupus erythematosus patients, except in those with concurrent HIV/AIDS. SN - 1477-0962 UR - https://www.unboundmedicine.com/medline/citation/28399687/Low_prevalence_of_Pneumocystis_pneumonia_in_hospitalized_patients_with_systemic_lupus_erythematosus:_review_of_a_clinical_data_warehouse_ L2 - http://journals.sagepub.com/doi/full/10.1177/0961203317703494?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -