Trimethoprim-sulfamethoxazole combined with echinocandins versus trimethoprim-sulfamethoxazole alone for Pneumocystis pneumonia in patients without human immunodeficiency virus infection: A nationwide retrospective cohort study

Jumpei Taniguchi; Shotaro Aso; Hiroki Matsui; Kiyohide Fushimi; Hideo Yasunaga

doi:10.1016/j.jiac.2024.08.004

Trimethoprim-sulfamethoxazole combined with echinocandins versus trimethoprim-sulfamethoxazole alone for Pneumocystis pneumonia in patients without human immunodeficiency virus infection: A nationwide retrospective cohort study

J Infect Chemother. 2024 Aug 6:S1341-321X(24)00213-7. doi: 10.1016/j.jiac.2024.08.004. Online ahead of print.

Authors

Jumpei Taniguchi¹, Shotaro Aso², Hiroki Matsui³, Kiyohide Fushimi⁴, Hideo Yasunaga³

Affiliations

¹ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan. Electronic address: taniguchi-jumpei0825@g.ecc.u-tokyo.ac.jp.
² Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
⁴ Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

PMID: 39117103
DOI: 10.1016/j.jiac.2024.08.004

Abstract

Background: Although combination therapy of echinocandins with trimethoprim-sulfamethoxazole (TMP-SMX) has been reported for patients with Pneumocystis jirovecii pneumonia (PCP), the effectiveness of this combination therapy in patients with PCP without human immunodeficiency virus (HIV) infection remains unknown.

Methods: Data from the Japanese Diagnosis Procedure Combination inpatient database was used to identify non-HIV patients who underwent their first hospitalisation for PCP between April 2012 and March 2022. The patients were divided into those treated with TMP-SMX alone and those treated with TMP-SMX combined with echinocandins. We performed propensity-score overlap-weighting analysis to estimate in-hospital mortality.

Results: Among the 1324 eligible patients, 122 received TMP-SMX plus echinocandins, while 1202 received TMP-SMX alone. The propensity-score overlap-weighting analysis showed that the combination therapy was not associated with reduced in-hospital mortality in comparison with TMP-SMX alone (22.2 % vs. 26.9 %; risk difference, 4.6 %; 95 % confidence interval, -6.1 %-15.3 %; P = 0.398).

Conclusions: Echinocandins combined with TMP-SMX may not improve in-hospital mortality due to PCP in patients without HIV infection.

Keywords: Caspofungin; Echinocandin; Micafungin; Non-human immune deficiency virus; Pneumocystis jirovecii pneumonia.

Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.