Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Dec;57(1):2511043.
doi: 10.1080/07853890.2025.2511043. Epub 2025 Jun 14.

Mortality of Pneumocystis jirovecii pneumonia in intensive care units: a post-hoc analysis of an international multicenter study by ESGCIP and EFISG

Daniele Roberto Giacobbe  1   2 , Silvia Dettori  1   2 , Vincenzo Di Pilato  3   4 , Erika Asperges  5 , Lorenzo Ball  5   6 , Enora Berti  7 , Ola Blennow  8   9 , Bianca Bruzzone  10 , Laure Calvet  11 , Federico Capra Marzani  12 , Antonio Casabella  13 , Sofia Choudaly  14 , Anais Dartevel  15 , Gennaro De Pascale  16   17 , Gabriele Di Meco  2 , Melissa Fallon  18 , Louis-Marie Galerneau  15 , Miguel Gallego  19   20 , Mauro Giacomini  21 , Adolfo González Saez  22   23   24 , Luise Hänsel  25   26 , Giancarlo Icardi  1   10 , Philipp Koehler  25   26 , Katrien Lagrou  27   28 , Tobias Lahmer  29 , Philip Lewis White  18   30 , Laura Magnasco  2 , Anna Marchese  3   4 , Cristina Marelli  2 , Mercedes Marín Arriaza  22   23 , Ignacio Martin-Loeches  31   32 , Armand Mekontso-Dessap  7   33   34 , Malgorzata Mikulska  1   2 , Marco Muccio  1 , Alessandra Mularoni  35 , Anna Nordlander  8   9 , Julien Poissy  14   36 , Giovanna Russelli  35 , Alessio Signori  37 , Carlo Tascini  38   39 , Louis-Maxime Vaconsin  40 , Joel Vargas  16 , Antonio Vena  1   2 , Joost Wauters  27   41 , Paolo Pelosi  3   6 , Jean-Francois Timsit  40   42 , Matteo Bassetti  1   2 ; JIR-ICU Investigators (Collaborators), the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESGCIP), and the Fungal Infections Study Group of the European Society of Clinical Microbiology and Infectious Diseases (EFISG); JIR-ICU investigators (collaborators)
Collaborators, Affiliations
Multicenter Study

Mortality of Pneumocystis jirovecii pneumonia in intensive care units: a post-hoc analysis of an international multicenter study by ESGCIP and EFISG

Daniele Roberto Giacobbe et al. Ann Med. 2025 Dec.

Abstract

Background: Pneumocystis jirovecii pneumonia (PJP) is a life-threatening disease. In the intensive care unit (ICU), PJP is most frequently observed among patients with several conditions not related to the human immunodeficiency virus (HIV) infection.

Methods: The primary objective of the present post-hoc analysis of a multicenter, multinational, retrospective study was to assess factors impacting prognosis in ICU patients with PJP through univariable and multivariable analyses.

Results: A total of 107 patients were included; 28 had proven PJP (26.2%), and 79 had presumptive PJP (73.8%). The overall 30-day mortality was 52.7% (95% confidence interval [CI] 42.1-62.2). In the multivariable analysis, metastatic solid tumor (hazard ratio [HR] 3.49; 95% CI 1.71-7.13, p < 0.001) and chronic liver disease (HR 2.44; 95% CI 1.03-5.80, p = 0.044) showed an independent association with 30-day mortality. The direction of effect remained consistent when center was added to the multivariable model as random effect.

Conclusion: PJP mortality remains high in ICU patients. Conditions other than HIV infection are emerging not only as non-classical risk factors for PJP development, but also as important mortality predictors. A better understanding of the reasons underlying this evolving landscape could be crucial to improve PJP management and survival.

Keywords: ICU; PCP; PJP; Pneumocystis; mortality; pneumonia.

PubMed Disclaimer

Conflict of interest statement

Outside the submitted work, DRG reports investigator-initiated grants from Pfizer, Shionogi, Tillotts Pharma, Menarini, bioMérieux, and Gilead Italia, and speaker and/or advisor fees from Pfizer, bioMérieux, Menarini and Tillotts Pharma. Outside the submitted work, MB reports research grants and/or personal fees for advisor/consultant and/or speaker/chairman from BioMérieux, Cidara, Gilead, Menarini, MSD, Pfizer, and Shionogi. Outside the submitted work, VDP reports research grant from Seegene Inc. Outside the submitted work, PLW performed diagnostic evaluations and received meeting sponsorship from Bruker; speakers fees, expert advice fees and meeting sponsorship from Gilead; expert advice fees from F2G and speaker fees from Pfizer; speakers fees and performed diagnostic evaluations for Associates of Cape Cod and IMMY. JW received meeting speakers and travel fees and investigator-initiated grants from MSD, Gilead and Pfizer, outside the scope of this manuscript. Outside the submitted work, PK reports grants or contracts from German Federal Ministry of Research and Education (BMBF) B-FAST (Bundesweites Forschungsnetz Angewandte Surveillance und Testung) and NAPKON (Nationales Pandemie Kohorten Netz, German National Pandemic Cohort Network) of the Network University Medicine (NUM) and the State of North Rhine-Westphalia; Consulting fees Ambu GmbH, Gilead Sciences, Mundipharma Resarch Limited, Noxxon N.V. and Pfizer Pharma; Honoraria for lectures from Akademie für Infektionsmedizin e.V., Ambu GmbH, Astellas Pharma, BioRad Laboratories Inc., Datamed GmbH, European Confederation of Medical Mycology, Gilead Sciences, GPR Academy Ruesselsheim, HELIOS Kliniken GmbH, Lahn-Dill-Kliniken GmbH, medupdate GmbH, MedMedia GmbH, MSD Sharp & Dohme GmbH, Pfizer Pharma GmbH, Scilink Comunicación Científica SC and University Hospital and LMU Munich; Participation on an Advisory Board from Ambu GmbH, Gilead Sciences, Mundipharma Resarch Limited and Pfizer Pharma; A pending patent currently reviewed at the German Patent and Trade Mark Office (DE 10 2021 113 007.7); Other non-financial interests from Elsevier, Wiley and Taylor & Francis online. Outsided the submitted work, KL received consultancy fees Mundipharma, speaker fees from Pfizer, Gilead, Mundipharma and FUJIFILM Wako chemicals Europe GmbH, a service fee from TECOmedical; a fee for Advisory Board participation from Pfizer and travel support from Pfizer, Gilead and AstraZeneca. The other authors report no conflicts of interests related to this study.

Figures

Figure 1.
Figure 1.
Flow-chart of the patients inclusion process.
Figure 2.
Figure 2.
Cumulative incidence of death at 30 days in critically ill patients with proven/presumptive PJP. The time of origin was set at the time of PJP diagnostic workup. Right-censoring was applied at the time of hospital discharge or at 30 days after the time of PJP diagnostic workup, whichever came first. Cumulative 30-day mortality in the entire study population (proven and presumptive PJP) is displayed in the top panel, whereas bottom panels compare cumulative 30-day mortality in patients with proven PJP vs. presumptive PJP (left panel) and patients with HIV infection vs. patients without HIV infection (right panel). Dashed lines represent the 95% confidence interval.
See this image and copyright information in PMC

References

    1. Wang Y, Huang X, Sun T, et al. Non-HIV-infected patients with Pneumocystis pneumonia in the intensive care unit: a bicentric, retrospective study focused on predictive factors of in-hospital mortality. Clin Respir J. 2022;16(2):152–161. doi: 10.1111/crj.13463. - DOI - PMC - PubMed
    1. Ko Y, Jeong BH, Park HY, et al. Outcomes of Pneumocystis pneumonia with respiratory failure in HIV-negative patients. J Crit Care. 2014;29(3):356–361. doi: 10.1016/j.jcrc.2013.12.005. - DOI - PubMed
    1. Reid AB, Chen SC, Worth LJ.. Pneumocystis jirovecii pneumonia in non-HIV-infected patients: new risks and diagnostic tools. Curr Opin Infect Dis. 2011;24(6):534–544. doi: 10.1097/QCO.0b013e32834cac17. - DOI - PubMed
    1. Pereira-Díaz E, Moreno-Verdejo F, de la Horra C, et al. Changing trends in the epidemiology and risk factors of Pneumocystis Pneumonia in Spain. Front Public Health. 2019;7:275. doi: 10.3389/fpubh.2019.00275. - DOI - PMC - PubMed
    1. Kolbrink B, Scheikholeslami-Sabzewari J, Borzikowsky C, et al. Evolving epidemiology of pneumocystis pneumonia: findings from a longitudinal population-based study and a retrospective multi-center study in Germany. Lancet Reg Health Eur. 2022;18:100400. doi: 10.1016/j.lanepe.2022.100400. - DOI - PMC - PubMed

Publication types

LinkOut - more resources