Prognostic impact and safety of early adjunctive corticosteroid therapy in HIV-negative severe pneumocystis pneumonia: a propensity-matched multicentre study

Florian Reizine; Vicky Stiegler; Romain Lecuyer; Benoit Tessoulin; Guillaume Rieul; Fabrice Camou; Florent Morio; Anne Cady; Frederic Gabriel; Emmanuel Canet; François Raffi; David Boutoille; Nahéma Issa; Benjamin Jean Gaborit; pronocystis study group

doi:10.1136/thorax-2025-223504

Prognostic impact and safety of early adjunctive corticosteroid therapy in HIV-negative severe pneumocystis pneumonia: a propensity-matched multicentre study

Thorax. 2025 Dec 10:thorax-2025-223504. doi: 10.1136/thorax-2025-223504. Online ahead of print.

Authors

Collaborators

pronocystis study group:
Francois Raffi, David Boutoille, Charlotte Biron, Maeva Lefebvre, Benjamin Jean Gaborit, Paul Le Turnier, Colin Deschanvres, Raphael Lecomte, Marie Chauveau, Romain Lécuyer, Antoine Asquier-Khati, Patrice Le Pape, Florent Morio, Rose-Anne Lavergne, Fakhri Jeddi, Stéphane Corvec, Pascale Bemer, Jocelyne Caillon, Aurélie Guillouzouic, Anne-Gaëlle Leroy, Karim Lakhal, Raphaël Cinotti, Antoine Roquilly, Jean Reignier, Emmanuel Canet, François Xavier Blanc, Cédric Bretonniere, Jean Morin, Fabrice Camou, Nahéma Issa, Olivier Guisset, Gaelle Mourissoux, Isabelle Accoceberry, Frederic Gabriel, Noémie Coron, Laurence Delhaes, Sébastien Imbert, Maxime Lefranc, Florian Lussac-Sorton, Amandine Rougeron, Marie Gousseff, Yoann Crabol, Grégory Corvaisier, Florent Lautredoux, Romain Lécuyer, Anne Cady, Myriam Auger, Pascal Pouedras

Affiliations

¹ Service de Réanimation Polyvalente, Groupement Hospitalier Broceliande Atlantique, Brittany, France florian.reizine@gmail.com.
² Service de Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France.
³ Service d'Hématologie, CHU Nantes, Nantes, France.
⁴ Service de Réanimation Polyvalente, Groupement Hospitalier Broceliande Atlantique, Brittany, France.
⁵ Intensive Care and Infectious Disease Unit, CHU de Bordeaux, Bordeaux, France.
⁶ Laboratoire de Mycologie-Parasitologie, Hôtel-Dieu, CHU Nantes, Nantes, France.
⁷ Laboratoire de Microbiologie, Groupement Hospitalier Broceliande Atlantique, Brittany, France.
⁸ Laboratoire de Mycologie, CHU de Bordeaux, Bordeaux, France.
⁹ Service de Médecine Intensive-Réanimation, CHU Nantes, Nantes, France.
¹⁰ Service de Maladies Infectieuses, CHU Bordeaux GH Pellegrin, Bordeaux, France.
¹¹ Université de Nantes, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France.

PMID: 41371766
DOI: 10.1136/thorax-2025-223504

Abstract

Background: Pneumocystis jirovecii pneumonia (PcP) in HIV-negative patients is associated with high mortality rates. While early adjunctive corticosteroid (AC) therapy benefits HIV-positive patients with severe PcP, its efficacy and safety in HIV-negative patients remain poorly investigated.

Methods: This multicentre retrospective observational study included consecutive patients diagnosed with proven or probable PcP, from January 2011 to January 2021. This study assessed the prognostic impact and safety of early AC in HIV-negative patients with PcP. To address baseline characteristic imbalances between patients, a non-parsimonious propensity matching analysis was performed with a 1/1 ratio. Survival analysis, day-90 mortality rate and healthcare-associated infections (HCAI) were compared using Cox and logistic regressions.

Results: 350 consecutive HIV-negative patients with proven or probable PcP were included. Of these, 116 (33.1%) received early AC within 5 days of anti-PcP therapy initiation. The median arterial oxygen partial pressure to fractional inspired oxygen (PaO₂/FiO₂) ratio was 224 (114-229). The 90-day mortality rate was 29.4% (103/350). There was no significant difference in 90-day mortality according to AC, both in overall and matched populations (OR 1.27 (0.78-2.05); p=0.336 and 0.92 (0.52-1.62); p=0.772, respectively). HCAI incidences appeared similar between groups. In the matched population, a higher proportion of AC patients required high-flow oxygen therapy (OR 2.15 (1.17-4.05); p=0.015) and mechanical ventilation duration was higher in corticosteroid recipients (OR 1.04 (1.01-1.09); p=0.048).

Conclusion: Early AC therapy was not associated with reduced 90-day mortality in HIV-negative PcP patients. Although recommended in hypoxemic HIV-positive PcP patients, the benefit of this strategy in HIV-negative patients remains to be proven.

Keywords: Critical Care; Hypoxemia; Immunodeficiency; Pneumonia; Respiratory Infection.