Practice Patterns of Pneumocystis Pneumonia Prophylaxis in Connective Tissue Diseases: A Survey of Infectious Disease Physicians

Rachel M. Wolfe, Susan E. Beekmann, Philip M. Polgreen, Kevin L. Winthrop, James E. Peacock

Research output: Contribution to journalArticle

Abstract

Background: Immunosuppressive therapy for connective tissue diseases (CTDs) increases risk for opportunistic infections including Pneumocystis pneumonia (PCP). High mortality rates are reported in CTD patients with PCP, which suggests a potential need for prophylaxis, but indications remain poorly defined. Wide variations in the use of PCP prophylaxis among rheumatologists have been documented. This study evaluated PCP prophylaxis patterns for CTD patients among infectious disease (ID) physicians. Methods: An electronic survey was emailed to 1264 adult ID physicians who are members of the Infectious Diseases Society of America Emerging Infections Network. Results: Six hundred thirty-one physicians responded to the survey. Respondents to the survey were more likely to work in academics (P =. 02) and be early (<5 years) or late (≥25 years) in their careers (P =. 0002). Forty-three percent (n = 269) made no recommendations for PCP prophylaxis in non-HIV patients. Of the 362 respondents who did make such recommendations, the greatest consensus for disease-based prophylaxis was for granulomatosis with polyangiitis (53%). For therapy-based prophylaxis, corticosteroids ≥20 mg/d was the most frequently cited indication (87%). Surrogate laboratory markers to aid in decisions about prophylaxis were not routinely used (21%). Although the majority recommended discontinuation of PCP prophylaxis with tapering of corticosteroids (65%), there was variability in the specific dose. Eighty-nine percent of respondents felt that guidelines about PCP prophylaxis would be helpful. Conclusions: There is little consensus about PCP prophylaxis in CTDs among ID physicians. Guidelines for PCP prophylaxis would be helpful when caring for these complex patients.

Original languageEnglish (US)
Article numberofz315
JournalOpen Forum Infectious Diseases
Volume6
Issue number9
DOIs
StatePublished - Oct 5 2019

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Pneumocystis Pneumonia
Connective Tissue Diseases
Communicable Diseases
Physicians
Consensus
Adrenal Cortex Hormones
Biomarkers
Guidelines
Surveys and Questionnaires
Granulomatosis with Polyangiitis
Decision Support Techniques
Opportunistic Infections
Immunosuppressive Agents
Mortality

Keywords

  • connective tissue diseases
  • PCP
  • Pneumocystis pneumonia
  • prophylaxis
  • rheumatologic disorders

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Practice Patterns of Pneumocystis Pneumonia Prophylaxis in Connective Tissue Diseases : A Survey of Infectious Disease Physicians. / Wolfe, Rachel M.; Beekmann, Susan E.; Polgreen, Philip M.; Winthrop, Kevin L.; Peacock, James E.

In: Open Forum Infectious Diseases, Vol. 6, No. 9, ofz315, 05.10.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Immunosuppressive therapy for connective tissue diseases (CTDs) increases risk for opportunistic infections including Pneumocystis pneumonia (PCP). High mortality rates are reported in CTD patients with PCP, which suggests a potential need for prophylaxis, but indications remain poorly defined. Wide variations in the use of PCP prophylaxis among rheumatologists have been documented. This study evaluated PCP prophylaxis patterns for CTD patients among infectious disease (ID) physicians. Methods: An electronic survey was emailed to 1264 adult ID physicians who are members of the Infectious Diseases Society of America Emerging Infections Network. Results: Six hundred thirty-one physicians responded to the survey. Respondents to the survey were more likely to work in academics (P =. 02) and be early (<5 years) or late (≥25 years) in their careers (P =. 0002). Forty-three percent (n = 269) made no recommendations for PCP prophylaxis in non-HIV patients. Of the 362 respondents who did make such recommendations, the greatest consensus for disease-based prophylaxis was for granulomatosis with polyangiitis (53{\%}). For therapy-based prophylaxis, corticosteroids ≥20 mg/d was the most frequently cited indication (87{\%}). Surrogate laboratory markers to aid in decisions about prophylaxis were not routinely used (21{\%}). Although the majority recommended discontinuation of PCP prophylaxis with tapering of corticosteroids (65{\%}), there was variability in the specific dose. Eighty-nine percent of respondents felt that guidelines about PCP prophylaxis would be helpful. Conclusions: There is little consensus about PCP prophylaxis in CTDs among ID physicians. Guidelines for PCP prophylaxis would be helpful when caring for these complex patients.",
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