Ann Med. 2026 Dec;58(1):2677997. doi: 10.1080/07853890.2026.2677997. Epub 2026 Jun 5.
ABSTRACT
PURPOSE: Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening opportunistic infection. Recent studies have demonstrated a poor prognosis and higher mortality rate in non-human immunodeficiency virus (HIV) patients, with associated risk factors including cytomegalovirus (CMV) co-infection. We aimed to investigate the outcomes of concomitant PJP and CMV infection in non-HIV mechanically ventilated critically ill patients.
PATIENTS AND METHODS: We retrospectively enrolled adult patients admitted to an intensive care unit (ICU) and diagnosed with PJP infection from January 2017 to December 2022. Data were retrieved from the Chang Gung Research Database, including clinical manifestations, comorbidities and mortality.
RESULTS: A total of 132 adult patients without HIV infection received mechanical ventilation in the ICU, underwent bronchoalveolar lavage and diagnosed with PJP were enrolled, of whom 26 patients had concomitant CMV infection and 106 did not. The PJP and concomitant CMV infection group had a significantly lower PaO2/FiO2 ratio (73.5 vs. 95.6, p = 0.04) and higher procalcitonin level (2.2 ng/ml vs. 0.4 ng/ml, p = 0.004). While CMV co-infection was associated with higher ICU mortality in the univariate analysis (33.3% vs. 11.1%, p = 0.002), multivariate analysis revealed that systemic CMV co-infection was not an independent predictor of mortality. Instead, the extended model demonstrated that mortality was significantly associated with acute respiratory distress syndrome (ARDS) (HR 4.281, 95% CI:1.178-15.565, p = 0.027) and the duration of PJP treatment (HR: 0.892, 95% CI: 0.803-0.990, p = 0.006).
CONCLUSION: Concomitant CMV infection was about one-fifth in the non-HIV critically ill patients with PJP infection but does not independently increase mortality risk. Clinical management should prioritize early, sustained anti-pneumocystis therapy and lung-protective strategies for ARDS.
PMID:42247214 | DOI:10.1080/07853890.2026.2677997
