EMPIRICALLY TREATED PNEUMOCYSTIS-CARINII AND MIAMI - 1987-1990

Many patients infected with the human immunodeficiency virus (HIV) wit h symptoms suggestive of pneumonia are treated empirically for Pneumoc ystis carinii pneumonia (PCP), although other bacterial infections (e. g., tuberculosis) and pulmonary Kaposi's sarcoma may cause identical s ymptoms. Empiric treatment for PCP may result in misdiagnosis and mist reatment. When the outcomes of cytologically confirmed versus empirica lly treated PCP cases were evaluated, the most important predictors of in-hospital mortality were severity of illness and use of bronchoscop y. Persons who did not undergo bronchoscopy had higher mortality rates than patients negative by bronchoscopy or cytologically confirmed as positive for PCP (22% vs. 11% vs. 14%, P < .01), although severity of illness and timing of anti-PCP medications did not differ significantl y. Compared with cytologically confirmed cases persons who did not hav e bronchoscopy were more likely to die than were bronchoscopy-negative patients (P < .05), after adjusting for severity of illness. Bronchos copy use may have contributed to better outcomes for persons treated f or HIV-related PCP.