Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in non-human immunodeficiency virus-infected patients: Retrospective study of 31 patients

The aim of this retrospective study was to assess whether corticosteroid ad junctive therapy (CAT) could prevent death in immunocompromised patients wi th severe Pneumocystis carinii pneumonia (PCP) who do not have human immuno deficiency virus (HIV) infection, similarly to what has been demonstrated f or HIV-infected patients. The charts of all non-HIV-infected patients who w ere admitted to two medical intensive care units between 1988 and 1996 beca use of severe PCP, defined by an arterial oxygen pressure (determined while the patient was breathing room air) of <70 mm Hg, and who were treated wit h trimethoprim-sulfamethoxazole were analyzed retrospectively. Thirty-one p atients met the study criteria, of whom 23 received CAT (within 72 hours of antibiotic therapy) and eight did not receive CAT. The need for mechanical ventilation (10 [43%] of 23 vs. 4 [50%] of 8) and the mortality rate (9 [3 9%] of 23 vs. 4 [50%] of 8) were similar for the two groups. Although this small study does not have a statistical power high enough to rule out the p ossibility of a difference, the results suggest that CAT does not improve t he survival of non-HIV-infected patients as has been described for HIV-infe cted patients with severe PCP.