Introduction:

Despite major advances in diagnosis and management, Pneumocystis carinii pneumonia (PCP) is a severe complication of immunocompromised patients.

We analysed the outcome of patients with PCP with a positive bronchoalveolar lavage (BAL).

Patients and methods:

We retrospectively analysed the medical records of all patients with a positive BAL culture admitted to a tertiary intensive care department from January 1999 to September 2003. Demographic, clinical and microbiological data were collected.

Results:

In the study period, 22 patients had a PCP, confirmed by clinical, radiological and microbiological data. Five of these patients had an acquired immunodeficiency syndrome and 17 had a severe immunocompromised state. Twelve patients had severe respiratory failure with a paO₂/FiO₂ ratio <300 mmHg, and among them nine received invasive mechanical ventilation. The rest of the 13 patients were managed by non-invasive mechanical ventilation. The degree of severity as calculated by APACHE II score was 17.2 ± 5.4. The length of stay in the ICU was 8 (5–18) days. Three of the patients received prophylactic antibiotic therapy at the time the BAL was performed. Overall mortality rate was 36%, for intubated patients mortality was 55%, and for non-intubated patients 23% (P = 0.01). There was no significant difference in the ICU and in-hospital mortality between patients with a PCP associated with a HIV infection compared with other immunocompromised states (40% vs. 35% and 50% vs. 45%, respectively). Risk factors for death were the need of mechanical ventilation (P = 0.03) and prophylactic antibiotic therapy (P = 0.04).

Conclusions:

PCP is associated with high mortality rates in immunocompromised patients. Critically ill patients requiring invasive mechanical ventilation and prophylactic antibiotherapy have a worse outcome.