Clinical Impact of Pneumothorax in Patients With Pneumocystis Jirovecii Pneumonia and Respiratory Failure in An HIV-Negative Cohort

Background: Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can result in development of pneumothorax during treatment. This study aimed to identify the incidence and related factors of pneumothorax in patients with PCP and acute respiratory failure and to analyze their prognosis. Methods: : We retrospectively reviewed the occurrence of pneumothorax, including clinical characteristics and results of other examinations, in 119 non-human immunodeficiency virus patients with PCP and respiratory failure requiring mechanical ventilator treatment in a medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019. Results: : The 28-day survival rate was 62.2% (N=74). Twenty-two patients (18.5%) developed pneumothorax during ventilator treatment, with 45 (37.8%) eventually requiring a tracheostomy due to weaning failure. Cytomegalovirus co-infection (odds ratio 13.9; p =0.013) was related with occurrence of pneumothorax. Of 74 patients with 28-day survival data, 15 (20.3%) developed pneumothorax. In those patients, five survived ( p =0.048) and only two were successfully weaned from mechanical ventilation ( p =0.037). Conclusions: : Patients with PCP and acute respiratory failure who developed pneumothorax did not have increased 28-day mortality, however pneumothorax increased in patient with cytomegalovirus co-infection, pneumothorax might have difficulty in and prolonged weaning from mechanical ventilators, which clinicians should be aware of when planning treatment for such patients.