Comprehensive National Inpatient Sample data reveals low but rising Pneumocystis jiroveci pneumonia risk in inflammatory bowel disease patients

BACKGROUND: There are only limited data to guide the management of infectious risk for Pneumocystis jiroveci pneumonia (PCP) in patients with inflammatory bowel disease (IBD). We evaluated the frequency of admissions for PCP among patients with IBD, as well as the temporal trend in PCP admission rates and the contribution of non-IBD risk factors to the development of infection. METHODS: The National Inpatient Sample from 2016-2017 was queried for all admissions involving both PCP and either Crohn’s disease or ulcerative colitis. Inpatient outcomes associated with PCP and additive risk factors for development of PCP within the IBD patient population were assessed using multivariate regression. Linear regression was performed on data from 2002-2017 to measure infectious trends over time. RESULTS: There were an estimated 225 admissions involving PCP among patients with IBD from 2016-2017 nationwide, representing 0.035% of total admissions. IBD patients with PCP faced a 4.67-fold higher adjusted odds of inpatient mortality (95% confidence interval 1.72-12.66), while 49% of patients with IBD who developed PCP had an unrelated risk factor. The most common factors were HIV and congenital immunodeficiency, both of which were associated with PCP in adjusted regression. The infectious incidence of PCP increased by 141% from 2002 to 2017 (P=0.003). CONCLUSIONS: National admissions data indicate that significant PCP is rare in IBD patients. Routine PCP prophylaxis is probably not necessary, although further study of high-risk subgroups of patients is required. The rising incidence of PCP indicates a need for continued surveillance.