P152 Pneumocystis jiroveci pneumonia prophylaxis in patients treated with mycophenolate mofetil for interstitial lung disease

BackgroundIncidence of Pneumocystis jirovecii Pneumonia (PJP) among immunosuppressed individuals who are HIV-negative is rising in the UK.1 There is a lack of evidence for whether patients with interstitial lung disease (ILD) treated with mycophenolate mofetil (MMF) benefit from PJP prophylaxis. This may increase variability in clinical practice between centres or clinicians. If PJP prophylaxis isn’t supported by the evidence, this may represent unnecessary use of antibiotics.AimsTo identify whether ILD patients treated with MMF were less likely to develop PJP or require antibiotics for lower respiratory tract infection (LRTI) while on PJP prophylaxis.MethodsWe performed a retrospective audit of patients at The Newcastle upon Tyne Hospitals NHS Foundation Trust who were treated with MMF for ILD. We recorded the proportion of patients given prophylaxis, the agents used, and the incidence of PJP and LRTI requiring antibiotics (including GP records) in this cohort.ResultsData was collected on 105 patients who were currently prescribed MMF or had been in the past 5 years. 75/105 (71.4%) were female and the median age was 68 years old. Median treatment length with MMF was 21 months. The majority of patients were diagnosed with chronic hypersensitivity pneumonitis (57.1%) or connective tissue disease-related ILD (16.2%). 36/105 (34.3%) were prescribed prophylaxis with co-trimoxazole, azithromycin or dapsone throughout the period studied, while 6/105 (5.7%) were prescribed prophylaxis for some but not all of the time that MMF was prescribed.No patients in the cohort developed PJP while prescribed MMF regardless of prophylaxis use. Significantly more patients (18/42 [42.9%]) received antibiotics for LRTI while prescribed PJP prophylaxis compared to those not concurrently prescribed prophylaxis (14/69 [20.3%], p = 0.011, χ2 test).ConclusionResults from this cohort suggest that PJP infection in patients prescribed MMF for ILD is relatively uncommon regardless of prophylaxis use. There may be an increase in the incidence of LRTIs with PJP prophylaxis, although further study is required to determine this and the value of PJP prophylaxis in this patient group.ReferenceMaini R, et al. Increasing pneumocystis pneumonia, England, UK, 2000–2010. Emerging Infectious Diseases, 2013;19(3):386–392.