{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:36:02Z","timestamp":1786703762725,"version":"build-2736575974"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Carl Gustav Carus Dresden an der Technischen Universit\u00e4t Dresden"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Although pneumocystis jirovecii pneumonia (PJP) in non-HIV patients is increasingly recognized, comprehensive data on immunosuppressive drivers remain limited. We conducted a population-based cohort study using a German health insurance\u2019s claims data (2015\u20132023). PJP, comorbidities, immunocompromising conditions and therapies were identified by means of ICD-10-GM-, ATC- and OPS-coded records. 922,200 individuals were assessed for PJP occurrence, hospitalization and 30-day all-cause mortality. An Andersen-Gill model adjusted for key covariates. We identified 171 PJP episodes, with hospitalization in 88.3% and mortality in 24.5%. Frequent immunocompromising causes were hematologic cancers (42.6%), immunosuppressants (28.7%) and steroids (28.7%). Immunosuppression rather than typical CAP risk factors strongly predicted all outcomes (HR 49.9\u00a0[31.5\u201378.9]). Robust associations with PJP occurred for HIV (HR 67.5\u00a0[19.4\u2013235]), systemic steroids (&gt;\u200920\u00a0mg prednisone daily equivalent (HR 26.2\u00a0[13.2\u201352.1])) and hematologic cancers (HR 8.5\u00a0[4.5\u201316.3]). Mortality was driven by hematologic cancers (HR 13.9\u00a0[4.8\u201340.2]) and high-dose steroids (HR 8.6\u00a0[1.6\u201347.1]). Malignancy-related immunosuppression and steroids critically affect PJP risk and prognosis.<\/jats:p>","DOI":"10.1007\/s15010-026-02802-1","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T09:50:31Z","timestamp":1778061031000},"page":"2115-2119","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of cancer and immunosuppression in pneumocystis pneumonia: a large comprehensive population-based study"],"prefix":"10.1007","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7905-1060","authenticated-orcid":false,"given":"Fabian","family":"Reichel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8933-643X","authenticated-orcid":false,"given":"Falko","family":"Tesch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6806-3257","authenticated-orcid":false,"given":"Saskia","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Seifert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5609-4574","authenticated-orcid":false,"given":"Dirk","family":"Koschel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0264-0960","authenticated-orcid":false,"given":"Jochen","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6022-6827","authenticated-orcid":false,"given":"Martin","family":"Kolditz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"2802_CR1","doi-asserted-by":"publisher","unstructured":"Kolbrink B, Scheikholeslami-Sabzewari J, Borzikowsky C, et al. Evolving epidemiology of pneumocystis pneumonia: Findings from a longitudinal population-based study and a retrospective multi-center study in Germany. Lancet Reg Health - Europe. 2022;18. https:\/\/doi.org\/10.1016\/j.lanepe.2022.100400.","DOI":"10.1016\/j.lanepe.2022.100400"},{"issue":"7","key":"2802_CR2","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.3201\/EID2007.140087","volume":"20","author":"D Bitar","year":"2014","unstructured":"Bitar D, Lortholary O, Le Strat Y, et al. Population-Based Analysis of Invasive Fungal Infections, France, 2001\u20132010. Emerg Infect Dis. 2014;20(7):1149. https:\/\/doi.org\/10.3201\/EID2007.140087.","journal-title":"Emerg Infect Dis"},{"issue":"9","key":"2802_CR3","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1111\/MYC.12636","volume":"60","author":"RN Wickramasekaran","year":"2017","unstructured":"Wickramasekaran RN, Jewell MP, Sorvillo F, Kuo T. The changing trends and profile of pneumocystosis mortality in the United States, 1999\u20132014. Mycoses. 2017;60(9):607\u201315. https:\/\/doi.org\/10.1111\/MYC.12636.","journal-title":"Mycoses"},{"key":"2802_CR4","doi-asserted-by":"publisher","first-page":"275","DOI":"10.3389\/FPUBH.2019.00275","volume":"7","author":"E Pereira-D\u00edaz","year":"2019","unstructured":"Pereira-D\u00edaz E, Moreno-Verdejo F, de la Horra C, Guerrero JA, Calder\u00f3n EJ, Medrano FJ. Changing Trends in the Epidemiology and Risk Factors of Pneumocystis Pneumonia in Spain. Front Public Health. 2019;7:275. https:\/\/doi.org\/10.3389\/FPUBH.2019.00275.","journal-title":"Front Public Health"},{"issue":"3","key":"2802_CR5","doi-asserted-by":"publisher","first-page":"386","DOI":"10.3201\/EID1903.121151","volume":"19","author":"R Maini","year":"2013","unstructured":"Maini R, Henderson KL, Sheridan EA, et al. Increasing Pneumocystis Pneumonia, England, UK, 2000\u20132010. Emerg Infect Dis. 2013;19(3):386. https:\/\/doi.org\/10.3201\/EID1903.121151.","journal-title":"Emerg Infect Dis"},{"key":"2802_CR6","doi-asserted-by":"publisher","unstructured":"Reichel F, Tesch F, Berger S, et al. Epidemiology and risk factors of community-acquired pneumonia in patients with different causes of immunosuppression. Infection Published online June. 2024;27. https:\/\/doi.org\/10.1007\/S15010-024-02314-W.","DOI":"10.1007\/S15010-024-02314-W"},{"issue":"6","key":"2802_CR7","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.1016\/j.chest.2024.01.015","volume":"165","author":"R L\u00e9cuyer","year":"2024","unstructured":"L\u00e9cuyer R, Gousseff M, Crabol Y, et al. Characteristics and prognosis factors of pneumocystis jirovecii pneumonia according to underlying disease: a retrospective multicenter study. Chest. 2024;165(6):1319\u201329. https:\/\/doi.org\/10.1016\/j.chest.2024.01.015.","journal-title":"Chest"},{"issue":"2","key":"2802_CR8","doi-asserted-by":"publisher","first-page":"e0292507","DOI":"10.1371\/JOURNAL.PONE.0292507","volume":"19","author":"K Miyake","year":"2024","unstructured":"Miyake K, Senoo S, Shiiba R, et al. Pneumocystis jirovecii pneumonia mortality risk associated with preceding long-term steroid use for the underlying disease: a multicenter, retrospective cohort study. PLoS ONE. 2024;19(2):e0292507. https:\/\/doi.org\/10.1371\/JOURNAL.PONE.0292507.","journal-title":"PLoS ONE"},{"issue":"6","key":"2802_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/S11926-017-0664-6\/TABLES\/3","volume":"19","author":"RM Wolfe","year":"2017","unstructured":"Wolfe RM, Peacock JE. Pneumocystis Pneumonia and the Rheumatologist: Which Patients Are At Risk and How Can PCP Be Prevented? Curr Rheumatol Rep. 2017;19(6):1\u201310. https:\/\/doi.org\/10.1007\/S11926-017-0664-6\/TABLES\/3.","journal-title":"Curr Rheumatol Rep"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02802-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-026-02802-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02802-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T10:09:59Z","timestamp":1786702199000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-026-02802-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":9,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["2802"],"URL":"https:\/\/doi.org\/10.1007\/s15010-026-02802-1","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,6]]},"assertion":[{"value":"23 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"FR reports payments or honoraria for lectures from AstraZeneca and travel grants by AstraZeneca and Boehringer Ingelheim; not associated with the submitted work. DK reports payments or honoraria for lectures from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, GSK, Novartis, Pfizer, Roche and Sanofi as well as participation in advisory boards for AstraZeneca, Boehringer Ingelheim, GSK and Sanofi; all of which are outside of the submitted work. Unrelated to the submitted work, JS reports institutional grants for investigator-initiated research from the German Federal Joint Committee, the German Ministry of Health, the German Ministry of Research, the European Union, the German Federal State of Saxony, Novartis, Sanofi, ALK and Pfizer. He participated in advisory board meetings as a paid consultant for Sanofi, Lilly and ALK; all of which are outside of the submitted work. MK reports research grants from Pfizer, payments or honoraria for lectures from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Gilead, GSK, Insmed, and Pfizer and participation in advisory boards for AstraZeneca, Gilead, GSK, Insmed and MSD; all of which are outside of the submitted work. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial or nonfinancial interest in the subject matter or materials discussed in this manuscript.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No artificial intelligence was used for the creation of this article.","order":2,"name":"Ethics","label":"Artificial intelligence involvement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Data of this study were retrieved from statutory health insurance AOK PLUS. As solely the insurance\u2019s claims data were retrospectively used, written consent from patients was not required. The analysis was approved by the Saxon State Ministry for Social Affairs and the ethics committee of TUD Dresden University of Technology (EK143052018).","order":3,"name":"Ethics","label":"Human Ethics and Consent to Participate declarations","group":{"name":"EthicsHeading","label":"Declarations"}}]}}