{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T04:41:27Z","timestamp":1780375287571,"version":"3.54.1"},"reference-count":56,"publisher":"Harborside Press, LLC","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Immune-related adverse events (irAEs) often require treatment with high-dose systemic steroids (SS) and other immunosuppressive agents (ISAs). NCCN Guidelines recommend prophylactic antibiotics for <jats:italic>Pneumocystis jirovecii<\/jats:italic> pneumonia (PJP) for patients receiving prolonged SS\/ISAs. However, there is a paucity of evidence regarding the incidence of opportunistic infections (OIs) and non-OIs and the role of prophylactic antibiotics in patients on SS\/ISAs for irAEs. <jats:bold>Methods:<\/jats:bold> A retrospective analysis was conducted of patients treated using immune checkpoint inhibitor (ICI) therapy at 5 MedStar Health hospitals from January 2011 to April 2018. OIs were defined per the Infectious Diseases Society of America guidelines for the prevention and treatment of OIs in patients with HIV. The study cohort included patients who received \u226520 mg daily of a prednisone equivalent for \u22654 weeks to manage irAEs. <jats:bold>Results:<\/jats:bold> The study cohort identified 112 (15%) of 758 total patients treated using ICIs. Baseline characteristics included the following: median age was 64 years, 74% (n=82) of patients were White, 89% (n=100) had an ECOG performance status \u22641, 61% (n=68) had melanoma, 19% (n=21) had non\u2013small cell lung cancer, 45% (n=50) were treated using an anti\u2013PD-(L)1 ICI, and 33% (n=37) were treated using an anti\u2013PD-1\/anti\u2013CTLA-4 combination. The median starting SS dose was 100 mg of a prednisone equivalent, and 25% of patients required additional ISAs, with infliximab (n=15) and mycophenolate mofetil (n=9) being the most common. We found that 20% (n=22) of patients developed any infection, including 7% (n=8) with OIs (oral candidiasis [n=4], nondisseminated varicella zoster infection [n=2], PJP [n=1], and <jats:italic>Listeria monocytogenes<\/jats:italic> endophthalmitis [n=1]) and 13% (n=14) with non-OIs (most common: <jats:italic>Clostridium difficile<\/jats:italic> and pneumonia [n=5 each]). PJP prophylaxis with sulfamethoxazole\/trimethoprim was given to 13% (n=14) patients, of whom 43% (n=6) developed OIs\/non-OIs. <jats:bold>Conclusions:<\/jats:bold> Our study highlights the fundamental issues for patients on ICI therapy who require SS\/ISAs for irAEs: the degree of immunosuppression and the relative risk of OI. We noted a low incidence of OIs overall and breakthrough infections despite PJP prophylaxis. We question whether PJP prophylaxis is efficacious or necessary. Prospective trials are required to answer these questions.<\/jats:p>","DOI":"10.6004\/jnccn.2022.7020","type":"journal-article","created":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T19:39:40Z","timestamp":1657741180000},"page":"800-807.e1","source":"Crossref","is-referenced-by-count":29,"title":["The Risk of Opportunistic Infections and the Role of Antibiotic Prophylaxis in Patients on Checkpoint Inhibitors Requiring Steroids"],"prefix":"10.6004","volume":"20","author":[{"given":"Neil J.","family":"Shah","sequence":"first","affiliation":[{"name":"1Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Cook","sequence":"additional","affiliation":[{"name":"2Department of Medicine, MedStar Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianmin","family":"Wu","sequence":"additional","affiliation":[{"name":"3Department of Biostatistics, Bioinformatics and Biomathematics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaked","family":"Lev-Ari","sequence":"additional","affiliation":[{"name":"4Department of Oncology, Georgetown University Medical Center, Washington, DC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Blackburn","sequence":"additional","affiliation":[{"name":"2Department of Medicine, MedStar Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Serzan","sequence":"additional","affiliation":[{"name":"2Department of Medicine, MedStar Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC; 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