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The 2025 EQUAL Pneumocystis Score—an ECMM tool to measure QUALity in Pneumocystis pneumonia management

Summary

Pneumocystis pneumonia is a serious lung infection that affects people with weakened immune systems, including those with HIV and transplant patients. Doctors use different guidelines to diagnose and treat this infection, but these guidelines are complex and can be hard to follow consistently. Researchers created a new scoring system called the EQUAL Pneumocystis Score that helps doctors follow the best treatment recommendations by assigning points for different diagnostic tests, medications, and follow-up strategies.

Background

Pneumocystis pneumonia (PCP) is an opportunistic fungal infection caused by Pneumocystis jirovecii affecting immunocompromised patients including those with HIV and non-HIV populations. While several clinical guidelines exist for PCP management from ECIL, AST-IDCOP, and IDSA, their complexity creates challenges for consistent implementation in routine clinical practice.

Objective

To develop a scoring tool and quality indicator that facilitates clinical decision-making and quantifies adherence to best-practice guidelines for PCP management in both HIV and non-HIV patients.

Results

The 2025 EQUAL Pneumocystis Score consists of 24 items for HIV patients and 22 for non-HIV patients, with maximum scores of 31 and 27 respectively. Bronchoalveolar lavage and immunofluorescence assays received highest scores for diagnosis, trimethoprim/sulfamethoxazole was awarded highest score for treatment, with corticosteroids recommended for HIV patients with respiratory failure.

Conclusion

The 2025 EQUAL Pneumocystis Score provides a concise, evidence-based tool for optimal PCP management that can support clinical decision-making in daily practice and measure guideline adherence in research settings, though validation in patient cohorts remains an essential next step.
  • Published in:JAC Antimicrobial Resistance,
  • Study Type:Guideline Development and Scoring Tool Development,
  • Source: PMID: 41030672, DOI: 10.1093/jacamr/dlaf165
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