Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort.
Details
State: Public
Version: Author's accepted manuscript
License: All rights reserved
Serval ID
serval:BIB_B857EB67958D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Pneumocystis jirovecii pneumonia in solid organ transplant recipients: a descriptive analysis for the Swiss Transplant Cohort.
Journal
Transplant infectious disease
Working group(s)
Swiss Transplant Cohort Study
Contributor(s)
Amico P., Aubert J.D., Banz V., Beldi G., Benden C., Berger C., Binet I., Bochud P.Y., Boëly E., Bucher H., Carell T., Catana E., Chalandon Y., de Geest S., de Rougemont O., Dickenmann M., Duchosal M., Elkrief L., Fehr T., Ferrari-Lacraz S., Garzoni C., Soccal P.G., Gaudet C., Giostra E., Golshayan D., Hadaya K., Halter J., Heim D., Hess C., Hillinger S., Hirsch H.H., Hofbauer G., Huynh-Do U., Immer F., Klaghofer R., Koller M., Laesser B., Lehmann R., Lovis C., Majno P., Marti H.P., Martin P.Y., Meylan P., Mohacsi P., Morel P., Mueller U., Mueller-McKenna H., Müller A., Müller T., Müllhaupt B., Pascual M., Passweg J., Posfay-Barbe K., Rick J., Roosnek E., Rosselet A., Rothlin S., Ruschitzka F., Schanz U., Schaub S., Schnyder A., Seiler C., Sprachta J., Stampf S., Steiger J., Stirnimann G., Toso C., Venetz J.P., Villard J., Wick M., Wilhelm M., Yerly P.
ISSN
1399-3062 (Electronic)
ISSN-L
1398-2273
Publication state
Published
Issued date
12/2018
Peer-reviewed
Oui
Volume
20
Number
6
Pages
e12984
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
Descriptive data on Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients (SOTr) in the era of routine Pneumocystis-prophylaxis are lacking.
All adult SOTr between 2008 and 2016 were included. PJP was diagnosed based on consensus guidelines. Early-onset PJP was defined as PJP within the first-year-post-transplant.
41/2842 SOTr (1.4%) developed PJP (incidence rate: 0.01/1000 person-days) at a mean of 493-days post-transplant: 21 (51.2%) early vs 20 (48.8%) late-onset PJP. 2465 (86.7%) SOTr received Pneumocystis-prophylaxis for a mean 316 days. PJP incidence was 0.001% and 0.003% (log-rank < 0.001) in SOTr with and without Pneumocystis-prophylaxis, respectively. PJP was an early event in 10/12 (83.3%) SOTr who did not receive Pneumocystis-prophylaxis and developed PJP, compared to those patients who received prophylaxis (11/29, 37.9%; P-value: 0.008). Among late-onset PJP patients, most cases (13/20, 65%) were observed during the 2nd year post-transplant. Age ≥65 years (OR: 2.4, P-value: 0.03) and CMV infection during the first 6 months post-SOT (OR: 2.5, P-value: 0.006) were significant PJP predictors, while Pneumocystis-prophylaxis was protective for PJP (OR: 0.3, P-value: 0.006) in the overall population. Most patients (35, 85.4%) were treated with trimethoprim-sulfamethoxazole for a mean 20.6 days. 1-year mortality was 14.6%.
In the Pneumocystis-prophylaxis-era, PJP remains a rare post-transplant complication. Most cases occurred post-PJP-prophylaxis-discontinuation, particularly during the second-year-post-transplant. Additional research may help identify indications for Pneumocystis-prophylaxis prolongation.
All adult SOTr between 2008 and 2016 were included. PJP was diagnosed based on consensus guidelines. Early-onset PJP was defined as PJP within the first-year-post-transplant.
41/2842 SOTr (1.4%) developed PJP (incidence rate: 0.01/1000 person-days) at a mean of 493-days post-transplant: 21 (51.2%) early vs 20 (48.8%) late-onset PJP. 2465 (86.7%) SOTr received Pneumocystis-prophylaxis for a mean 316 days. PJP incidence was 0.001% and 0.003% (log-rank < 0.001) in SOTr with and without Pneumocystis-prophylaxis, respectively. PJP was an early event in 10/12 (83.3%) SOTr who did not receive Pneumocystis-prophylaxis and developed PJP, compared to those patients who received prophylaxis (11/29, 37.9%; P-value: 0.008). Among late-onset PJP patients, most cases (13/20, 65%) were observed during the 2nd year post-transplant. Age ≥65 years (OR: 2.4, P-value: 0.03) and CMV infection during the first 6 months post-SOT (OR: 2.5, P-value: 0.006) were significant PJP predictors, while Pneumocystis-prophylaxis was protective for PJP (OR: 0.3, P-value: 0.006) in the overall population. Most patients (35, 85.4%) were treated with trimethoprim-sulfamethoxazole for a mean 20.6 days. 1-year mortality was 14.6%.
In the Pneumocystis-prophylaxis-era, PJP remains a rare post-transplant complication. Most cases occurred post-PJP-prophylaxis-discontinuation, particularly during the second-year-post-transplant. Additional research may help identify indications for Pneumocystis-prophylaxis prolongation.
Keywords
Adult, Aged, Anti-Bacterial Agents/therapeutic use, Antibiotic Prophylaxis/methods, Antibiotic Prophylaxis/standards, Female, Humans, Incidence, Male, Middle Aged, Mortality, Organ Transplantation/adverse effects, Pneumocystis carinii/isolation & purification, Pneumonia, Pneumocystis/drug therapy, Pneumonia, Pneumocystis/epidemiology, Pneumonia, Pneumocystis/microbiology, Pneumonia, Pneumocystis/prevention & control, Practice Guidelines as Topic, Prospective Studies, Switzerland/epidemiology, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use, Young Adult, Epidemiology, Pneumocystis jirovecii pneumonia, Solid organ transplant recipients
Pubmed
Web of science
Create date
03/09/2018 13:05
Last modification date
27/01/2024 7:36
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