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An outbreak of Pneumocytis jirovecii pneumonia among liver transplant recipients.
- Source :
-
Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2018 Oct; Vol. 20 (5), pp. e12956. Date of Electronic Publication: 2018 Jul 02. - Publication Year :
- 2018
-
Abstract
- Background: An outbreak of Pneumocystis pneumonia (PCP) in liver transplant recipients occurred between 2009 and 2011 at the Beaujon University Hospital just after immediate-release tacrolimus was replaced by extended-release tacrolimus. We conducted a retrospective study to analyze the transmission mode of Pneumocystis, the role of the change in the immunosuppressive regimen, and the factors associated with PCP.<br />Patients and Methods: To analyze transmission, we built a transmission map. Two control groups were built. First, to assess the role of the change from tacIR to tacER, cases were matched to controls transplanted before 2009 (tacIR control group). Tacrolimus trough concentrations were compared between the 2 groups. Then, to assess factors associated with PCP, each PCP case was matched to 2 control patients: the one transplanted just before and the one just after (PCPAsFact control group). No PCP prophylaxis was given to any patient.<br />Results: Fifteen cases of PCP were recorded. A contact between a case and a patient who developed PCP afterward was identified in 4 occasions. The comparison of tacrolimus trough concentrations did not conclude to a difference in the exposure to the drug. Lymphopenia was the only factor independently associated with the occurrence of PCP (odds ratio 0.78, 95% confidence interval 0.61-0.99, P = .04).<br />Conclusion: Our results suggest that patient-to-patient transmission was not the main mode of transmission of PCP. We found no evidence that the switch from tacIR to tacER led to an overexposure to tacrolimus. Our results suggest the possibility of targeted prophylaxis in immunosuppressed liver transplant recipients.<br /> (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Subjects :
- Anti-Bacterial Agents therapeutic use
Antibiotic Prophylaxis methods
Female
France epidemiology
Humans
Immunocompromised Host
Immunosuppressive Agents adverse effects
Male
Middle Aged
Opportunistic Infections drug therapy
Opportunistic Infections immunology
Opportunistic Infections microbiology
Pneumocystis carinii pathogenicity
Pneumonia, Pneumocystis drug therapy
Pneumonia, Pneumocystis microbiology
Pneumonia, Pneumocystis transmission
Retrospective Studies
Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use
Disease Outbreaks prevention & control
Liver Transplantation adverse effects
Opportunistic Infections epidemiology
Pneumocystis carinii isolation & purification
Pneumonia, Pneumocystis epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1399-3062
- Volume :
- 20
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Transplant infectious disease : an official journal of the Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 29896781
- Full Text :
- https://doi.org/10.1111/tid.12956