Pneumocystis jirovecii pneumonia is rare in renal transplant recipients receiving only one month of prophylaxis

被引:20
作者
Anand, S.
Samaniego, M. [2 ]
Kaul, D. R. [1 ]
机构
[1] Univ Michigan, Med Ctr, Div Infect Dis, Dept Internal Med,Med Sch, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Div Nephrol, Dept Internal Med, Sch Med, Ann Arbor, MI 48109 USA
关键词
Pneumocystis jirovecii pneumonia; PCP; Nocardia; renal transplantation; trimethoprim-sulfamethoxazole; MYCOPHENOLATE-MOFETIL; ACUTE REJECTION; RISK-FACTORS; INTERHUMAN TRANSMISSION; MOLECULAR EVIDENCE; CARINII-PNEUMONIA; INFECTION; PREVENTION; OUTBREAK; NOCARDIA;
D O I
10.1111/j.1399-3062.2011.00692.x
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Prophylaxis against Pneumocystis jirovecii pneumonia (PCP) is recommended for at least 412months after solid organ transplant. In our center, renal transplant recipients receive only 1month of post-transplant trimethoprimsulfamethoxazole, which also may provide limited protection against Nocardia. We identified only 4 PCP cases and 4 Nocardia cases in 1352 patients receiving renal and renal-pancreas transplant from 2003 to 2009 at the University of Michigan Health System. Two PCP cases were identified <1year after transplant, and 2 PCP cases were identified >1year after transplant (gross attack rate 4/1352, 0.3%). Two Nocardia cases were identified <1year after transplant, and 2 cases were identified >1year after transplant. All identified cases received induction therapy (7 of 8 with anti-thymocyte globulin), whereas about one-half of all renal transplant patients received induction therapy at our institution. No patient was treated for rejection within 6months of PCP; 2 of 4 patients with PCP had recent cytomegalovirus infection. All patients with PCP and 3 of 4 patients with Nocardia survived. The benefits of prolonged PCP prophylaxis should be weighed against the adverse events associated with prolonged use of antimicrobials.
引用
收藏
页码:570 / 574
页数:5
相关论文
共 24 条
[1]   Rejection treatment and cytomegalovirus infection as risk factors for Pneumocystis carinii pneumonia in renal transplant recipients [J].
Arend, SM ;
Westendorp, RGJ ;
Kroon, FP ;
vantWout, JW ;
Vandenbroucke, JP ;
vanEs, LA ;
vanderWoude, FJ .
CLINICAL INFECTIOUS DISEASES, 1996, 22 (06) :920-925
[2]   Infectious disease prophylaxis in renal transplant patients: a survey of US transplant centers [J].
Batiuk, TD ;
Bodziak, KA ;
Goldman, M .
CLINICAL TRANSPLANTATION, 2002, 16 (01) :1-8
[3]   Pneumocystis Infection: Seeing beyond the Tip of the Iceberg [J].
Calderon, Enrique J. .
CLINICAL INFECTIOUS DISEASES, 2010, 50 (03) :354-356
[4]   Nocardia in Solid Organ Transplant Recipients [J].
Clark, N. M. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2009, 9 :S70-S77
[5]   An outbreak of Pneumocystis jiroveci pneumonia with 1 predominant genotype among renal transplant recipients:: Interhuman transmission or a common environmental source? [J].
de Boer, Mark G. J. ;
van Coppenraet, Lesla E. S. Bruijnesteijn ;
Gaasbeek, Andre ;
Berger, Stefan P. ;
Gelinck, Luc B. S. ;
van Houwelingen, Hans C. ;
van den Broek, Peterhans ;
Kuijper, Ed J. ;
Kroon, Frank P. ;
Vandenbroucke, Jan P. .
CLINICAL INFECTIOUS DISEASES, 2007, 44 (09) :1143-1149
[6]  
EBPG Expert Group on Renal Transplantation, 2002, Nephrol Dial Transplant, V17 Suppl 4, P36
[7]   Prevention of infection caused by Pneumocystis carinii in transplant recipients [J].
Fishman, JA .
CLINICAL INFECTIOUS DISEASES, 2001, 33 (08) :1397-1405
[8]   A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND-STUDY OF TRIMETHOPRIM-SULFAMETHOXAZOLE FOR PROPHYLAXIS OF INFECTION IN RENAL-TRANSPLANTATION - CLINICAL EFFICACY, ABSORPTION OF TRIMETHOPRIM-SULFAMETHOXAZOLE, EFFECTS ON THE MICROFLORA, AND THE COST-BENEFIT OF PROPHYLAXIS [J].
FOX, BC ;
SOLLINGER, HW ;
BELZER, FO ;
MAKI, DG .
AMERICAN JOURNAL OF MEDICINE, 1990, 89 (03) :255-274
[9]   Molecular evidence of interhuman transmission in an outbreak of Pneumocystis jirovecii pneumonia among renal transplant recipients [J].
Gianella, S. ;
Haeberli, L. ;
Joos, B. ;
Ledergerber, B. ;
Wuethrich, R. P. ;
Weber, R. ;
Kuster, H. ;
Hauser, P. M. ;
Fehr, T. ;
Mueller, N. J. .
TRANSPLANT INFECTIOUS DISEASE, 2010, 12 (01) :1-10
[10]   Should prophylaxis for Pneumocystis carinii pneumonia in solid organ transplant recipients ever be discontinued? [J].
Gordon, SM ;
LaRosa, SP ;
Kalmadi, S ;
Arroliga, AC ;
Avery, RK ;
Truesdell-LaRosa, L ;
Longworth, DL .
CLINICAL INFECTIOUS DISEASES, 1999, 28 (02) :240-246