Sunita Mulpuru1, Greg Knoll2, Colleen Weir3, Marc Desjardins4, Daniel Johnson3, Ivan Gorn3, Todd Fairhead5, Janice Bissonnette3, Natalie Bruce3, Baldwin Toye4, Kathryn Suh6, Virginia Roth6. 1. The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: smulpuru@toh.on.ca. 2. The Ottawa Hospital, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Nephrology, Kidney Research Centre, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 3. The Ottawa Hospital, Ottawa, Ontario, Canada. 4. The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada. 5. The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Nephrology, Kidney Research Centre, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 6. The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: Pneumocystis pneumonia is a severe opportunistic fungal infection. Outbreaks among renal transplant recipients have been reported in Europe and Japan, but never in North America. METHODS: We conducted a retrospective case-control study among adult renal transplant recipients at a Canadian center, using a 3:1 matching scheme. Ten cases and 30 controls were matched based on initial transplantation date, and all patients received prophylaxis with trimethoprim-sulfamethoxazole for 1 year posttransplantation. RESULTS: The median time between transplantation and infection was 10.2 years, and all patients survived. Compared with controls, case patients had statistically lower estimated glomerular filtration rate (29.3 mL/min vs 66.3 mL/min; P = .028) and lymphopenia (0.51 × 10(9)/L vs 1.25 × 10(9)/L; P = .002). Transmission mapping revealed significant overlap in the clinic and laboratory visits among case vs control patients (P = .0002). One hundred percent of patients (4 out of 4) successfully genotyped had the same strain of Pneumocystis jirovecii. CONCLUSIONS: Our study demonstrated an outbreak of pneumocystis more than 10 years following initial transplantation, despite using recommended initial prophylaxis. We identified low estimated glomerular filtration rate and lymphopenia as risk factors for infection. Overlapping ambulatory care visits were identified as important potential sources of infection transmission, suggesting that institutions should re-evaluate policy and infrastructure strategies to interrupt transmission of respiratory pathogens.
BACKGROUND:Pneumocystis pneumonia is a severe opportunistic fungal infection. Outbreaks among renal transplant recipients have been reported in Europe and Japan, but never in North America. METHODS: We conducted a retrospective case-control study among adult renal transplant recipients at a Canadian center, using a 3:1 matching scheme. Ten cases and 30 controls were matched based on initial transplantation date, and all patients received prophylaxis with trimethoprim-sulfamethoxazole for 1 year posttransplantation. RESULTS: The median time between transplantation and infection was 10.2 years, and all patients survived. Compared with controls, case patients had statistically lower estimated glomerular filtration rate (29.3 mL/min vs 66.3 mL/min; P = .028) and lymphopenia (0.51 × 10(9)/L vs 1.25 × 10(9)/L; P = .002). Transmission mapping revealed significant overlap in the clinic and laboratory visits among case vs control patients (P = .0002). One hundred percent of patients (4 out of 4) successfully genotyped had the same strain of Pneumocystis jirovecii. CONCLUSIONS: Our study demonstrated an outbreak of pneumocystis more than 10 years following initial transplantation, despite using recommended initial prophylaxis. We identified low estimated glomerular filtration rate and lymphopenia as risk factors for infection. Overlapping ambulatory care visits were identified as important potential sources of infection transmission, suggesting that institutions should re-evaluate policy and infrastructure strategies to interrupt transmission of respiratory pathogens.
Authors: Marwan M Azar; Elizabeth Cohen; Liang Ma; Ousmane H Cissé; Geliang Gan; Yanhong Deng; Kristen Belfield; William Asch; Matthew Grant; Shana Gleeson; Alan Koff; David C Gaston; Jeffrey Topal; Shelly Curran; Sanjay Kulkarni; Joseph A Kovacs; Maricar Malinis Journal: Clin Infect Dis Date: 2022-03-01 Impact factor: 9.079
Authors: Andreas M J Meyer; Daniel Sidler; Cédric Hirzel; Hansjakob Furrer; Lukas Ebner; Alan A Peters; Andreas Christe; Uyen Huynh-Do; Laura N Walti; Spyridon Arampatzis Journal: J Fungi (Basel) Date: 2021-12-13