LUBEM EA 3882, IFR 148, University of Brest, Brest, France.
Clin Infect Dis. 2012 Apr;54(7):e62-71. doi: 10.1093/cid/cir996. Epub 2012 Feb 14.
Eighteen renal transplant recipients (RTRs) developed Pneumocystis jirovecii infections at the renal transplantation unit of Brest University Hospital (Brest, Brittany, France) from May 2008 through April 2010, whereas no cases of P. jirovecii infection had been diagnosed in this unit since 2002. This outbreak was investigated by identifying P. jirovecii types and analyzing patient encounters.
The identification of P. jirovecii internal transcribed spacer (ITS) types was performed on P. jirovecii isolates from the 18 RTRs (12 patients with Pneumocystis pneumonia [PCP], 6 colonized patients), 22 unlinked control patients (18 patients with PCP, 4 colonized patients), and 69 patients (34 patients with PCP, 35 colonized patients) with contemporaneously diagnosed P. jirovecii infections in the Brest geographic area. A transmission map was drawn up. Its analysis was combined with the results of P. jirovecii typing.
P. jirovecii ITS type identification was successful in 14 of 18 RTRs, 15 of 22 control patients, and 48 of the 69 patients. Type Eg was the most frequent type in the 3 patient groups. However, its frequency was significantly higher in the first patient group than in the 2 other groups (P < .05 and P < .01, respectively). Fourteen encounters between RTRs who harbored an identical type were observed. Ten patients were considered as possible index patients, of whom 3 were colonized by the fungus, and 7 presented PCP.
The results provide to our knowledge the first data on the role of colonized patients as potential sources of P. jirovecii in a context of nosocomial acquisition of the fungus.
2008 年 5 月至 2010 年 4 月，法国布列塔尼大区布雷斯特大学医院（Brest University Hospital）的肾脏移植病房（renal transplantation unit）共有 18 例肾移植受者（RTR）发生肺孢子菌感染，而自 2002 年以来，该病房并未诊断出肺孢子菌感染病例。该暴发疫情通过鉴定肺孢子菌类型和分析患者接触情况进行了调查。
对 18 例 RTR（12 例肺孢子菌肺炎[PCP]患者，6 例定植患者）、22 例无关联对照患者（18 例 PCP 患者，4 例定植患者）和 69 例同期在布列塔尼地区诊断为肺孢子菌感染的患者（34 例 PCP 患者，35 例定植患者）的肺孢子菌内部转录间隔区（ITS）类型进行鉴定。绘制了传播图，并结合肺孢子菌分型结果进行了分析。
18 例 RTR、22 例对照患者和 69 例患者中的 14 例成功鉴定了肺孢子菌 ITS 类型。在这 3 组患者中，Eg 型最常见。然而，在第一组患者中，其频率明显高于后两组（分别为 P<0.05 和 P<0.01）。观察到 14 例携带相同类型的 RTR 之间的接触。10 例患者被认为是可能的感染源，其中 3 例为定植患者，7 例为 PCP 患者。
这些结果提供了我们所知的关于定植患者作为医院获得性真菌潜在来源的第一份数据。
