Mulpuru Sunita, Knoll Greg, Weir Colleen, Desjardins Marc, Johnson Daniel, Gorn Ivan, Fairhead Todd, Bissonnette Janice, Bruce Natalie, Toye Baldwin, Suh Kathryn, Roth Virginia
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.
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.
Am J Infect Control. 2016 Apr 1;44(4):425-31. doi: 10.1016/j.ajic.2015.11.012. Epub 2016 Jan 21.
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.
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.
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.
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.
肺孢子菌肺炎是一种严重的机会性真菌感染。欧洲和日本曾报道过肾移植受者中出现疫情，但北美从未有过此类报道。
我们在加拿大一家中心对成年肾移植受者进行了一项回顾性病例对照研究，采用3:1匹配方案。根据初次移植日期匹配了10例病例和30例对照，所有患者在移植后均接受了1年的甲氧苄啶-磺胺甲恶唑预防治疗。
移植与感染之间的中位时间为10.2年，所有患者均存活。与对照组相比，病例组患者的估计肾小球滤过率在统计学上较低（29.3毫升/分钟对66.3毫升/分钟；P = 0.028），且淋巴细胞减少（0.51×10⁹/L对1.25×10⁹/L；P = 0.002）。传播图谱显示病例组与对照组患者在门诊和实验室就诊方面有显著重叠（P = 0.0002）。成功进行基因分型的患者（4例中的4例）100%感染的是同一种耶氏肺孢子菌菌株。
我们的研究表明，尽管使用了推荐的初始预防措施，但在初次移植10多年后仍爆发了肺孢子菌感染。我们确定低估计肾小球滤过率和淋巴细胞减少是感染的危险因素。门诊就诊重叠被确定为感染传播的重要潜在来源，这表明机构应重新评估政策和基础设施策略以阻断呼吸道病原体的传播。
