1665. Opportunistic Infections in Solid Organ Transplant Patients on Minimally-Dosed Sulfamethoxazole-Trimethoprim Prophylaxis
Session: Poster Abstract Session: Pre-emptive Therapy in Transplantation and Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Opportunistic infections (OIs), such as Pneumocystis jiroveci pneumonia (PJP) and nocardiosis, were a significant source of morbidity and mortality in post-transplant patients prior to anti-infective prophylaxis regimens. Based on anecdotal evidence, a preliminary evaluation at our institution identified an increased incidence of nocardiosis in abdominal transplant recipients. As a result, the prophylaxis protocol for OIs in abdominal organ transplant recipients was changed from sulfamethoxazole-trimethoprim (SMX-TMP) single-strength (SS) twice-weekly (BIW) to once daily for one year. Reported SMX-TMP regimens for PJP prophylaxis range from SS to double strength tablets taken daily to three times-a-week. However, there is little literature available regarding the efficacy of SS BIW regimens. The purpose of this study is to assess the prevalence of PJP and nocardiosis in abdominal organ transplant recipients treated with SMX-TMP SS BIW.

Methods: This was a retrospective, single-center, cohort study evaluating the prevalence of OIs in adults undergoing liver, kidney, pancreas, or any multi-organ abdominal transplant between 12/05 and 03/11. Adult patients were included if they had SMX-TMP SS BIW documented within a month of discharge and one-year follow-up or death within a year. The primary outcome was the prevalence of PJP and nocardiosis on SMX-TMP SS BIW. Secondary outcomes stratified the prevalence rates based on organ transplanted.

Results: 781 transplant cases were included. No cases of PJP were found. Six cases of nocardiosis (0.77% prevalence) were reported on this regimen: one liver (0.32%), two kidney (0.52%), and three pancreas (8.3%) transplant recipients. Notably, all pancreas transplant OIs were in pancreas-after-kidney (PAK) transplants, which corresponded to 14.3% of all PAK transplants.

Conclusion: Our data suggest that SMX-TMP SS BIW may provide effective prophylaxis for PJP in abdominal transplant recipients. The estimated prevalence of nocardiosis in liver and kidney transplants is reported to be <0.3%; therefore, the data suggest this regimen provides ineffective prophylaxis for Nocardia infections in this population. The highest risk of nocardiosis was seen in PAK transplants.

Hasan Kazmi, PharmD1, Winston Ally, PharmD1, Bryan T. Alexander, PharmD2, Michelle Campolieto, PharmD1, Kenneth Brayman, MD1, Avinash Agarwal, MD1 and Costi D. Sifri, MD3, (1)University of Virginia Health System, Charlottesville, VA, (2)Department of Pharmacy Services, University of Virginia Health System, Charlottesville, VA, (3)Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, VA

Disclosures:

H. Kazmi, None

W. Ally, None

B. T. Alexander, None

M. Campolieto, None

K. Brayman, None

A. Agarwal, None

C. D. Sifri, None

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