1212. Pneumocystis jiroveci Pneumonia in Solid Organ Transplantation: Associations with Infection and Implications for Prophylaxis
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Posters
  • Werbel et al IDWeek 2015 Poster 1212.pdf (450.2 kB)
  • Background: Pneumocystis jiroveci pneumonia (PJP) affected ~16% of solid organ transplant recipients (SOTRs) prior to universal prophylaxis (PPX), typically with trimethoprim-sulfamethoxazole (TMP-SMX). Guidelines recommend 612 months post SOT; optimal duration has not been established with current immunosuppressive regimens (IS).

    Methods: A single-center, retrospective 1:4 case-control study of PJP among SOTRs from Jan 1998-Dec 2013 matched by nearest date of SOT was conducted. Cases had positive PJ direct fluorescent antibody assay of respiratory specimens. T-test, Chi-square, and Fisher's exact tests were performed.

    Results: 15 cases were identified (rate 0.26%); 14 cases analyzed vs 56 controls (Table 1). Most cases were in kidney transplant recipients at a mean of 6.1 years post SOT. None was receiving PPX at diagnosis. Nearly all (86%) were treated with reduced IS, TMP-SMX, and steroids; 8 (43%) required ICU care. Cases tended to be older (p=0.055) and have higher serum creatinine (p=0.086). There were no differences in IS or incidence of acute rejection. PJP occurred more frequently in SOTRs with prior viral infection (64% vs 32%, p=0.028, OR 3.8) and in those with lower absolute lymphocyte counts (ALC) at diagnosis (700 vs 1272 cells/ul, p=0.007); odds of infection was high if ALC was less than or equal to 500 (OR 17.1 [CI 3.8-76.8]). Mortality was 21%.

    Conclusion: PJP is a rare, late complication of SOT resulting in significant morbidity and mortality. Severe lymphopenia and post-SOT viral infection may identify SOTRs who warrant longer PPX to prevent this life threatening infection.

    Description: https://idsa.confex.com/data/abstract/idsa/2015/Paper_51598_abstract_51089_0.png

    William Werbel, MD, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, Michael Ison, MD MS, FIDSA, Infectious Diseases, Northwestern Memorial Hospital, Chicago, IL, Michael Angarone, DO, Northwestern University Feinberg School of Medicine, Chicago, IL, Amy Yang, MS, Biostatistics Collaboration Center, Northwestern Memorial Hospital, Chicago, IL and Valentina Stosor, MD, FIDSA, Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL

    Disclosures:

    W. Werbel, None

    M. Ison, None

    M. Angarone, None

    A. Yang, None

    V. Stosor, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.