Background

Pneumocystis pneumonia (PCP) is an opportunistic infection occurring in renal transplant patients. Over a 14-month period an increase in PCP cases was identified among our renal transplant cohort.

Aim

The outbreak population was studied to identify potential risk factors for the development of PCP.

Methods

A retrospective analysis of hospital records was carried out, with each case being matched with two case-linked controls. Information was collected on patient demographics, laboratory tests, and hospital visits pre and post development of infection.

Findings

No patients were receiving PCP prophylaxis at the time of infection and mean time from transplantation to developing PCP was 4.7 years (range: 0.51–14.5). The PCP group had a significantly lower mean estimated glomerular filtration rate than the control group (29.3 mL/min/1.73 m² vs 70 mL/min⁻¹ (P = 0.0007)). Three patients were treated for active cytomegalovirus (CMV) infection prior to PCP diagnosis and two had active CMV at the time of diagnosis compared to none in the control group (P = 0.001). Those who developed PCP were more likely to have shared a hospital visit with another patient who went on to develop PCP; 37% of clinic visits vs 19% (P = 0.014).

Conclusion

This study highlights the ongoing risk of opportunistic infection several years after transplantation and adds weight to potential person-to-person Pneumocystis jirovecii transmission. Risk factors have been identified which may highlight those most at risk, enabling targeted rather than blanket long-term PCP prophylaxis.

中文翻译：

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从苏格兰肾脏移植中心的肺囊虫性肺炎暴发中吸取的教训

背景

肺囊虫性肺炎（PCP）是肾移植患者中发生的机会性感染。在我们的肾脏移植队列中，经过14个月的时间，发现PCP病例增加。

目的

对爆发人群进行了研究，以确定潜在的危险因素，以发展五氯苯酚。

方法

对医院记录进行了回顾性分析，每个病例都与两个与病例相关的对照相匹配。在感染发生之前和之后，收集了有关患者人口统计信息，实验室测试以及医院就诊的信息。

发现

感染时没有患者接受PCP预防，从移植到发展为PCP的平均时间为4.7年（范围：0.51-14.5）。PCP组的平均肾小球滤过率估计值明显低于对照组（29.3 mL / min / 1.73 m ²与70 mL / min ^-1（P  = 0.0007））。三名患者在进行PCP诊断之前接受了巨细胞病毒（CMV）感染的主动治疗，而诊断时有2例患有活跃的巨细胞病毒，与之相比，对照组则没有（P  = 0.001）。那些发展为PCP的人更有可能与另一名继续发展为PCP的患者进行医院就诊；37％的临床访视vs. 19％（P  = 0.014）。

结论

这项研究强调了移植后数年仍存在机会感染的风险，并增加了潜在的人对人肺炎巴氏肺孢子虫传播。已确定风险因素，这些风险因素可能会突出显示那些风险最大的因素，从而有针对性地而不是长期地进行PCP预防。