ComplicationInfectionCluster Outbreak of Pneumocystis Pneumonia Among Kidney Transplant Patients Within a Single Center
Section snippets
Patients and Methods
Among 441 patients who underwent kidney transplantation between February 1973 and January 2008, PCP occurred in 10 recipients in 35 years. No patient had received TMP-SMX prior to overt evidence of a PCP infection. Several immunosuppressive protocols were used in this period: azathioprine and steroids from 1973–1984; cyclosporine in 1984; and tacrolimus since 1990. Mycophenolate mofetil (MMF) and basiliximab have been used at our hospital since 1995 and 2002, respectively. The PCP diagnosis was
Results
Table 1 shows the demographic data of 441 patients who underwent kidney transplantation. Nine cases were affected as a cluster between June 2007 and January 2008 and the remaining one in 1988. Seven cases were affected in an outpatient setting and the remaining 3 during hospitalization. No overlap of hospital admission was found among the 3 inpatients. Likewise, no specific personal contact was identified among the outpatients prior to overt PCP infection. Overall mortality rate was 33.3%; all
Discussion
P. jirovecii is an opportunistic pathogen especially found in patients with impaired cellular immunity.4, 5, 6 The reported prevalence of PCP has reached 10% within the first 6 months after transplantation,7 suggesting that the risk for PCP development is greater during the early phase after transplantation, especially under intensive immunosuppression.14, 15 The mortality rate of PCP in this study was 33.3%, which was compatible with rates reported previously (29%–50%).2, 3 Radistic et al13
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