Genetic and Epidemiologic Analyses of an Outbreak of Pneumocystis jirovecii Pneumonia Among Kidney Transplant Recipients in the United States.
Pneumocystis jirovecii
belatacept
kidney transplant
next-generation sequencing
outbreak
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
received:
16
03
2021
pubmed:
22
5
2021
medline:
15
3
2022
entrez:
21
5
2021
Statut:
ppublish
Résumé
Pneumocystis jirovecii is an opportunistic fungus that causes Pneumocystis pneumonia (PCP) in immunocompromised hosts. Over an 11-month period, we observed a rise in cases of PCP among kidney-transplant recipients (KTR), prompting an outbreak investigation. Clinical and epidemiologic data were collected for KTR diagnosed with PCP between July 2019 and May 2020. Pneumocystis strain typing was performed using restriction fragment length polymorphism analyses and multilocus sequence typing in combination with next-generation sequencing. A transmission map was drawn, and a case-control analysis was performed to determine risk factors associated with PCP. Nineteen cases of PCP in KTR were diagnosed at a median of 79 months post-transplantation; 8 received monthly belatacept infusions. Baseline characteristics were similar for KTR on belatacept versus other regimens; the number of clinic visits was numerically higher for the belatacept group during the study period (median 7.5 vs 3). Molecular typing of respiratory specimens from 9 patients revealed coinfection with up to 7 P. jirovecii strains per patient. A transmission map suggested multiple clusters of interhuman transmission. In a case-control univariate analysis, belatacept, lower absolute lymphocyte count, non-White race, and more transplant clinic visits were associated with an increased risk of PCP. In multivariate and prediction power estimate analyses, frequent clinic visits was the strongest risk factor for PCP. Increased clinic exposure appeared to facilitate multiple clusters of nosocomial PCP transmission among KTR. Belatacept was a risk factor for PCP, possibly by increasing clinic exposure through the need for frequent visits for monthly infusions.
Sections du résumé
BACKGROUND
Pneumocystis jirovecii is an opportunistic fungus that causes Pneumocystis pneumonia (PCP) in immunocompromised hosts. Over an 11-month period, we observed a rise in cases of PCP among kidney-transplant recipients (KTR), prompting an outbreak investigation.
METHODS
Clinical and epidemiologic data were collected for KTR diagnosed with PCP between July 2019 and May 2020. Pneumocystis strain typing was performed using restriction fragment length polymorphism analyses and multilocus sequence typing in combination with next-generation sequencing. A transmission map was drawn, and a case-control analysis was performed to determine risk factors associated with PCP.
RESULTS
Nineteen cases of PCP in KTR were diagnosed at a median of 79 months post-transplantation; 8 received monthly belatacept infusions. Baseline characteristics were similar for KTR on belatacept versus other regimens; the number of clinic visits was numerically higher for the belatacept group during the study period (median 7.5 vs 3). Molecular typing of respiratory specimens from 9 patients revealed coinfection with up to 7 P. jirovecii strains per patient. A transmission map suggested multiple clusters of interhuman transmission. In a case-control univariate analysis, belatacept, lower absolute lymphocyte count, non-White race, and more transplant clinic visits were associated with an increased risk of PCP. In multivariate and prediction power estimate analyses, frequent clinic visits was the strongest risk factor for PCP.
CONCLUSIONS
Increased clinic exposure appeared to facilitate multiple clusters of nosocomial PCP transmission among KTR. Belatacept was a risk factor for PCP, possibly by increasing clinic exposure through the need for frequent visits for monthly infusions.
Identifiants
pubmed: 34017984
pii: 6279489
doi: 10.1093/cid/ciab474
pmc: PMC9012955
doi:
Types de publication
Journal Article
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
639-647Subventions
Organisme : National Institute of Health Clinical Center
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
Diagn Microbiol Infect Dis. 2015 Jun;82(2):137-42
pubmed: 25801779
Transpl Infect Dis. 2021 Jun;23(3):e13511
pubmed: 33217136
Clin Microbiol Rev. 2012 Apr;25(2):297-317
pubmed: 22491773
Eur J Clin Microbiol Infect Dis. 2000 Sep;19(9):671-8
pubmed: 11057500
Transplantation. 2013 Nov 15;96(9):834-42
pubmed: 23903011
Am J Infect Control. 2016 Apr 1;44(4):425-31
pubmed: 26804301
Clin Microbiol Rev. 2018 Jun 13;31(3):
pubmed: 29899010
J Clin Microbiol. 2016 May;54(5):1314-20
pubmed: 26935726
Infect Drug Resist. 2019 May 30;12:1457-1467
pubmed: 31239724
Clin Transplant. 2019 Sep;33(9):e13587
pubmed: 31077616
J Infect Dis. 2003 Mar 15;187(6):901-8
pubmed: 12660936
J Infect Dis. 1984 Feb;149(2):143-7
pubmed: 6321606
Arch Pathol Lab Med. 2020 Jan 6;:
pubmed: 31904277
Clin Infect Dis. 2020 Sep 12;71(6):1367-1376
pubmed: 31802125
J Fungi (Basel). 2015 Sep 28;1(3):293-331
pubmed: 29376913
Transpl Infect Dis. 2009 Apr;11(2):171-4
pubmed: 19210692
Clin Infect Dis. 2010 Aug 1;51(3):259-65
pubmed: 20572759
Transplant Proc. 2016 Nov;48(9):2924-2930
pubmed: 27932109
Med Mycol. 2011 Oct;49(7):673-80
pubmed: 21453224
Transplant Direct. 2017 Apr 05;3(5):e151
pubmed: 28573186
Clin Infect Dis. 2017 Oct 1;65(7):1120-1126
pubmed: 28549105