title: Cluster outbreak of Pneumocystis pneumonia among kidney transplant patients within a single center.
abstract: Pneumocystis pneumonia (PCP), a life-threatening opportunistic infection occurring in immunocompromised hosts, developed in 10 patients in the past 35 years at our hospital. Among the 7 outpatients and 3 inpatients, 9 cases clustered within 7 months. The mean time was 32.1 +/- 27.5 months between transplantation and PCP diagnosis. The mortality rate was 33.3%. The patients developing PCP were older at transplantation (46.9 +/- 11.8 vs 34.0 +/- 11.1 years; P = .003) and had a longer pretransplantation dialysis period (146.3 +/- 120.0 vs 51.3 +/- 66.6 months; P < .0001). Multivariate analysis showed that age at transplantation and the use of mycophenolate mofetil (MMF) were risk factors for development of PCP. Despite prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) during the first 3 to 6 months after transplantation, the time period that showed the highest incidence rate of PCP, the disease may occur at later intervals.
authors.affiliation: Urology and Renal Transplant Center, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Arichi
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kishikawa
authors.forename: Yozo
authors.initials: Y
authors.lastname: Mitsui
authors.forename: Taigo
authors.initials: T
authors.lastname: Kato
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishimura
authors.forename: Ryo
authors.initials: R
authors.lastname: Tachikawa
authors.forename: Keisuke
authors.initials: K
authors.lastname: Tomii
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiina
authors.forename: Mikio
authors.initials: M
authors.lastname: Igawa
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Ichikawa
mesh_terms: D000328:Adult; D002102:Cadaver; D016000:Cluster Analysis; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D045363:Pneumocystis carinii / Q000302:isolation & purification; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents