Single‐center outbreak of Pneumocystis jirovecii pneumonia in heart transplant recipients

• DOI: 10.1111/tid.12880
• Publication Date: 2018-03-08T00:26:37Z
• Authors: Giacomo Veronese; Enrico Ammirati; Maria Cristina Mo...; Rossella Baldan; Carlo Andrea Orcese; Gisele De Rezende; Silvio Veronese; Gabriella Masciocco; Enrico Perna; Giovanna Travi; Massimo Puoti; Manlio Cipriani; Simon Tiberi; Daniela Cirillo; Maria Frigerio
• Keywords: Male; Infection Control; 0303 health sciences; Pneumonia, Pneumocystis; Middle Aged; Pneumocystis carinii; Transplant Recipients; Disease Outbreaks; 3. Good health; Hospitalization; 03 medical and health sciences; Risk Factors; Heart Transplantation; Humans; Female; epidemiology; genotyping; heart transplantation; outbreak; Pneumocystis jirovecii

AbstractBackgroundPneumocystis jirovecii pneumonia (PJP) outbreaks are described in solid organ transplant recipients. Few reports suggest interhuman transmission with important infection control implications. We described a large PJP outbreak in heart transplant (HTx) recipients.MethodsSix cases of PJP occurred in HTx recipients within 10 months in our hospital. Demographics, clinical characteristics, treatment and outcomes were described. To identify contacts among individuals a review of all dates of out‐patient visits and patient hospitalizations was performed. Cross exposure was also investigated using genotyping on PJ isolates.ResultsAt the time of PJP‐related hospitalization, patients' mean age was 49 ± standard deviation 4 years, median time from HTx was 8 (25%‐75% interquartile range [Q1‐Q3] 5‐12) months and none of the cases were on prophylaxis. At PJP‐related admission, 5 patients had CMV reactivation, of whom 4 were on antiviral preemptive treatment. Median in‐hospital stay was 30 (Q1‐Q3, 28‐48) days; and 2 cases required intensive care unit admission. All patients survived beyond 2 years. Transmission map analysis suggested interhuman transmission in all cases (presumed incubation period, median 90 [Q1‐Q3, 64‐91] days). Genotyping was performed in 4 cases, demonstrating the same PJ strain in 3 cases.ConclusionsWe described a large PJP cluster among HTx recipients, supporting the nosocomial acquisition of PJP through interhuman transmission. Based on this experience, extended prophylaxis for more than 6 months after HTx could be considered in specific settings. Further work is required to understand its optimal duration and timing based on individual risk factor profiles and to define standardized countermeasures to prevent and limit PJP outbreaks.