Pneumocystis jirovecii Pneumonia Outbreaks in Solid Organ Transplant Recipients: A Systematic Review of Epidemiology, Transmission Dynamics, and Outbreak Investigations.

IF 2.5 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2026-10-02 DOI:10.1111/tid.70333

Francesca Gioia, Sarah Almansour, Ani Orchanian-Cheff, Jay A Fishman, Seyed M Hosseini-Moghaddam

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引用次数: 0

Abstract

Background: Although Pneumocystis jirovecii pneumonia (PJP) outbreaks continue to occur in solid organ transplantation (SOT) recipients, no systematic review has synthesized the available evidence to provide an aggregated understanding of their epidemiology and transmission.

Methods: We searched MEDLINE, Embase, Cochrane, and manual sources through May 1, 2024 for studies of PJP outbreaks in adult SOT recipients. Data on patient characteristics, immunosuppression, diagnostics, outcomes, outbreak investigations, and control measures were extracted. The primary outcome was all-cause mortality, and the secondary outcome was characterization of outbreak investigation.

Results: Twenty-nine outbreaks involving 360 SOT recipients (median age, 51.8 years [range, 22-70.5 years]; 32.6% female) were identified. Late-onset PJP (> 1 year posttransplant) occurred in 92.6% of outbreaks, which lasted a median of 365 days (range, 90-1260 days); kidney transplant recipients accounted for 77.8% of cases. Across 22 studies, the crude aggregate mortality was 19.0% (51 of 268 patients), while 27 of 64 patients (42.2%) required dialysis in six studies. Most patients were not on prophylaxis at diagnosis; breakthrough infections were rare (< 5%). Molecular typing was performed in most studies (21/28, 75%) among which single or predominant genotypes were identified in 19/20 (95%), supporting clonal transmission. Control measures included extended prophylaxis and surveillance, although their individual effectiveness could not be determined.

Conclusion: Transplant centers remain susceptible to prolonged PJP outbreaks associated with substantial mortality. Nosocomial airborne transmission is likely. Most outbreaks occurred after prophylaxis discontinuation, but optimal control measures and prophylaxis duration remain uncertain. Standardized investigations incorporating molecular epidemiology will guide outbreak control and prevention.

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实体器官移植受者的流行性肺囊虫肺炎暴发：流行病学、传播动力学和暴发调查的系统综述。

背景：虽然在实体器官移植（SOT）受者中继续发生乙基肺囊虫肺炎（PJP）暴发，但没有系统综述综合现有证据来提供对其流行病学和传播的总体理解。方法：我们检索MEDLINE， Embase， Cochrane和手册来源，直到2024年5月1日，寻找成人SOT接受者中PJP爆发的研究。提取了患者特征、免疫抑制、诊断、结果、疫情调查和控制措施的数据。主要结局是全因死亡率，次要结局是疫情调查的特征。结果：共发现29例暴发，涉及360例SOT受者（中位年龄51.8岁[范围22-70.5岁]，其中32.6%为女性）。92.6%的患者出现晚发型PJP（移植后1年），病程中位数为365天（范围90-1260天）；肾移植受者占77.8%。在22项研究中，粗总死亡率为19.0%（268例患者中有51例），而在6项研究中，64例患者中有27例（42.2%）需要透析。大多数患者在诊断时未采取预防措施；突破性感染罕见（< 5%）。大多数研究（21/ 28,75 %）进行了分子分型，其中19/20（95%）鉴定出单一或显性基因型，支持克隆传播。控制措施包括扩大预防和监测，但无法确定其个别效果。结论：移植中心仍然容易发生与大量死亡率相关的长期PJP暴发。可能存在医院内空气传播。大多数暴发发生在停药后，但最佳控制措施和预防持续时间仍不确定。结合分子流行病学的标准化调查将指导疫情控制和预防。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.