4.7 Article

Prophylactic effect of low-dose trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia in adult recipients of kidney transplantation: a real-world data study

期刊

INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
卷 125, 期 -, 页码 209-215

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ELSEVIER SCI LTD
DOI: 10.1016/j.ijid.2022.10.004

关键词

Trimethoprim-sulfamethoxazole; Kidney transplantation; Pneumocystis jirovecii pneumonia; Fungal infection; Prophylaxis

资金

  1. Clinical Plus Excellence Program of Renji Hospital [2021ZYA022]
  2. Shanghai Shenkang Hospital Development Center, Clinical Skills and Clinical Innovation program [SHDC2020CR5012]
  3. Clinical Scientific Research Innovation Cultivation Program, Renji Hospital
  4. Clinical Scientific Research Innovation Cultivation Program, Renji Hospital, School of Medicine, Shanghai Jiao Tong University [RJPY-D2X-010]

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This study evaluated the efficacy and safety of low-dose TMP-SMX as the primary prophylaxis for PJP in adult recipients of kidney transplantation. The results showed that low-dose TMP-SMX significantly reduced the incidence of PJP after kidney transplantation and had a favorable safety profile.
Objectives: To evaluate the efficacy and safety of low-dose trimethoprim (TMP)-sulfamethoxazole (SMX) (TMP-SMX) as the primary prophylaxis for Pneumocystis jirovecii pneumonia (PJP) in adult recipients of kidney transplantation.Methods: Three kinds of prescriptions in kidney recipients were documented, including 20 mg TMP/100 mg SMX oral daily, 20 mg TMP/100 mg SMX oral every other day, and nonprophylaxis. The primary outcome was the incidence of PJP in the first 180 days of follow-up after kidney transplantation. The secondary outcomes were changes in renal and liver function.Results: Among the 1469 recipients, 1066 (72.56%) received 20 mg TMP/100 mg SMX daily, 127 (8.65%) received 20 mg TMP/100 mg SMX every other day, and 276 (18.79%) did not have prophylaxis prescrip-tion. The 276 recipients in the nonprophylaxis group had 124.92 person-years of follow-up, during which PJP occurred in 29 patients, for an incidence rate of 23.21 (95% confidence interval 15.76-32.72) per 100 person-years. The TMP-SMX daily group and the TMP-SMX every other day group had 524.89 and 62.07 person-years of follow-up, respectively, with no occurrence of PJP. There was no significant difference among the three groups in changes in renal and liver function ( P > 0.05, respectively). A total of 111 recipients in each group were enrolled in the propensity score matching analysis. It was revealed that the 111 nonprophylaxis recipients had 51.27 person-years of follow-up and 10 PJP cases. Prophylaxis was considered effective because there was a significant difference between the three groups ( P < 0.001).Conclusion: Low-dose TMP-SMX prophylaxis significantly reduces the incidence of PJP within 6 months after kidney transplantation and has a favorable safety profile.& COPY; 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

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