期刊
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
卷 125, 期 -, 页码 209-215出版社
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
- Clinical Plus Excellence Program of Renji Hospital [2021ZYA022]
- Shanghai Shenkang Hospital Development Center, Clinical Skills and Clinical Innovation program [SHDC2020CR5012]
- Clinical Scientific Research Innovation Cultivation Program, Renji Hospital, School of Medicine, Shanghai Jiao Tong University [RJPY-D2X-010]
The study evaluated the efficacy and safety of low-dose trimethoprim-sulfamethoxazole (TMP-SMX) as the primary prophylaxis for Pneumocystis jirovecii pneumonia (PJP) in adult recipients of kidney transplantation. The results showed that low-dose TMP-SMX prophylaxis significantly reduced the incidence of PJP within 6 months 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 prescription. 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. (c) 2022TheAuthors. PublishedbyElsevierLtdonbehalfofInternationalSocietyforInfectiousDiseases. 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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