Contemporary US Prevalence and Outcomes of Pneumocystis jirovecii Pneumonia and Toxoplasmosis in Pediatric Solid Organ and Hematopoietic Cell Transplantation Recipients
1Pediatrics, Infectious Diseases & Host Defense, Nationwide Children's Hospital & The Ohio State University, Columbus, OH, 2Pediatrics, Biostatistics, Nationwide Children's Hospital, Columbus, OH, 3Pediatrics, Infectious Diseases, Children's National Health System, Washington, DC, 4Pediatrics, Infectious Diseases, Children's National Health System & The George Washington University, Washington, DC, DC, 5Pediatrics, Pharmacy, Medical University of South Carolina, Charleston, SC, 6Pediatrics, Hematology/Oncology/HCT, Nationwide Children's Hospital & The Ohio State University, Columbus, OH
Meeting: 2019 American Transplant Congress
Abstract number: 234
Session Information
Date: Monday, June 3, 2019
Session Name: Concurrent Session: Infectious Epidemiology
Session Time: 2:30pm-4:00pm
Presentation Time: 2:54pm-3:06pm
Location: Room 304
*Purpose: We sought to evaluate the contemporary prevalence and outcomes of Pneumocystis jirovecii pneumonia (PCP) and toxoplasmosis among pediatric transplantation recipients in the US in the era of universal prophylaxis and evolving immunosuppressive regimens.
*Methods: Using the Pediatric Health Information System (PHIS), an inpatient database of 45 US pediatric hospitals, we performed a retrospective analysis in children 19 years of age and younger who had undergone either solid organ (SOT) or hematopoietic cell transplantation (HCT) and were hospitalized from 2007-2017 with an ICD9 or ICD10 discharge diagnosis code of PCP or toxoplasmosis. First hospitalizations for infection discharge code were evaluated; demographic and outcome data were collected.
*Results: Among the 22,053 patients who underwent transplantation (SOT= 11,037, HCT = 11,056) during the 10 year study period, 173 unique patients were hospitalized with a discharge diagnosis of PCP and 37 for toxoplasmosis, for a prevalence of 0.8% and 0.2%, respectively (Figure 1). Patient demographics are detailed in Table 1. The diagnosis of PCP was made during the transplant hospitalization in 84 (48%) patients; among the other patients, median time from transplant to PCP was 309 days [11-2660] and median duration of hospitalization was 50 days [2 – 708]. 126 (73%) required intensive care utilization including mechanical ventilation (98, 57 %) and ECMO (10, 6%). All-cause in-hospital mortality occurred in 41 (23%) patients with PCP, 22 during transplant hospitalization and 19 on subsequent hospitalizations, occurring a median of 222 days after transplant [35-1613]. Toxoplasmosis was diagnosed during the initial transplant hospitalization in 22 (59%) patients, in the other patients, the median time from transplant to toxoplasmosis hospitalization was 105 days [36 – 1350]; 20 patients required intensive care utilization. All-cause mortality occurred in 4 (11%) patients, all during the initial transplant admission.
*Conclusions: Based on ICD-9 or ICD-10 hospital discharge codes, the overall prevalence of PCP and toxoplasma infections was low, but with significant morbidity and all-cause mortality in pediatric transplantation recipients.
To cite this abstract in AMA style:
Ardura MI, Stanek J, Hanisch B, Hanisch B, Sprott K, Rangarajan H. Contemporary US Prevalence and Outcomes of Pneumocystis jirovecii Pneumonia and Toxoplasmosis in Pediatric Solid Organ and Hematopoietic Cell Transplantation Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/contemporary-us-prevalence-and-outcomes-of-pneumocystis-jirovecii-pneumonia-and-toxoplasmosis-in-pediatric-solid-organ-and-hematopoietic-cell-transplantation-recipients/. Accessed April 9, 2020.« Back to 2019 American Transplant Congress