Study purpose

We evaluated the epidemiology of pneumonia (PNE) in a longitudinal cohort of patients with abdominal (kidney, liver, and/or pancreas) solid organ transplants (SOT).

Methods

Retrospective study using a pooled database derived from the electronic health records (EHR) of 4 institutions participating in the Multisite Electronic Data Infectious Diseases Consortium (MEDIC). From the larger MEDIC dataset (400,000+ patients), we identified 5,028 patients with SOT occurring between January 1, 2008 and December 31, 2012. Data elements collected included clinical variables, inpatient utilization, and outcomes pertaining to PNE during the study period. Analyses focused on descriptive epidemiology.

Results

Among 5,028 SOT patients, 563 (11%) had at least one documented PNE episode treated in an inpatient setting during the study period. 413 patients had PNE episodes requiring hospitalization subsequent (median time of 8 months, IQR 3-20 months) to the index admit for transplantation procedure. Median hospital length of stay (LOS) for all SOT patients with PNE was 10 days (IQR 5-22 days). LOS for the hospitalization at time of index transplantation was longer in patients who developed PNE compared to those who did not (median 27 days versus 7 days, p<0.01). 32.1% of SOT patients hospitalized with PNE required an ICU stay (median duration 9 days), 25.8% needed mechanical ventilation support, and 21.9% underwent bronchoscopy. Blood, sputum, body fluid, or bronchoalveolar lavage cultures were positive in 15% of PNE episodes. Of identified isolates, staphylococcus was the most common species (7.5%), followed by enterococcus (7.0%), candida albicans, klebsiella, pseudomonas, and streptococcus (all ≤5.0%). Inpatient mortality for PNE episodes was 12.4%; 20% of patients discharged alive received dispositions to locations other than home. Following hospitalization with PNE, 30- and 90-day readmission rates were 27.4% and 41.7% respectively. Post-SOT survival was lower in patients with PNE episodes compared to patients without PNE episodes at 1-year (90.9% vs 97.0%, p<0.01) and 5-years (82.2% vs. 93.8%, p<0.01).

Discussion and conclusions

PNE is an important source of morbidity and mortality in SOT patients. PNE incidence, inpatient utilization frequency, and care intensity during hospitalization for PNE in SOT patients exceeds that of the general population. Further work in this SOT cohort will investigate patient-level risk factors for PNE and independent predictors of clinical outcomes.

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