Background: Pneumocystis jiroveci pneumonia (PJP) is an important illness amongst solid organ transplant (SOT) recipients. Trimethoprim-sulfamethoxazole (TMP-SMX) is the prophylaxis of choice based on efficacy and its additional antibacterial activity. Atovaquone is an option for patients intolerant of TMP-SMX. We aimed to assess infectious outcomes among SOT recipients who received TMP-SMX vs atovaquone in the year following transplant.

Methods: We performed a retrospective review of patients who received a SOT at a single transplant center from 1/1/2014 through 12/31/2015 and identified infections in the year following transplant. We used guidelines for case definition criteria suggested by the American Society of Transplantation, CDC and NHSN. Subjects were included for analysis if they were initiated on TMP-SMX or atovaquone, completed at least 6 months of prophylaxis, and did not switch to another agent.

Results: During the study period, 440 individuals underwent SOT. 230 and 38 subjects were initiated on TMP-SMX and atovaquone, respectively. 129 subjects had 324 infectious episodes. No subjects who met the inclusion criteria were treated for PJP.

There were no significant differences in the number of infections per subject between the TMP-SMX and atovaquone groups (median (IQR): 0 (0, 1) vs 0.5 (0, 3), p=0.34). In the TMP-SMX group, there was a significantly lower proportion of pneumonia (p = 0.03), skin and soft tissue infection (p = 0.0002), and primary bacteremia (p=0.02), a significantly higher rate of TMP-SMX resistant bacteria compared to the atovaquone group (87.4% vs 34.4%, p<0.0001), but similar frequency of multidrug resistant gram negative bacteria. A higher rate of methicillin-sensitive Staphylococcus aureus was isolated in the atovaquone group (p=<0.0001). There was no significant difference in mortality between the groups (p=1.00).

Conclusion: TMP-SMX and atovaquone were both effective as prophylaxis. There was no significant difference in the incidence of infections and mortality between the two groups. In the TMP-SMX group, there were lower rates of skin and soft tissue infection, pneumonia and primary bacteremia, but higher rates of TMP-SMX resistance.

CITATION INFORMATION: Drelick A., Mowrey W., Minamoto G. Infection Outcomes in Solid Organ Transplant Recipients Receiving Trimethoprim-Sulfamethoxazole as Opposed to Atovaquone for Prophylaxis Am J Transplant. 2017;17 (suppl 3).

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