Aetiology, clinical features, diagnostic studies, and outcomes of community-acquired pneumonia in kidney transplant recipients admitted to hospital: a multicentre retrospective French cohort study

• Published in: Clinical microbiology and infection Vol. 29; no. 4; p. 542.e1
• Main Authors: Schwartz, Benoît, Dupont, Vincent, Dury, Sandra, Carsin-Vu, Aline, Thomas Guillard, Caillard, Sophie, Frimat, Luc, Sanchez, Stephane, Schvartz, Betoul, Bani-Sadr, Firouzé, Damien Jolly, Philippe Rieu, Antoine Goury
• Format: Journal Article
• Language: English
• Published: England 01-04-2023
• Subjects: Cohort Studies; Community-Acquired Infections - diagnosis; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Hospitals; Humans; Kidney Transplantation - adverse effects; Pneumonia - diagnosis; Pneumonia - epidemiology; Renal Dialysis; Retrospective Studies; Diagnostic studies; Community-acquired pneumonia; Aetiology; Outcomes; Kidney transplantation
• ISSN: 1469-0691
• DOI: 10.1016/j.cmi.2022.12.014

To assess the aetiology, clinical features, diagnostic studies and outcomes of community-acquired pneumonia (CAP) in a French cohort of hospitalized kidney transplant recipients.
We performed a retrospective, multicentre study in kidney transplant recipients admitted to ten French centres for CAP from January 2016 to December 2018. CAP discharge diagnoses were clinically and radiologically validated. We assessed a descriptive analysis of all confirmed CAP including medical ward and intensive care unit admissions.
One hundred sixty-five CAP episodes in 132 patients were included. Median time from transplantation to admission was 6.4 (interquartile range, 1.6-12.3) years, with corticosteroid exposure in 112/165 (67.9%) cases. Sputum culture was performed in 47/165 (28.5%) cases including 7/47 (14.9%) positive samples. Bronchoscopy was performed in 87/165 (52.7%) cases with pathogens identified in 39/87 (44.8%) cases. Microbiological studies led to identifying a respiratory pathogen in 64/165 (38.8%) CAP episodes including 11/64 (17.2%) polymicrobial cases. Among these 64 episodes, 75 microorganisms were identified; 46/75 (61.3%) were core respiratory pathogens and 29/75 (38.7%) were opportunistic or drug-resistant organisms including Pneumocystis jirovecii 9/75 (12%), Pseudomonas aeruginosa 5/75 (6.7%), multidrug-resistant Enterobacteriaceae 4/75 (5.3%), and Aspergillus 4/75 (5.3%). Patients required intensive care unit admission in 26/165 (15.8%) episodes, invasive ventilation in 20/165 (12.1%) cases, and 22/165 (13.3%) needed in-hospital dialysis.
CAP episodes occurred in kidney transplant recipients with a long history of immunosuppressive drug exposure. Diagnostic studies identified a microorganism in more than one-third of CAP episodes, including drug-resistant and opportunistic pathogens.