Lifelong, universal Pneumocystis jirovecii pneumonia prophylaxis: Patient uptake and adherence after kidney transplant. Issue 3 (29th November 2020)

• Record Type: Journal Article
• Authors: Peterson, Kathryn; Berrigan, Liam; Popovic, Katarina; Wiebe, Christopher; Sun, Siyao; Ho, Julie
• Is Part Of: Transplant infectious disease. Volume 23:Issue 3(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-11-29
• Subjects: implementation science -- kidney transplant -- patient adherence -- Pneumocystis jirovecii prophylaxis -- quality improvement; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13509
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Introduction: Pneumocystis jirovecii pneumonia (PJP) is a significant cause of morbidity and mortality in transplant patients yet little is known about their adherence to prophylaxis. The goal of this study was to evaluate patient uptake and long‐term adherence after implementing universal, lifelong PJP prophylaxis. Materials and Methods: This retrospective cohort study evaluated an adult kidney transplant program 18‐months after initiating trimethoprim‐sulfamethoxazole (TMP‐SMX) 80/400 mg thrice‐weekly following a cluster of PJP cases. The protocol incorporated multi‐modal patient education and drug tolerability strategies to improve adherence, including a modified re‐challenge strategy for TMP‐SMX intolerance. Adherence was independently confirmed by the transplant pharmacist and nurse for each patient, with an a priori target ≥ 75% population on prophylaxis. Results: Initial uptake was high with 237/250 (94.8%) patients starting prophylaxis. Long‐term maintenance was high with 192/237 (81.0%) patients remaining on prophylaxis at 18‐months. Of the remaining 45 patients who initiated prophylaxis, 36/237 (15.2%) were non‐adherent and 9/237 (3.8%) discontinued prophylaxis by 18‐months. Reasons for non‐adherence included gastrointestinal upset, fear of drug reactions and cost; but the majority of reasons were not delineated by the patients (31/36, 86.1%). There was a statistically significant increase in serum creatinine 3.3 µmol/L (0.3‐6.3 µmol/L 95% CI) and potassium 0.08 mmol/L (0.03‐0.15 mmol/L 95% CI) in those prescribed TMP‐SMX with only 3/237 (1.3%) patients discontinuing TMP‐SMX for an increase in creatinine. Conclusion: High rates of patient uptake (94.8%) and long‐term adherence (81.0%) were observed after implementing universal lifelong PJP prophylaxis. This may be due in part to the in‐depth patient education and drug tolerability strategies employed.