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Lifelong, universal Pneumocystis jirovecii pneumonia prophylaxis: Patient uptake and adherence after kidney transplant
Author(s) -
Peterson Kathryn,
Berrigan Liam,
Popovic Katarina,
Wiebe Christopher,
Sun Siyao,
Ho Julie
Publication year - 2021
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13509
Subject(s) - medicine , tolerability , pneumocystis jirovecii , pneumocystis pneumonia , population , retrospective cohort study , cohort , regimen , antibiotic prophylaxis , pneumonia , adverse effect , surgery , antibiotics , environmental health , microbiology and biotechnology , biology
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.