Nosocomial XXXX : lessons from a cluster in kidney transplant recipients.

@entity1 @entity2803 @entity8 @entity10592 @entity1009 @entity358 @entity1576 @entity207 @entity206
BACKGROUND: @entity10592 ( @entity10592 ) is an important infection-related complication, whose mode of transmission remains uncertain. METHODS: We investigated a nosocomial cluster of 14 @entity10592 cases (11 confirmed and 3 probable) in kidney transplant recipients using epidemiological and genotyping methods. RESULTS: Poisson regression calculated an incidence density ratio of 42.8 (95% confidence interval [CI], 14.1-129.3) versus background 0.64 cases of 1000 @entity1 -years (P<0.001). All @entity1 presented with @entity1576 , 10 required ventilation, two died, and six transplants failed, costing  31,854 (  SD  26,048) per @entity1 . Four-locus multilocus sequence typing analysis using DNA extracts from 11 confirmed cases identified two closely related genotypes, with 9 of 11 sharing an identical composite multilocus sequence typing genotype. Contact tracing found colocalization of cases within clinic waiting areas, suggesting @entity1 -to- @entity1 transmission. Minimal and maximal @entity10592 incubation periods were 124  83 to 172  71 days, respectively. Oropharyngeal washes from outpatient staff and ambient air samples were negative for P. jirovecii DNA. Cohort analysis (14 cases vs. 324 unaffected clinic control @entity1 ) identified independent risk factors including previous @entity2803 (odds ratio [OR], 65.9; 95% CI, 7.9-550; P<0.001), underlying @entity358 (OR, 10.1; 95% CI, 2.3-45.0; P=0.002), and @entity8 (OR=1.61 per 10 mL/ @entity1009 .73 m, 95% CI, 1.15-2.25, P=0.006). The outbreak was controlled by reintroduction of @entity206 / @entity207 prophylaxis to all potentially exposed clinic @entity1 and its extension to 12 months in recent recipients. CONCLUSIONS: Nosocomial @entity10592 clusters are likely due to interhuman transmission by airborne droplets to susceptible hosts. Prompt recognition and a strategy of early preemptive @entity10592 prophylaxis to all exposed transplant clinic recipients from the third confirmed case are recommended to limit outbreak escalation.
