背景:肾移植受者(KTR)在感染COVID-19后进展为严重感染的风险较高。我们对SARS-CoV-2Omicron变体的KTRs的危险因素和多病原体感染进行了研究。
方法:对KTRs进行了全面的病因评估。只要可行,他们还接受了支气管镜检查和支气管肺泡灌洗,以实现宏基因组下一代测序(mNGS),理想情况下在入院后48小时的窗口内。我们对COVID-19病毒变种Omicron的KTRs病原体和危险因素进行了回顾性分析。
结果:我们在研究中纳入了30名患者,其中16例表现为单一感染COVID-19,14例表现为共同感染,主要与肺孢子虫jirovecii。值得注意的是,与中度患者相比,重度患者的C反应蛋白(CRP)和白细胞介素-6水平显著升高(P<0.05).此外,病情进展的个体基线血清肌酐水平明显高于无此类进展的个体(P<0.05).心力衰竭的存在,肾功能不全急性加重,由于SARS-CoV-2Omicron变体,机会性感染史与更高的恶化和入院可能性显着相关,与对照组比较(P<0.05)。在随后的后续分析中,全因再住院率为21.4%,肺孢子虫感染占这些病例的一半。
结论:在KTR中,观察到47%的显著合并感染率,在这些情况下,肺孢子虫成为主要病原体。心力衰竭的发展,慢性肾功能不全急性加重,和先前的机会性感染史已被确定为可能导致KTRs临床恶化的潜在危险因素.此外,肺孢子虫感染已被确定为影响该患者人群全因再住院率的关键因素。
BACKGROUND: Kidney transplant recipients (KTRs) are at an elevated risk of progressing to severe infections upon contracting COVID-19. We conducted a study on risk factors and multi-pathogen infections in KTRs with SARS-CoV-2 Omicron variant.
METHODS: KTRs were subjected to a thorough etiological evaluation. Whenever feasible, they were also provided with bronchoscopy and bronchoalveolar lavage to enable metagenomic next-generation sequencing (mNGS), ideally within a 48-hour window post-admission. We performed a retrospective analysis for pathogens and risk factors of KTRs with the COVID-19 virus variant Omicron.
RESULTS: We included thirty patients in our study, with sixteen exhibiting single infection of COVID-19 and fourteen experiencing co-infections, predominantly with Pneumocystis jirovecii. Notably, patients with severe cases demonstrated significantly elevated levels of C-reactive protein (CRP) and interleukin-6 compared to those with moderate cases (P < 0.05). Furthermore, individuals whose conditions progressed had markedly higher baseline serum creatinine levels than those without such progression (P < 0.05). The presence of heart failure, acute exacerbation of renal dysfunction, and a history of opportunistic infections were significantly associated with a higher likelihood of deterioration and hospital admission due to the SARS-CoV-2 Omicron variant, as compared to the control group (P < 0.05). In subsequent follow-up analysis, the all-cause rehospitalization rate was observed to be 21.4%, with Pneumocystis jirovecii infection accounting for half of these cases.
CONCLUSIONS: Among KTRs, a significant coinfection rate of 47% was observed, with Pneumocystis jirovecii emerging as the predominant pathogen in these cases. The development of heart failure, acute exacerbation of chronic renal dysfunction, and a prior history of opportunistic infections have been identified as potential risk factors that may contribute to clinical deterioration in KTRs. Additionally, Pneumocystis jirovecii infection has been established as a critical factor influencing the rate of all-cause rehospitalization within this patient population.