Pneumonia In Solid Organ Transplantation
Recommendations
DIAGNOSTIC TESTING
- Key features of the patient's medical, transplant, immunization, and social histories.
- Current and prior microbial colonization and current and prior antimicrobial prophylaxis regimens.
- Social history for exposure(s) which would suggest risk of un‐treated latent infection such as latent TB infection, coccidioidomycosis, and strongyloidiasis.
- The acuity of the patient's clinical presentation and use of this information in guiding the differential diagnosis, diagnostic evaluation, and empiric antimicrobial therapy.
(see Endemic Fungi section of 4th edition of AST ID Guidelines)
No studies have evaluated whether performance characteristics vary depending on post‐transplant timing of infection. Given the paucity of data evaluating utility of 1,3β‐d‐glucan, we do not recommend the use of this test currently in SOT recipients.
- Traditional bacterial, fungal, viral, and mycobacterial culture.
- Diagnostic testing including Pneumocystis jirovecii (PJP)‐directed stains or nucleic acid‐based testing for PJP from BAL fluid.
- Fungal‐directed stains in patients with radiographic findings suggestive of invasive fungal infection.
- Galactomannan in patients with radiographic findings suggestive of invasive fungal infection.
- Antigen‐based testing for endemic fungal infections such as Histoplasma, Blastomyces, Coccidioides, and Paracoccidioides for patients with a compatible clinical history and geographic exposure risk.
- Nucleic acid‐based testing (PCR, QNAT, Film array) testing for the following pathogens depending on test availability and on the patient's clinical history, exposure risk, and radiographic findings:
- Respiratory viruses
- CMV
- Mycoplasma spp, Ureaplasma spp, and/or Legionella spp
- Nocardia spp
- Invasive mold species
- Mycobacterium tuberculosis.
EMPIRIC INITIAL TREATMENT
(See RNA Respiratory Viruses section of 4th editionof AST ID Guidelines)
Recommendation Grading
Overview
Title
Pneumonia In Solid Organ Transplantation
Authoring Organization
American Society of Transplantation
Publication Month/Year
April 1, 2019
Last Updated Month/Year
January 30, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
These guidelines from the AST Infectious Diseases Community of Practice review the diagnosis and management of pneumonia in the post‐transplant period.
Target Patient Population
Post solid organ transplant patients
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Prevention, Management, Treatment
Diseases/Conditions (MeSH)
D011014 - Pneumonia, D019072 - Antibiotic Prophylaxis, D014180 - Transplantation, D019737 - Transplants, D016377 - Organ Transplantation
Keywords
community-acquired pneumonia, pneumonia, infection prevention, infection, hospital-acquired pneumonia, solid organ transplant
Source Citation
Dulek, DE, Mueller, NJ; on behalf of the AST Infectious Diseases Community of Practice. Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019; 33:e13545.