Pneumococcal pneumonia in adult hospitalized solid organ transplant recipients: Nationwide, population-based surveillance.

BACKGROUND Pneumococcal disease poses a burden to the community in high risk population. Most early studies focused on invasive pneumococcal disease. However, the epidemiology of pneumococcal pneumonia (PP) requiring hospitalization in solid organ transplant recipients (SOTRs) is poorly defined. METHODS We conducted a retrospective cohort study (January 1, 2000and December 31, 2012) to evaluate the risk of PP requiring hospitalization in SOTRs. SOTRs and non-SOT cohorts, propensity score-matched at a 1:1 ratio for age, sex, index date, and underlying comorbidities, were identified from the National Health Insurance Research Database. RESULTS Each cohort consisted of 7507 patients. In the SOT cohort, 26 episodes of PP requiring hospitalization were identified (incidence rate of 52.4 per 100,000 person-years). The risk of PP requiring hospitalization in the SOT cohort was 1.50 times greater than in the non-SOT cohort [adjusted hazard ratio: 1.50, 95% confidence interval = 1.31-1.71, p<0.001]. The nested case control study identified older age, kidney transplant, and concomitant chronic obstructive pulmonary disease, chronic kidney disease and heart failure as predictors of PP requiring hospitalization in the SOT cohort. The highest risk period for PP requiring hospitalization occurred within the first year of transplantation (36.47 per 1000 patients). Among kidney transplant recipients, patients with PP requiring hospitalization exhibited higher cumulative incidences of graft failure than those without PP (log-rank test: p-value=0.004). CONCLUSIONS SOTRs are at risk of PP requiring hospitalization with its attendant morbidity. Strategies to reduce risk of PP requiring hospitalization using preventive vaccinations warrant further study.