1487. Variability of <i>Pneumocystis jirovecii</i> Prophylaxis Use Among Pediatric Solid Organ Transplant Providers
Bibliographic record
Abstract
Pneumocystis jirovecii pneumonia (PJP) prophylaxis after pediatric solid-organ transplant (SOT) is routinely recommended, but practice patterns vary. In 2018, an online survey was sent to 707 members of the International Pediatric Transplant Association. 105 responded, representing 47 institutions in 18 countries. Majority were transplant physicians (66%) or transplant surgeons (20%). Remainder were nurse practitioners (6%), infectious disease physicians (5%) or pharmacists (4%). Routine PJP prophylaxis was reported by 87%, while 13% do not routinely administer any prophylaxis. The majority not using PJP prophylaxis performed only renal transplants (67%) and listed low incidence of PJP infection as the primary reason (88%). Trimethoprim/sulfamethoxazole (TMP/SMX) was the preferred first-line agent (97%). Common second-line agents were dapsone (33%), inhaled pentamidine (33%), and atovaquone (12%). Of those that provide PJP prophylaxis following renal transplant (n = 51), the majority (51%) provide 4–6 months (Figure 1). Durations following liver transplant (n = 25) were similar; and heart transplant providers (n = 24) most commonly give 4–6 months (42%) as well. Majority of abdominal multivisceral (MVS) providers (55%) give 10–12 months and most lung transplant responders provide lifelong prophylaxis (81%). Across all organs, at least 20% provide lifetime prophylaxis. After completion of PJP prophylaxis, 36% do not restart for any reason and 54% would restart for treatment of acute graft rejection. Duration of PJP Prophylaxis. Reported PJP infections were uncommon with 80% reporting no PJP cases in the prior 12 months and 15% reporting 1–5 infections. Only 2% reported a case of PJP infection on prophylaxis. PJP prophylaxis remains routine for the majority of pediatric SOT patients; albeit with notable practice variations. The most common duration of PJP prophylaxis following renal, liver and heart transplant was 4–6 months; while in abdominal multivisceral and lung transplant recipients, durations of either 10–12 months or lifelong prophylaxis were common. There remains a lack of evidence-based guidelines balancing the utility of PJP prevention against potential treatment side effects and unnecessary medication use. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".