Julien Coussement1, David Lebeaux2, Christian van Delden3, Hélène Guillot4, Romain Freund5, Sierk Marbus6, Giovanna Melica7, Eric Van Wijngaerden8, Benoit Douvry9, Steven Van Laecke10, Fanny Vuotto11, Leïla Tricot12, Mario Fernández-Ruiz13, Jacques Dantal14, Cédric Hirzel15, Jean-Philippe Jais5, Veronica Rodriguez-Nava16, Olivier Lortholary2, Frédérique Jacobs1. 1. Department of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels. 2. Université Paris Descartes, Sorbonne Paris Cité, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, France. 3. Transplant Infectious Diseases Unit, Hôpitaux Universitaires de Genève Swiss Transplant Cohort Study, Switzerland. 4. Service des Maladies Infectieuses et Tropicales, Sorbonne Universités, UPMC Université Paris 06, AP-HP, Hôpital Pitié-Salpêtrière. 5. Université Paris Descartes, INSERM UMRS 1138 Team 22 Biostatistics Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France. 6. Department of Infectious Diseases, Leiden University Medical Center, The Netherlands. 7. Immunologie Clinique et Maladies Infectieuses, AP-HP, Hôpital Henri Mondor, Créteil, France. 8. Department of General Internal Medicine, University Hospitals Leuven, Belgium. 9. Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France. 10. Renal Division, Ghent University Hospital, Belgium. 11. Infectious Diseases Unit, Huriez Hospital, CHRU Lille. 12. Service de Néphrologie-Transplantation Rénale, Hôpital Foch, Suresnes, France. 13. Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain. 14. Institut de Transplantation, d'Urologie et de Néphrologie, CHU Nantes, France. 15. Swiss Transplant Cohort Study, Switzerland Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland. 16. Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, France.
Abstract
BACKGROUND: Nocardiosis is a rare, life-threatening opportunistic infection, affecting 0.04% to 3.5% of patients after solid organ transplant (SOT). The aim of this study was to identify risk factors for Nocardia infection after SOT and to describe the presentation of nocardiosis in these patients. METHODS: We performed a retrospective case-control study of adult patients diagnosed with nocardiosis after SOT between 2000 and 2014 in 36 European (France, Belgium, Switzerland, the Netherlands, Spain) centers. Two control subjects per case were matched by institution, transplant date, and transplanted organ. A multivariable analysis was performed using conditional logistic regression to identify risk factors for nocardiosis. RESULTS: One hundred and seventeen cases of nocardiosis and 234 control patients were included. Nocardiosis occurred at a median of 17.5 (range, 2-244) months after transplant. In multivariable analysis, high calcineurin inhibitor trough levels in the month before diagnosis (odds ratio [OR], 6.11; 95% confidence interval [CI], 2.58-14.51), use of tacrolimus (OR, 2.65; 95% CI, 1.17-6.00) and corticosteroid dose (OR, 1.12; 95% CI, 1.03-1.22) at the time of diagnosis, patient age (OR, 1.04; 95% CI, 1.02-1.07), and length of stay in the intensive care unit after SOT (OR, 1.04; 95% CI, 1.00-1.09) were independently associated with development of nocardiosis; low-dose cotrimoxazole prophylaxis was not found to prevent nocardiosis. Nocardia farcinica was more frequently associated with brain, skin, and subcutaneous tissue infections than were other Nocardia species. Among the 30 cases with central nervous system nocardiosis, 13 (43.3%) had no neurological symptoms. CONCLUSIONS: We identified 5 risk factors for nocardiosis after SOT. Low-dose cotrimoxazole was not found to prevent Nocardia infection. These findings may help improve management of transplant recipients.
BACKGROUND:Nocardiosis is a rare, life-threatening opportunistic infection, affecting 0.04% to 3.5% of patients after solid organ transplant (SOT). The aim of this study was to identify risk factors for Nocardia infection after SOT and to describe the presentation of nocardiosis in these patients. METHODS: We performed a retrospective case-control study of adult patients diagnosed with nocardiosis after SOT between 2000 and 2014 in 36 European (France, Belgium, Switzerland, the Netherlands, Spain) centers. Two control subjects per case were matched by institution, transplant date, and transplanted organ. A multivariable analysis was performed using conditional logistic regression to identify risk factors for nocardiosis. RESULTS: One hundred and seventeen cases of nocardiosis and 234 control patients were included. Nocardiosis occurred at a median of 17.5 (range, 2-244) months after transplant. In multivariable analysis, high calcineurin inhibitor trough levels in the month before diagnosis (odds ratio [OR], 6.11; 95% confidence interval [CI], 2.58-14.51), use of tacrolimus (OR, 2.65; 95% CI, 1.17-6.00) and corticosteroid dose (OR, 1.12; 95% CI, 1.03-1.22) at the time of diagnosis, patient age (OR, 1.04; 95% CI, 1.02-1.07), and length of stay in the intensive care unit after SOT (OR, 1.04; 95% CI, 1.00-1.09) were independently associated with development of nocardiosis; low-dose cotrimoxazole prophylaxis was not found to prevent nocardiosis. Nocardia farcinica was more frequently associated with brain, skin, and subcutaneous tissue infections than were other Nocardia species. Among the 30 cases with central nervous system nocardiosis, 13 (43.3%) had no neurological symptoms. CONCLUSIONS: We identified 5 risk factors for nocardiosis after SOT. Low-dose cotrimoxazole was not found to prevent Nocardia infection. These findings may help improve management of transplant recipients.
Authors: Marion Hemmersbach-Miller; Jason E Stout; Michael H Woodworth; Gary M Cox; Jennifer L Saullo Journal: Transpl Infect Dis Date: 2018-05-07 Impact factor: 2.228
Authors: Dana M Harris; Adrian G Dumitrascu; Razvan M Chirila; Mohamed Omer; Fernando F Stancampiano; D Jane Hata; Diana M Meza Villegas; Michael G Heckman; Jordan J Cochuyt; Salvador Alvarez Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-01-19