Nocardia Infection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study.
- Coussement J Department of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels.
- Lebeaux D Université Paris Descartes, Sorbonne Paris Cité, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, France.
- van Delden C Transplant Infectious Diseases Unit, Hôpitaux Universitaires de Genève Swiss Transplant Cohort Study, Switzerland.
- Guillot H Service des Maladies Infectieuses et Tropicales, Sorbonne Universités, UPMC Université Paris 06, AP-HP, Hôpital Pitié-Salpêtrière.
- Freund R Université Paris Descartes, INSERM UMRS 1138 Team 22 Biostatistics Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France.
- Marbus S Department of Infectious Diseases, Leiden University Medical Center, The Netherlands.
- Melica G Immunologie Clinique et Maladies Infectieuses, AP-HP, Hôpital Henri Mondor, Créteil, France.
- Van Wijngaerden E Department of General Internal Medicine, University Hospitals Leuven, Belgium.
- Douvry B Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France.
- Van Laecke S Renal Division, Ghent University Hospital, Belgium.
- Vuotto F Infectious Diseases Unit, Huriez Hospital, CHRU Lille.
- Tricot L Service de Néphrologie-Transplantation Rénale, Hôpital Foch, Suresnes, France.
- Fernández-Ruiz M Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
- Dantal J Institut de Transplantation, d'Urologie et de Néphrologie, CHU Nantes, France.
- Hirzel C Swiss Transplant Cohort Study, Switzerland Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
- Jais JP Université Paris Descartes, INSERM UMRS 1138 Team 22 Biostatistics Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France.
- Rodriguez-Nava V Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, France.
- Lortholary O Université Paris Descartes, Sorbonne Paris Cité, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, France.
- Jacobs F Department of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels.
- 2016-04-20
Published in:
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. - 2016
Nocardia
nocardiosis
opportunistic infections
organ transplant
Adult
Aged
Calcineurin Inhibitors
Case-Control Studies
Europe
Female
Humans
Logistic Models
Male
Middle Aged
Nocardia
Nocardia Infections
Opportunistic Infections
Retrospective Studies
Risk Factors
Transplant Recipients
Transplants
Trimethoprim, Sulfamethoxazole Drug Combination
English
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.
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.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1093/cid/ciw241
- PMID 27090987
- Persistent URL
- https://sonar.ch/global/documents/140357
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