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Clin Infect Dis. 2017 May 15;64(10):1396-1405. doi: 10.1093/cid/cix124.

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study.

Author information

1
Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine.
2
Université Paris Descartes, INSERM UMRS 1138 Team 22, and.
3
Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Biostatistics Unit, Paris, France.
4
Transplant Infectious Diseases Unit, Hôpitaux Universitaires de Genève, Geneva, and.
5
Swiss Transplant Cohort Study, Basel, Switzerland.
6
Sorbonne Universités, UPMC Université Paris 06, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Service des Maladies Infectieuses et Tropicales, France.
7
Department of Infectious Diseases, Leiden University Medical Center, The Netherlands.
8
Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier, Nephrology and Transplantation Department, Centre d'Investigation Clinique-BioThérapies 504 and Institut National de la Santé et de la Recherche Médicale U955 and Paris Est University, Créteil, France.
9
Department of General Internal Medicine, University Hospitals Leuven, Belgium.
10
Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France.
11
Department of Internal Medicine and Infectious Diseases, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
12
Infectious Diseases Unit, Huriez Hospital, CHRU Lille, and.
13
Service de Néphrologie-Transplantation Rénale, Hôpital Foch, Suresnes, France.
14
Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
15
Institut de Transplantation, d'Urologie et de Néphrologie, CHU Nantes, France.
16
Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
17
Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, France; and.
18
Division of Infectious Diseases, CUB-Erasme, Université Libre de Bruxelles, Belgium.

Abstract

Background:

Solid organ transplant (SOT) recipients are at risk of nocardiosis, a rare opportunistic bacterial infection, but prognosis and outcome of these patients are poorly defined. Our objectives were to identify factors associated with 1-year mortality after nocardiosis and describe the outcome of patients receiving short-course antibiotics (≤120 days).

Methods:

We analyzed data from a multicenter European case-control study that included 117 SOT recipients with nocardiosis diagnosed between 2000 and 2014. Factors associated with 1-year all-cause mortality were identified using multivariable conditional logistic regression.

Results:

One-year mortality was 10-fold higher in patients with nocardiosis (16.2%, 19/117) than in control transplant recipients (1.3%, 3/233, P < .001). A history of tumor (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8), invasive fungal infection (OR, 1.3; 95% CI, 1.1-1.5), and donor age (OR, 1.0046; 95% CI, 1.0007-1.0083) were independently associated with 1-year mortality. Acute rejection in the year before nocardiosis was associated with improved survival (OR, 0.85; 95% CI, 0.73-0.98). Seventeen patients received short-course antibiotics (median duration 56 [24-120] days) with a 1-year success rate (cured and surviving) of 88% and a 5.9% risk of relapse (median follow-up 49 [6-136] months).

Conclusions:

One-year mortality was 10-fold higher in SOT patients with nocardiosis than in those without. Four factors, largely reflecting general medical condition rather than severity and/or management of nocardiosis, were independently associated with 1-year mortality. Patients who received short-course antibiotic treatment had good outcomes, suggesting that this may be a strategy for further study.

KEYWORDS:

Nocardia; mortality; opportunistic infections.; organ transplantation; prognosis

PMID:
28329348
DOI:
10.1093/cid/cix124
[Indexed for MEDLINE]
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