Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study
- PMID: 28329348
- PMCID: PMC10941331
- DOI: 10.1093/cid/cix124
Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study
Erratum in
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Erratum.Clin Infect Dis. 2017 Oct 15;65(8):1431-1433. doi: 10.1093/cid/cix563. Clin Infect Dis. 2017. PMID: 29017252 Free PMC article. No abstract available.
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.
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com
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References
-
- Lebeaux D Morelon E Suarez F et al. Nocardiosis in transplant recipients. Eur J Clin Microbiol Infect Dis 2014; 33:689–702. - PubMed
-
- Husain S McCurry K Dauber J Singh N Kusne S. Nocardia infection in lung transplant recipients. J Heart Lung Transplant 2002; 21:354–9. - PubMed
-
- Poonyagariyagorn HK Gershman A Avery R et al. Challenges in the diagnosis and management of Nocardia infections in lung transplant recipients. Transpl Infect Dis 2008; 10:403–8. - PubMed
-
- Santos M Gil-Brusola A Morales P. Infection by Nocardia in solid organ transplantation: thirty years of experience. Transplant Proc 2011; 43:2141–4. - PubMed
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