Nocardia infection in solid organ transplant recipients: a multicenter European case-control study.

Research paper by Julien J Coussement, David D Lebeaux, Christian C van Delden, Hélène H Guillot, Romain R Freund, Sierk S Marbus, Giovanna G Melica, Eric E Van Wijngaerden, Benoit B Douvry, Steven S Van Laecke, Fanny F Vuotto, Leïla L Tricot, Mario M Fernández-Ruiz, Jacques J Dantal, Cédric C Hirzel, et al.

Indexed on: 20 Apr '16Published on: 20 Apr '16Published in: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America


 Nocardiosis is a rare, life-threatening opportunistic infection, affecting 0.04% to 3.5% of patients after solid organ transplantation (SOT). The aim of this study was to identify risk factors forNocardiainfection after SOT and to describe the presentation of nocardiosis in these patients. 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, 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. 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 transplantation. In multivariable analysis, high calcineurin inhibitor trough levels in the month before diagnosis (OR=6.11 [2.58-14.51]), use of tacrolimus (OR=2.65 [1.17-6.00]) and corticosteroid dose (OR=1.12 [1.03-1.22]) at the time of diagnosis, patient age (OR=1.04 [1.02-1.07]) and length of stay in intensive care unit after SOT (OR=1.04 [1.00-1.09]) were independently associated with development of nocardiosis; low-dose cotrimoxazole prophylaxis was not found to prevent nocardiosis.Nocardia farcinicawas more frequently associated with brain, skin and subcutaneous tissue infections than were otherNocardiaspecies. Among the 30 cases with central nervous system nocardiosis, 13 (43.3%) had no neurological symptoms. We identified five risk factors for nocardiosis after SOT. Low-dose cotrimoxazole was not found to preventNocardiainfection. These findings may help improve management of transplant recipients.

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