Pulmonary nocardiosis in heart transplant recipients: treatment and outcome.
BACKGROUND
Nocardial infections typically affect patients receiving immunosuppressants, occurring early after surgery in 3% to 40% of heart transplant (HTx) recipients. The emergence of antibiotic resistance and occurrence of disease recurrences in AIDS population has engendered controversy about the treatment for immunodepressed HTx patients.


METHODS
We present a retrospective study of the diagnosis, treatment and outcome of 560 HTx recipients between 1984 and 2002.


RESULTS
Among the five cases of Nocardia infection (0.9%), three cases developed late after HTx (between 3.1 and 11 years follow-up). All patients had pulmonary disease and one in addition had subcutaneous nodules. Microbiological diagnosis required open lung biopsy in one case. All patients were treated primarily with trimethoprim-sulphamethoxazole, but evidence of resistance to sulfonamides led us to change the antimicrobial combination in two cases. Four patients who received one year of antibiogram-guided therapy showed complete healing without recidivism. Three patients died, all due to non-related causes, at follow-ups between 1 and 5 years. In one case a cutaneous recurrence of disease was attributed to noncompliance.


CONCLUSIONS
Nocardiosis in current HTx is less common than previously reported. Its incidence seems to be delayed in time with modern immunosuppressants. Given the high incidence of sulfamide resistance, treatment must be guided by antibiotic sensitivity. We believe that maintenance therapy for a whole year is the appropriate option in order to avoid recidivism in this population.
Peraira
J R
JR
Hospital Universitario Puerta de Hierro, Madrid, Spain.
Segovia
J
J
Fuentes
R
R
Jiménez-Mazuecos
J
J
Arroyo
R
R
Fuertes
B
B
Mendaza
P
P
Pulpon
L A
LA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy*; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents