title: Nocardia Infection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels.
authors.forename: Julien
authors.initials: J
authors.lastname: Coussement
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, France.
authors.forename: David
authors.initials: D
authors.lastname: Lebeaux
authors.affiliation: Transplant Infectious Diseases Unit, Hôpitaux Universitaires de Genève Swiss Transplant Cohort Study, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: van Delden
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Sorbonne Universités, UPMC Université Paris 06, AP-HP, Hôpital Pitié-Salpêtrière.
authors.forename: Hélène
authors.initials: H
authors.lastname: Guillot
authors.affiliation: Université Paris Descartes, INSERM UMRS 1138 Team 22 Biostatistics Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Freund
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, The Netherlands.
authors.forename: Sierk
authors.initials: S
authors.lastname: Marbus
authors.affiliation: Immunologie Clinique et Maladies Infectieuses, AP-HP, Hôpital Henri Mondor, Créteil, France.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Melica
authors.affiliation: Department of General Internal Medicine, University Hospitals Leuven, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Wijngaerden
authors.affiliation: Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Douvry
authors.affiliation: Renal Division, Ghent University Hospital, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Van Laecke
authors.affiliation: Infectious Diseases Unit, Huriez Hospital, CHRU Lille.
authors.forename: Fanny
authors.initials: F
authors.lastname: Vuotto
authors.affiliation: Service de Néphrologie-Transplantation Rénale, Hôpital Foch, Suresnes, France.
authors.forename: Leïla
authors.initials: L
authors.lastname: Tricot
authors.affiliation: Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.affiliation: Institut de Transplantation, d'Urologie et de Néphrologie, CHU Nantes, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Dantal
authors.affiliation: Swiss Transplant Cohort Study, Switzerland Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Cédric
authors.initials: C
authors.lastname: Hirzel
authors.affiliation: Université Paris Descartes, INSERM UMRS 1138 Team 22 Biostatistics Unit, AP-HP, Hôpital Necker Enfants Malades, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Jais
authors.affiliation: Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, France.
authors.forename: Veronica
authors.initials: V
authors.lastname: Rodriguez-Nava
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: Department of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000008:administration & dosage*; D016022:Case-Control Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009615:Nocardia / Q000187:drug effects*; D009617:Nocardia Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D009894:Opportunistic Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D019737:Transplants; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*
chemical_list: D065095:Calcineurin Inhibitors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Nocardia; nocardiosis; opportunistic infections; organ transplant