Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study.
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.
Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine.
David
D
Lebeaux
Université Paris Descartes, INSERM UMRS 1138 Team 22, and.|Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Biostatistics Unit, Paris, France.
Romain
R
Freund
Transplant Infectious Diseases Unit, Hôpitaux Universitaires de Genève, Geneva, and.|Swiss Transplant Cohort Study, Basel, Switzerland.
Christian
C
van Delden
Sorbonne Universités, UPMC Université Paris 06, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Service des Maladies Infectieuses et Tropicales, France.
Hélène
H
Guillot
Department of Infectious Diseases, Leiden University Medical Center, The Netherlands.
Sierk D
SD
Marbus
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.
Marie
M
Matignon
Department of General Internal Medicine, University Hospitals Leuven, Belgium.
Eric
E
Van Wijngaerden
Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France.
Benoit
B
Douvry
Department of Internal Medicine and Infectious Diseases, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
Julien
J
De Greef
Infectious Diseases Unit, Huriez Hospital, CHRU Lille, and.
Fanny
F
Vuotto
Service de Néphrologie-Transplantation Rénale, Hôpital Foch, Suresnes, France.
Leïla
L
Tricot
Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
Mario
M
Fernández-Ruiz
Institut de Transplantation, d'Urologie et de Néphrologie, CHU Nantes, France.
Jacques
J
Dantal
Swiss Transplant Cohort Study, Basel, Switzerland.|Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
Cédric
C
Hirzel
Université Paris Descartes, INSERM UMRS 1138 Team 22, and.|Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Biostatistics Unit, Paris, France.
Jean-Philippe
JP
Jais
Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, France; and.
Veronica
V
Rodriguez-Nava
Division of Infectious Diseases, CUB-Erasme, Université Libre de Bruxelles, Belgium.
Frédérique
F
Jacobs
Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine.
Olivier
O
Lortholary
Division of Infectious Diseases, CUB-Erasme, Université Libre de Bruxelles, Belgium.
Julien
J
Coussement
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D000072742:Invasive Fungal Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D016017:Odds Ratio; D009894:Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology; D016377:Organ Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Nocardia; mortality; opportunistic infections.; organ transplantation; prognosis