<i>In vitro</i> activity of multiple antibiotic combinations against <i>Nocardia</i>: relationship with a short‐term treatment strategy in heart transplant recipients with pulmonary nocardiosis

Tripodi, Marie‐Francoise; Durante‐Mangoni, Emanuele; Fortunato, R; Cuccurullo, Susanna; Mikami, Yuzuru; Farina, Claudio; Utili, Riccardo

doi:10.1111/j.1399-3062.2010.00588.x

Cited by 43 publications

(45 citation statements)

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“…In 1982, Wallace et al reported 25 cases of pulmonary nocardiosis (in patients without SOT) and described a higher rate of relapse among patients receiving less than 4 months of treatment [14]. Almost 30 years later, in a retrospective description of 12 cases of nocardiosis after heart transplantation who received short-course (≤120 days) antibiotic treatment, Tripodi et al [15] reported that none of their patients who were treated with 3-4 weeks of intravenous bactericidal antibiotics followed by 1-3 months of oral antibiotic relapsed. Reducing antibiotic treatment duration could have potential benefits, such as cost savings and reduction in the risk of adverse events, especially among transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

“…Total duration of antibiotic treatment was recorded, and a short-course was defined as ≤120 days [15].…”

Section: Variablesmentioning

confidence: 99%

“…These guidelines are based on a retrospective study of 25 pulmonary cases published in 1982 that described a high rate of relapse (60%, 3/5 patients) among patients who received only SXT for less than 4 months [14]. Strikingly, a more recent study that included 12 heart transplant recipients suggested that a shorter (≤120 days) treatment course was feasible in pulmonary nocardiosis, without relapse [15].…”

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confidence: 99%

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Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Lebeaux

Freund

Delden

et al. 2017

Clinical Infectious Diseases

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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 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.

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Section: Discussionmentioning

confidence: 99%

“…Total duration of antibiotic treatment was recorded, and a short-course was defined as ≤120 days [15].…”

Section: Variablesmentioning

confidence: 99%

mentioning

confidence: 99%

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Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Lebeaux

Freund

Delden

et al. 2017

Clinical Infectious Diseases

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“…Carbapenem usually displays a low MIC, and meropenem exhibits the best cerebral diffusion among this class. Time-kill studies showed that imipenem-amikacin and imipenem-moxifloxacin combinations are bactericidal for most isolates, whereas linezolid and SXT exhibit mainly bacteriostatic activity (16). The recognized patient intolerance to SXT, and the limit of the initial identification to the genus level, did not allow us to make a decision for antibiotic treatment based on the in vitropredicted susceptibility.…”

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confidence: 99%

First Case of Disseminated Infection with Nocardia cerradoensis in a Human

et al. 2015

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iHere we report in a human, a renal transplant patient, the first disseminated infection with Nocardia cerradoensis, isolated after a brain biopsy. Species identification was based on 16S rRNA, gyrB, and hsp65 gene analyses. Antibiotic treatment was successful by combining carbapenems and aminoglycosides and then switching to oral trimethoprim-sulfamethoxazole. CASE REPORTA 59-year-old woman with a history of end-stage renal disease, secondary to autosomal-dominant polycystic kidney disease, received a renal transplant in 2010. Her immunosupressive regimen included tacrolimus at 12 mg/day and prednisolone at 7.5 mg/day. Prophylaxis with trimethoprim-sulfamethoxazole (SXT) was given for 6 months after the transplantation and then stopped due to intolerance symptoms. The patient had no history of recent travel. Two weeks before admission, she had had a mild headache with fever and chills and she was empirically treated with amoxicillin and prednisone for 7 days. After a brief improvement, she developed a nonproductive cough with dyspnea. Based on the hypothesis of pneumonia, antibiotic treatment was switched to ceftriaxone combined with aerosol bronchodilators. The patient's pulmonary symptoms rapidly worsened, and in September 2013, she was admitted to the hospital for further investigation.On examination, the patient was awake and complained of inspiratory dyspnea. Diarrhea was noted a few days after the initiation of antibiotic treatment and resolved spontaneously. The patient's temperature was measured at 37.8°C, blood pressure was 150/90 mm Hg, pulse was 97 beats/min, respiratory rate was 36/ min, and oxygen saturation was 97% while she was breathing ambient air. The auscultation evidenced bilateral basal crepitus and no other abnormal sounds. Heart sounds were normal, abdomen was soft, without tenderness, distention, or organomegaly, and neurologic examination was normal. No peripheral lymph nodes were detected. Subcutaneous nodules of the lower extremities appeared a few days after the patient was admitted (Fig. 1A). The white cell count was 18.6 ϫ 10 9 /liter, with 95% neutrophils, and the blood level of C-reactive protein was 159 mg/liter. A chest X-ray and a computed tomography (CT) scan showed wall thickening of the right main bronchus, moderate ground-glass opacities of the right upper lobe, a right hilar lymph node, a small right parenchymal nodule (Ͻ10 mm), and moderate homolateral pleural effusion (Fig. 1B). An abdominal CT scan revealed diffuse peritoneal and right retroperitoneal nodules (Fig. 1C) and a thickening of the cecal wall. Bronchoalveolar lavage (BAL) fluid, bronchial, and subcutaneous biopsy specimens were collected, and examination of stained smears (using Gram, Ziehl-Neelsen, May-Grünwald-Giemsa, Papanicolaou, Perls, and hematoxylin-safranin stains) showed no bacteria or abnormal cells. Cultures for bacteria, fungi, and mycobacteria were all negative. Histological examination of the subcutaneous nodule identified an erythema nodosum. Amplification of bacterial 16S rRNA gene from the c...

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“…While there have been no randomized controlled trials to allow the recommendation of an optimal therapy for pulmonary nocardiosis, in general, the agents most commonly used include trimethoprim-sulfamethoxazole, amikacin, carbapenems, and thirdgeneration cephalosporins (5,13), which were used successfully in our patient.…”

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confidence: 99%

Nocardia thailandica Pulmonary Nocardiosis in a Post-Solid Organ Transplant Patient

et al. 2015

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Nocardia thailandica is a rare pathogen related to Nocardia asteroides, Nocardia neocaledoniensis, and Nocardia caishijiensis that, since its original description in 2004, has only been reported to cause wound and ocular infections in humans. We report a case of pulmonary nocardiosis caused by Nocardia thailandica in a 66-year-old solid organ transplant patient from Connecticut, which was identified at the molecular taxonomic level by secA1 analysis, 16S rRNA gene sequencing, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). To our knowledge, this is the first reported case of N. thailandica in the United States and the first report of pulmonary infection by this pathogen in the literature. CASE REPORT We report a case of pulmonary nocardiosis caused by Nocardia thailandica in a 66-year-old patient from Connecticut with a history of ischemic cardiomyopathy and heart transplant in 2013.The patient presented complaining of upper respiratory symptoms including sinus pressure, headaches, and decreased hearing in the left ear for a month prior to admission. There was no history of fevers, chills, exposure to sick contacts, or recent travel. Nine months earlier, he was admitted and underwent heart transplant surgery, for which he received and was maintained on immunosuppressive therapy with tacrolimus, mycophenolate, and prednisone, as well as prophylactic treatment with valganciclovir and trimethoprim-sulfamethoxazole (TMP-SMX). Four months after his cardiac transplant, the patient developed chronic cough. Chest X rays and computed tomography (CT) scanning performed at that time revealed bilateral patchy, ill-defined, dense nodular parenchymal opacities (Fig. 1A and B). Sputum Gram stains revealed few hyphae, and cultures performed from a bronchoalveolar lavage (BAL) fluid sample grew 1 CFU of Aspergillus fumigatus. A right upper lobe transbronchial biopsy specimen revealed mild chronic mucosal wall inflammation with no evidence of malignancy or granuloma, and the acid-fast bacillus (AFB) and Grocott-Gomori's methenamine silver (GMS) stains were negative. Routine bacterial, AFB, and mycology cultures from lavage samples were without growth, as were AFB cultures of the biopsy specimen. The patient was started on voriconazole and had subjective improvement after 2 weeks.Four months later, and while still on voriconazole, he presented with acute shortness of breath. A chest CT scan showed pulmonary embolism with a large clot burden within the right pulmonary artery and multiple areas of consolidation with cavitation, evolving from larger, denser areas of consolidation seen in the prior study ( Fig. 1C and D). In addition, a new left lower lobe consolidation was revealed. He was started on enoxaparin, and an inferior vena cava (IVC) filter was placed. A sputum Gram stain revealed Gram-negative bacilli later identified as Pseudomonas aeruginosa. Additionally, rhinovirus was detected in a BAL fluid specimen by multiplex PCR (Biofire FilmArray). A repeat right upper lobe transb...

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In vitro activity of multiple antibiotic combinations against Nocardia: relationship with a short‐term treatment strategy in heart transplant recipients with pulmonary nocardiosis

Cited by 43 publications

References 25 publications

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study

First Case of Disseminated Infection with Nocardia cerradoensis in a Human

Nocardia thailandica Pulmonary Nocardiosis in a Post-Solid Organ Transplant Patient

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