Infection by Nocardia in Solid Organ Transplantation: Thirty Years of Experience

Santos, Maria Izabel Penha de Oliveira; Gil-Brusola, Ana; Morales, P.

doi:10.1016/j.transproceed.2011.06.065

Cited by 48 publications

(57 citation statements)

References 23 publications

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“…The mortality rate observed in our study (16.2%, 19/117) is comparable to that seen in a previous study reporting on 35 patients with post-SOT nocardiosis (6-month mortality = 14.3%, 5/35) [6] but appears to be lower than what has been reported in other studies (~30%) [4,5]. This apparent discrepancy may be explained by the different outcome periods used in the various studies and the large proportion of lung recipients in the 2 latter studies.…”

Section: Discussionsupporting

confidence: 84%

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: Discussionsupporting

confidence: 84%

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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“…The overall proportion of immunocompromised hosts in our study (71.9%) was higher than that in a previous review of Nocardia infections (13). Patients with systemic disseminated infection accounted for 12.5% of our cases, which was lower than the proportion reported in highly immunosuppressed populations (20%-21%) such as solid-organ transplant patients (14), possibly owing to our smaller sample size. In this study, patients aged between 18 and 65 years accounted for 84.4% (27/32) of all cases, of whom 33.3% (9/27) were immunocompetent.…”

Section: Discussioncontrasting

confidence: 75%

Microbiological and clinical data analysis of 32 patients with Nocardia infections in Yantai

Yu¹,

Liu²,

Pu³

et al. 2018

Turk J Med Sci

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Background/aim: Nocardia is an opportunistic pathogen that mostly affects hosts with immune deficiencies. Recently, the widespread use of immunosuppressive agents and antitumor drugs has led to an increasing number of Nocardia infections being reported. However, it is difficult to confirm this diagnosis owing to the slow growth of the bacterium and its complex resultant clinical manifestations, potentially delaying treatment and increasing mortality. Thus, further knowledge on the clinical characteristics of Nocardia infection is required. Hence, this study aimed to review the demographics, comorbidities, clinical presentation, microbiology, treatment, and outcomes of Nocardia infections in Yantai. Materials and methods:This is a retrospective study including 32 patients identified to have Nocardia infection from the Yantai Yuhuangding Hospital. The relevant patient samples were collected by two researchers, while the other researchers analyzed the relevant data. Results:The male to female ratio among the 32 patients was 3:5, and 23 patients (71.9%) were immunocompromised. Pulmonary sites of infection were the most common (65.6% of patients). N. brasiliensis infections were present in 25.0% and N. asteroides infections were present in 21.9% of patients. Because of limited biotechnological resources, Nocardia spp. in 50.0% of cases were not classified. The TMP-SMX resistance rate among isolates was 9.4%. All isolates were susceptible to amikacin, ceftriaxone, and imipenem. Conclusion:In Yantai, immunocompromised patients predominate among cases of Nocardia infection. The rate of occurrence was higher in females than in males. Because of potential TMP-SMX resistance, treatment for Nocardia infection should be based on drug susceptibility or should include combination therapy.

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“…Pulmonary nocardiosis is described as the most common clinical presentation of Nocardia infection [4], and 82% of our cohort had pulmonary involvement. Fifteen percent of patients in our series had disseminated disease, slightly higher than the 6%–13% seen in other unrestricted case series [7, 18, 19] but lower than the 20%–21% reported in highly immunosuppressed populations such as solid organ transplant patients [5, 20]. The overall proportion of immunocompromised hosts in our population (36%) was lower than that reported in a previous review of the Nocardia literature [2].…”

Section: Discussioncontrasting

confidence: 69%

Nocardiosis in the Tropical Northern Territory of Australia, 1997–2014

McGuinness¹,

Whiting²,

Baird

et al. 2016

Open Forum Infectious Diseases

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Background.Nocardia is an opportunistic pathogen that can cause life-threatening disease. We aimed to characterize the epidemiological, microbiological, and clinical features of nocardiosis in the tropical north of Australia.Methods.We conducted a retrospective cohort study of nocardiosis diagnosed between 1997 and 2014. Population-based incidences were calculated using district population data.Results.Clinically significant nocardiosis was identified in 61 patients. The unadjusted population-based annual incidence of nocardiosis was 2.02 (95% confidence interval [CI], 1.55–2.60) per 100000 people and was 1.7 (95% CI, .96–2.90) fold higher in Indigenous compared with non-Indigenous persons (P = .027). Of 61 patients, 47 (77%) had chronic lung disease, diabetes, and/or hazardous alcohol consumption; 22 (36%) were immunocompromised; and 8 (13%) had no identified comorbidities. Disease presentations included pulmonary (69%; 42 of 61), cutaneous (13%; 8 of 61), and disseminated nocardiosis (15%; 9 of 61). The most commonly identified species were Nocardia asteroides and Nocardia cyriacigeorgica (each 11%). Linezolid was the only antimicrobial to which isolates were universally susceptible; 89% (48 of 54), 60% (32 of 53), and 48% (26 of 54) of isolates were susceptible to trimethoprim-sulfamethoxazole, ceftriaxone, and imipenem, respectively. Eighteen patients (30%) required intensive care unit (ICU) admission, and 1-year mortality was 31%.Conclusions.The incidence of nocardiosis in tropical Australia is amongst the highest reported globally. Nocardiosis occurs in both immunocompromised and immunocompetent hosts, and it is associated with high rates of ICU admission, 1-year mortality, and resistance to commonly recommended antimicrobials. Diagnosis should be considered in patients with consistent clinical features, particularly if they are Indigenous or have chronic lung disease.

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Infection by Nocardia in Solid Organ Transplantation: Thirty Years of Experience

Cited by 48 publications

References 23 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

Microbiological and clinical data analysis of 32 patients with Nocardia infections in Yantai

Nocardiosis in the Tropical Northern Territory of Australia, 1997–2014

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