Low-Dose Cotrimoxazole Administered in Hematopoietic Stem Cell Transplant Recipients as Prophylaxis for Pneumocystis jirovecii Pneumonia Is Effective in Prevention of Infection due to Nocardia

Gkirkas, Konstantinos; Stamouli, Maria; Thomopoulos, Thomas; Kontos, Fanourios; Kavatha, Dimitra; Siafakas, Nikolaos; Karagiannidou, Angeliki; Pournaras, Spyridon; Antoniadou, Anastasia; Tsirigotis, Panagiotis

doi:10.1016/j.bbmt.2019.07.018

Cited by 7 publications

(9 citation statements)

References 5 publications

(5 reference statements)

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“…Our study highlights the potential to prevent nocardiosis with TMP‐SMX prophylaxis. Studies examining TMP‐SMX as Nocardia prophylaxis have reported inconsistent results 4,5,7–10,18 . However, study of TMP‐SMX prophylaxis is prone to confounding by indication, where patients at highest risk for nocardiosis will often also be those receiving prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 However, other studies of SOT recipients and non-SOT immunocompromised populations have suggested benefit from TMP-SMX prophylaxis. [7][8][9][10][11] In this study, we aimed to evaluate proposed risk factors for development of nocardiosis in SOT recipients, including TMP-SMX prophylaxis, by examining a large, three site transplant center database.…”

Section: Introductionmentioning

confidence: 99%

“…Breakthrough Nocardia infection has been well‐documented and two studies examining associations with nocardiosis in SOT recipients did not show reduced odds of nocardiosis in those receiving TMP‐SMX 4,5 . However, other studies of SOT recipients and non‐SOT immunocompromised populations have suggested benefit from TMP‐SMX prophylaxis 7–11 …”

Section: Introductionmentioning

confidence: 99%

“…It is possible that the cumulative effect from other posttransplant complications, such as declining graft function, malignancies, and cumulative immunosuppression, played a role in its development, though this is speculative.Our study highlights the potential to prevent nocardiosis with TMP-SMX prophylaxis. Studies examining TMP-SMX as Nocardia prophylaxis have reported inconsistent results 4,5,[7][8][9][10]…”

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confidence: 99%

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Risk factors and prophylaxis for nocardiosis in solid organ transplant recipients: A nested case‐control study

Yetmar

Chesdachai

Duffy

et al. 2023

Clinical Transplantation

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Background: Nocardia is an opportunistic pathogen that primarily affects immunocompromised individuals, including solid organ transplant (SOT) recipients. Up to 2.65% of SOT recipients develop nocardiosis; however, few studies have examined risk factors and prophylaxis for nocardiosis. Methods: We performed a multicenter, matched nested case-control study of adult SOT recipients with culture-confirmed nocardiosis from 2000 through 2020. Controls were matched up to 2:1 by sex, first transplanted organ, year of transplant, transplant center, and adequate post-transplant follow-up. Multivariable conditional logistic regression was performed to analyze associations with nocardiosis. Cox proportional hazards regression compared 12-month mortality between infection and uninfected patients.Results: One hundred and twenty-three SOT recipients were matched to 245 uninfected controls. Elevated calcineurin inhibitor level, acute rejection, cytomegalovirus infection, lymphopenia, higher prednisone dose, and older age were significantly associated with nocardiosis while trimethoprim-sulfamethoxazole prophylaxis was protective (odds ratio [OR] .34; 95% confidence interval [CI] .13-.84). The effect of prophylaxis was similar, though not always statistically significant, in sensitivity analyses that only included prophylaxis dosed more than twice-per-week (OR .30; 95% CI .11-.80) or restricted to years 2015-2020 (OR .33, 95% CI .09-1.21). Nocardiosis was associated with increased 12-month mortality (hazard ratio 5.47; 95% confidence interval 2.42-12.35).Conclusions: Multiple measures of immunosuppression and lack of trimethoprimsulfamethoxazole prophylaxis were associated with nocardiosis in SOT recipients.Effectiveness of prophylaxis may be related to trimethoprim-sulfamethoxazole dose or frequency. Trimethoprim-sulfamethoxazole should be preferentially utilized over alternative agents in SOT recipients with augmented immunosuppression or signs of heightened immunocompromise.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk factors and prophylaxis for nocardiosis in solid organ transplant recipients: A nested case‐control study

Yetmar

Chesdachai

Duffy

et al. 2023

Clinical Transplantation

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“…126 Prophylaxis with TMP-SMX Low-dose cotrimoxazole in HSCT used as prophylaxis against PCJ theoretically may reduce the likelihood of nocardiosis. 263 However, randomized trials are lacking, and several groups have reported breakthrough nocardiosis despite prophylactic use of TMP-SMX. 7,54,128…”

Section: The Infectious Disease Community Of Practice Of the Americanmentioning

confidence: 99%

Nocardia spp.: A Rare Cause of Pneumonia Globally

Lynch

Reid

Clark

2020

Semin Respir Crit Care Med

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AbstractMembers of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

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Risk factors for Nocardia infection among allogeneic hematopoietic cell transplant recipients: A case-control study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation

De Greef,

Averbuch,

Tondeur

et al. 2024

Journal of Infection

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Low-Dose Cotrimoxazole Administered in Hematopoietic Stem Cell Transplant Recipients as Prophylaxis for Pneumocystis jirovecii Pneumonia Is Effective in Prevention of Infection due to Nocardia

Cited by 7 publications

References 5 publications

Risk factors and prophylaxis for nocardiosis in solid organ transplant recipients: A nested case‐control study

Risk factors and prophylaxis for nocardiosis in solid organ transplant recipients: A nested case‐control study

Nocardia spp.: A Rare Cause of Pneumonia Globally

Risk factors for Nocardia infection among allogeneic hematopoietic cell transplant recipients: A case-control study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation

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