Nocardia Infection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study. (18th April 2016)

• Record Type: Journal Article
• Authors: Coussement, Julien; Lebeaux, David; van Delden, Christian; Guillot, Hélène; Freund, Romain; Marbus, Sierk; Melica, Giovanna; Van Wijngaerden, Eric; Douvry, Benoit; Van Laecke, Steven; Vuotto, Fanny; Tricot, Leïla; Fernández-Ruiz, Mario; Dantal, Jacques; Hirzel, Cédric; Jais, Jean-Philippe; Rodriguez-Nava, Veronica; Lortholary, Olivier; Jacobs, Frédérique
• Other Names: author non-byline.; Anstey James R. author non-byline.; Antoine Martine author non-byline.; Belhaj Asmae author non-byline.; Boelens Jerina author non-byline.; de Beenhouwer Hans author non-byline.; de Greef Julien author non-byline.; Denis Catherine author non-byline.; Ho Erwin author non-byline.; Ieven Margareta author non-byline.; Jonckheere Stijn author non-byline.; Knoop Christiane author non-byline.; Le Moine Alain author non-byline.; Rodriguez-Villalobos Hector author non-byline.; Racapé Judith author non-byline.; Roisin Sandrine author non-byline.; Vandercam Bernard author non-byline.; Vander Zwalmen Marie-Laure author non-byline.; Vanfraechem Gaëlle author non-byline.; Verhaegen Jan author non-byline.; Vollaard Albert M. author non-byline.; Wunderink Herman F. author non-byline.; Boggian Katia author non-byline.; Egli Adrian author non-byline.; Garzoni Christian author non-byline.; Hoffmann Matthias author non-byline.; Hirsch Hans H. author non-byline.; Khanna Nina author non-byline.; Manuel Oriol author non-byline.; Meylan Pascal author non-byline.; Mueller Nicolas J. author non-byline.; Posfay-Barbe Klara M. author non-byline.; Vu Diem-Lan author non-byline.; Weisser Maja author non-byline.; Barrou Benoit author non-byline.; Battistella Pascal author non-byline.; Bergeron Emmanuelle author non-byline.; Bouvier Nicolas author non-byline.; Caillard Sophie author non-byline.; Caumes Eric author non-byline.; Chaussade Hélène author non-byline.; Chauvet Cécile author non-byline.; Crochette Romain author non-byline.; Epailly Eric author non-byline.; Essig Marie author non-byline.; Gallien Sébastien author non-byline.; Guillemain Romain author non-byline.; Herel Canan author non-byline.; Hoen Bruno author non-byline.; Kamar Nassim author non-byline.; Le Gall Thierry author non-byline.; Lionet Arnaud author non-byline.; Longuet Hélène author non-byline.; Matignon Marie author non-byline.; Miel Anaick author non-byline.; Morel Hélène author non-byline.; Ould Ammar Salima author non-byline.; Pattier Sabine author non-byline.; Peraldi Marie-Noelle author non-byline.; Sayegh Johnny author non-byline.; Scemla Anne author non-byline.; Senechal Agathe author non-byline.; Tourret Jérome author non-byline.;
• Is Part Of: Clinical infectious diseases. Volume 63:Number 3(2016)
• Page Start: 338
• Page End: 345
• Publication Date: 2016-04-18
• Subjects: Nocardia -- nocardiosis -- organ transplant -- opportunistic infections; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciw241
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : In this European multicenter case-control study, Nocardia infection after organ transplant was associated with high blood concentrations of calcineurin inhibitors, use of tacrolimus, dose of corticosteroids, patient age, and length of stay in the intensive care unit after transplant. Abstract : Background. 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. Methods. 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. Results. 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. Conclusions. 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.