A 20-Year Experience with Nocardiosis in Solid Organ Transplant (SOT) Recipients in the Southwestern United States: A Single-center Study. (4th October 2017)

• Record Type: Journal Article
• Authors: Majeed, Aneela; Beatty, Norman; Iftikhar, Ahmad; Mushtaq, Adeela; Gaynor, Pryce; Kim, Jeeyong C; Marquez, Jose Luis; Mora, Francisco E; Georgescu, Anca; Zangeneh, Tirdad
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S707
• Page End: S707
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1899
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Nocardiosis is a life-threatening opportunistic infection with a high incidence (0.04% to 3.5%) reported in SOT recipients. Rate of nocardiosis in the Southwestern United States may be higher due to environmental factors. The purpose of the present study was to identify key factors, including the role of TMP/SMX prophylaxis, intensity of immunosuppression, treatment regimens, and disease outcome among SOT recipients at our institution. Methods: We performed a retrospective review of laboratory and clinical records of 260 adult patients diagnosed with nocardiosis between 1997 and 2016 at our center. Out of 260, 54 patients met the inclusion criteria of nocardiosis after SOT. Key variables related to each patient's SOT and nocardiosis diagnosis were recorded in a REDCap database for ease of further data aggregation. Numeric data were summarized using means, standard deviations, medians, and ranges. Categorical data were summarized using counts and percentages. Results: Total of 2038 patients underwent SOT between 1997 to 2016. Incidence was 2.65%. Thirty-seven percent had undergone heart transplant followed by lung, kidney, liver and pancreas. 44 % had elevated tacrolimus levels (>20 ng/mL) 6 months prior to diagnosis and 18 (33%) of patients experienced rejection. Twenty percent had CMV viremia after transplant. Pulmonary involvement was present in 76% while 24% had disseminated infection. All-cause mortality rate was 12%. Eighty-five percent of patients received TMP/SMX prophylaxis after transplant. Ninety-one percent nocardia isolates were sensitive to TMP/SMX and at least 44% of patients were diagnosed with nocardia species while on TMP/SMX prophylaxis. Conclusion: Based on these results we conclude that incidence of nocardiosis among SOT recipients is relatively high in the Southwestern United States. Many patients developed nocardiosis on TMP/SMX prophylaxis. Based on our findings, TMP/SMX prophylaxis did not provide reliable protection against nocardiosis. Greater than 40% of patients had an increase in tacrolimus dose and/or elevated tacrolimus levels 6 months prior to diagnosis. Compared with other studies, all cause mortality was lower at our institution (12% vs. 20%), which may have been due to early diagnosis and/or rapid decrease in immunosuppression, while mortality directly related to Nocardiosis was found to be 2%. Disclosures: All authors: No reported disclosures.