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

Abstract : 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], 1.11.8), invasive fungal infection (OR, 1.3; 95% CI, 1.11.5), and donor age (OR, 1.0046; 95% CI, 1.00071.0083) were independently associated with 1-year mortality. Acute rejection in the year before nocardiosis was associated with improved survival (OR, 0.85; 95% CI, 0.730.98). Seventeen patients received short-course antibiotics (median duration 56 [24120] days) with a 1-year success rate (cured and surviving) of 88% and a 5.-% risk of relapse (median follow-up 49 [6136] 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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Submitted on : Friday, February 21, 2020 - 2:13:26 PM
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David Lebeaux, Romain Freund, Christian Delden, Hélène Guillot, Sierk D. Marbus, et al.. Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study. Clinical Infectious Diseases, Oxford University Press (OUP), 2017, 64 (10), pp.1396-1405. ⟨10.1093/cid/cix124⟩. ⟨hal-02487192⟩

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