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

David Lebeaux Romain Freund Christian Van Delden Hélène Guillot Sierk D. Marbus Marie Matignon Eric van Wijngaerden Benoit Douvry Julien de Greef Fanny Vuotto Leïla Tricot Mario Fernández-Ruiz Jacques Dantal Cédric Hirzel Jean-Philippe Jais Veronica Rodriguez-Nava 1 Frédérique Jacobs Olivier Lortholary Julien Coussement James R. Anstey Martine Antoine Nathalie Ausselet Asmae Belhaj Jerina Boelens Hans De Beenhouwer Catherine Denis Erwin Ho Margareta Ieven Stijn Jonckheere Christiane Knoop Alain Le Moine Hector Rodriguez-Villalobos Judith Racapé Sandrine Roisin Bernard Vandercam Marie-Laure Vander Zwalmen Gaëlle Vanfraechem Steven van Laecke Jan Verhaegen Benoit Barrou Pascal Battistella Emmanuelle Bergeron Nicolas Bouvier Sophie Caillard Eric Caumes Hélène Chaussade Cécile Chauvet Romain Crochette Eric Epailly Marie Essig Sébastien Gallien Romain Guillemain Canan Herel Bruno Hoen Nassim Kamar Thierry Le Gall Charlene Levi Arnaud Lionet Hélène Longuet Giovanna Melica Anaick Miel Hélène Morel Salima Ould Ammar Sabine Pattier Marie-Noelle Peraldi Johnny Sayegh Anne Scemla Agathe Senechal Jérome Tourret Katia Boggian Adrian Egli Christian Garzoni Matthias Hoffman Hans H. Hirsch Nina Khanna Oriol Manuel Pascal Meylan Nicolas J. Mueller Klara M. Posfay-Barbe Diem-Lan Vu Maja Weisser Albert M. Vollaard Herman F. Wunderink 
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 Van 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, 2017, 64 (10), pp.1396-1405. ⟨10.1093/cid/cix124⟩. ⟨hal-02487192⟩

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