Trimethoprim/sulfamethoxazole for nocardiosis in solid organ transplant recipients: Real-life data from a multicentre retrospective study.

Conan, Pierre-Louis; Matignon, Marie; Bleibtreu, Alexandre; Guillot, Hélène; Van Laecke, Steven; Brenier, Henri; Crochette, Romain; Melica, Giovanna; Fernández-Ruiz, Mario; Dantal, Jacques; Walti, Laura N; Levi, Charlène; Chauvet, Cécile; De Greef, Julien; Marbus, Sierk D; Mueller, Nicolas J; Ieven, Margareta; Vuotto, Fanny; Lortholary, Olivier; Coussement, Julien; ... (2021). Trimethoprim/sulfamethoxazole for nocardiosis in solid organ transplant recipients: Real-life data from a multicentre retrospective study. Transplant infectious disease, 23(4), e13669. Wiley 10.1111/tid.13669

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Little is known regarding the optimal management of nocardiosis among solid organ transplant (SOT) recipients. It is often suggested to avoid trimethoprim/sulfamethoxazole (TMP-SMX) monotherapy in heavily immunocompromised patients (such as SOT recipients) and/or in case of severe or disseminated nocardiosis. Our aim was to report our experience with TMP-SMX monotherapy in SOT recipients with nocardiosis.


Using data from a previously published European study, we assessed the incidence of adverse events in SOT recipients receiving TMP-SMX monotherapy and assessed its effectiveness.


Thirty-one SOT recipients with nocardiosis were included, mostly kidney transplant recipients (20/31, 65%). Eleven (36%) had disseminated infection, and four (13%) had brain nocardiosis. Most patients had lung and/or pleural involvement (26/31, 84%). Daily dose of trimethoprim at initiation was 10 [6.4-14.8] mg/kg. The median estimated glomerular filtration rate at time of diagnosis of nocardiosis was 44 [30-62] ml/min/1.73 m². TMP-SMX was discontinued prematurely in one third of the patients (10/31, 32%, mostly for hematological toxicity [n = 3] or increased serum creatinine [n = 3]). Focusing on the 24 (77%) patients who completed at least 30 days of TMP-SMX monotherapy, 4 had late (>30 days) drug discontinuation, 1 experienced treatment failure, and 19 completed planned TMP-SMX monotherapy. Clinical outcome was favorable in these 19 patients, despite the fact that 8 (42%) had disseminated infection and 2 (11%) brain nocardiosis. Overall, all-cause 1-year mortality was 10% (3/31).


TMP-SMX monotherapy appears to be effective for the treatment of most nocardiosis among SOT recipients. Interventional studies are needed to compare its safety and effectiveness with those of other regimens used to treat posttransplant nocardiosis.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Walti, Laura Naëmi


600 Technology > 610 Medicine & health








Annelies Luginbühl

Date Deposited:

16 Dec 2021 11:30

Last Modified:

05 Dec 2022 15:55

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

acute kidney injury cotrimoxazole transplantation trimethoprim/sulfamethoxazole




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