Outcome and treatment of nocardiosis after solid organ transplantation: new insights from a European study.

Lebeaux, David; Freund, Romain; van Delden, Christian; Guillot, Hélène; Marbus, Sierk D; Matignon, Marie; Van Wijngaerden, Eric; Douvry, Benoit; De Greef, Julien; Vuotto, Fanny; Tricot, Leïla; Fernández-Ruiz, Mario; Dantal, Jacques; Hirzel, Cédric; Jais, Jean-Philippe; Rodriguez-Nava, Veronica; Jacobs, Frédérique; Lortholary, Olivier; Coussement, Julien (2017). Outcome and treatment of nocardiosis after solid organ transplantation: new insights from a European study. Clinical infectious diseases, 64(10), pp. 1396-1405. Oxford University Press 10.1093/cid/cix124

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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 one-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 one-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<0.001). A history of tumor (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.1-1.8), invasive fungal infection in the six months before nocardiosis (OR 1.3; 95%CI 1.1-1.5) and donor age (OR 1.0046; 95%CI 1.0007-1.0083) were independently associated with one-year mortality. Acute rejection in the year before nocardiosis was associated with improved survival (OR 0.85; 95%CI 0.73-0.98). Seventeen patients received short-course antibiotics (median duration 56 [24-120] days) with a one-year success rate (cured and surviving) of 88% and a 5.9% risk of relapse (median follow-up 49 [6-136] month).

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 one-year mortality. Patients receiving short-course antibiotic treatment had good outcomes, suggesting this may be a strategy for further study.

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