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Nocardia infections in the transplanted host
Author(s) -
HemmersbachMiller Marion,
Stout Jason E.,
Woodworth Michael H.,
Cox Gary M.,
Saullo Jennifer L.
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12902
Subject(s) - nocardia , nocardiosis , medicine , nocardia infections , incidence (geometry) , epidemiology , transplantation , trimethoprim , surgery , microbiology and biotechnology , antibiotics , biology , bacteria , genetics , physics , optics
Background Nocardia are uncommon pathogens that disproportionately afflict the immunocompromised host. Epidemiology and outcome data of Nocardia infections in transplant recipients are limited. Methods We performed a retrospective chart review of all patients at Duke University Hospital with a history of solid organ transplant (SOT) or hematopoietic cell transplant (HCT) and at least one positive culture for Nocardia between 1996 and 2013. Our aim was to describe the epidemiology and outcomes of Nocardia infections in the transplanted host. Results During the 18‐year study period, 51 patients (14 HCT and 37 SOT recipients) had Nocardia infection. Nocardia incidence was stable during the study period in all populations except heart transplants, whose incidence declined. Infection occurred earlier in the HCT group than the SOT group (median time to diagnosis of 153 and 370 days, respectively). In both groups, the most common site involved was the lung. Outcomes were overall poor, especially in the HCT group with a cure rate of 29%. Heart transplant recipients had significantly better overall survival ( P < .05) than other patients. Trimethoprim‐sulfamethoxazole (TMP‐SMX) prophylaxis did not provide complete protection from Nocardia infections, nor did it appear to select for resistant Nocardia isolates. Conclusions Infections with Nocardia are typically a late post‐transplant complication. The use of TMP‐SMX prophylaxis was not associated with TMP‐SMX‐resistant Nocardia . Overall outcomes remain poor.