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Trimethoprim/sulfamethoxazole for nocardiosis in solid organ transplant recipients: Real‐life data from a multicentre retrospective study
Author(s) -
Conan PierreLouis,
Matig Marie,
Bleibtreu Alexandre,
Guillot Hélène,
Van Laecke Steven,
Brenier Henri,
Crochette Romain,
Melica Giovanna,
FernándezRuiz 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,
Lebeaux David
Publication year - 2021
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.13669
Subject(s) - medicine , nocardiosis , trimethoprim , discontinuation , sulfamethoxazole , renal function , incidence (geometry) , retrospective cohort study , surgery , gastroenterology , nocardia , antibiotics , genetics , physics , optics , bacteria , microbiology and biotechnology , biology
Background 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. Methods 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. Results 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). Conclusions 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.