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
David Lebeaux
- Function : Author
Romain Freund
- Function : Author
Christian Van Delden
- Function : Author
Hélène Guillot
- Function : Author
Sierk D. Marbus
- Function : Author
Marie Matignon
- Function : Author
- PersonId : 760751
- ORCID : 0000-0001-7704-427X
Eric van Wijngaerden
- Function : Author
Benoit Douvry
- Function : Author
Julien de Greef
- Function : Author
Fanny Vuotto
- Function : Author
Leïla Tricot
- Function : Author
Mario Fernández-Ruiz
- Function : Author
Jacques Dantal
- Function : Author
Cédric Hirzel
- Function : Author
Jean-Philippe Jais
- Function : Author
Frédérique Jacobs
- Function : Author
Olivier Lortholary
- Function : Author
Julien Coussement
- Function : Author
James R. Anstey
- Function : Author
Martine Antoine
- Function : Author
Nathalie Ausselet
- Function : Author
Asmae Belhaj
- Function : Author
Jerina Boelens
- Function : Author
Hans De Beenhouwer
- Function : Author
Catherine Denis
- Function : Author
Erwin Ho
- Function : Author
Margareta Ieven
- Function : Author
Stijn Jonckheere
- Function : Author
Christiane Knoop
- Function : Author
Alain Le Moine
- Function : Author
Hector Rodriguez-Villalobos
- Function : Author
Judith Racapé
- Function : Author
Sandrine Roisin
- Function : Author
Bernard Vandercam
- Function : Author
Marie-Laure Vander Zwalmen
- Function : Author
Gaëlle Vanfraechem
- Function : Author
Steven van Laecke
- Function : Author
Jan Verhaegen
- Function : Author
Benoit Barrou
- Function : Author
Pascal Battistella
- Function : Author
Emmanuelle Bergeron
- Function : Author
Nicolas Bouvier
- Function : Author
Sophie Caillard
- Function : Author
Eric Caumes
- Function : Author
Hélène Chaussade
- Function : Author
Cécile Chauvet
- Function : Author
Romain Crochette
- Function : Author
Eric Epailly
- Function : Author
Marie Essig
- Function : Author
Sébastien Gallien
- Function : Author
- PersonId : 760825
- IdHAL : sebastien-gallien
- ORCID : 0000-0002-8033-0936
Romain Guillemain
- Function : Author
Canan Herel
- Function : Author
Bruno Hoen
- Function : Author
- PersonId : 11357
- IdHAL : bruno-hoen
- ORCID : 0000-0003-3070-3017
- IdRef : 058486194
Nassim Kamar
- Function : Author
- PersonId : 862464
- ORCID : 0000-0003-1930-8964
- IdRef : 067702414
Thierry Le Gall
- Function : Author
Charlene Levi
- Function : Author
Arnaud Lionet
- Function : Author
Hélène Longuet
- Function : Author
Giovanna Melica
- Function : Author
Anaick Miel
- Function : Author
Hélène Morel
- Function : Author
Salima Ould Ammar
- Function : Author
Sabine Pattier
- Function : Author
Marie-Noelle Peraldi
- Function : Author
Johnny Sayegh
- Function : Author
Anne Scemla
- Function : Author
Agathe Senechal
- Function : Author
Jérome Tourret
- Function : Author
Katia Boggian
- Function : Author
Adrian Egli
- Function : Author
Christian Garzoni
- Function : Author
Matthias Hoffman
- Function : Author
Hans H. Hirsch
- Function : Author
Nina Khanna
- Function : Author
- PersonId : 799897
- ORCID : 0000-0002-2642-419X
Oriol Manuel
- Function : Author
Pascal Meylan
- Function : Author
Nicolas J. Mueller
- Function : Author
Klara M. Posfay-Barbe
- Function : Author
Diem-Lan Vu
- Function : Author
Maja Weisser
- Function : Author
Albert M. Vollaard
- Function : Author
Herman F. Wunderink
- Function : Author
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.