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Oxford University Press, Clinical Infectious Diseases, 10(64), p. 1396-1405, 2017

DOI: 10.1093/cid/cix124

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Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study.

Journal article published in 2017 by David Lebeaux, Sierk D. Marbus, Romain Freund, James R. Anstey, Martine Antoine, Nathalie Ausselet, Christian van Delden, Asmae Belhaj, Jerina Boelens, Helene Guillot, Hans de Beenhouwer, Catherine Denis, Erwin Ho, Margareta Ieven, Stijn Jonckheere and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

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], 1.1–1.8), invasive fungal infection (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 1-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 1-year success rate (cured and surviving) of 88% and a 5.9% risk of relapse (median follow-up 49 [6–136] 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.