Nocardia infection in kidney transplant recipients: A single-center experience.
Adult
Aged
Anti-Bacterial Agents
/ therapeutic use
Antibiotic Prophylaxis
/ methods
Female
Humans
Immunocompromised Host
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Nocardia
/ immunology
Nocardia Infections
/ diagnosis
Opportunistic Infections
/ diagnosis
Retrospective Studies
Risk Factors
Severity of Illness Index
Survival Analysis
Trimethoprim, Sulfamethoxazole Drug Combination
/ therapeutic use
Nocardia
immunocompromised
kidney transplant
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
received:
01
07
2019
revised:
23
09
2019
accepted:
29
09
2019
pubmed:
10
10
2019
medline:
1
5
2020
entrez:
10
10
2019
Statut:
ppublish
Résumé
Data on Nocardia infection in kidney transplant patients remain limited. A chart review of patients with a history of kidney transplant and one positive culture for Nocardia between 1999 and 2019 was performed. Ten patients (0.1%) had a Nocardia infection. Eight were deceased donor kidney transplant recipients, and the mean age at the time of transplant was 56.0 ± 14.5 years. Nocardia infection occurred at a median of 12 months (range, 6-102) after transplant with half of the cases within 1 year. Breakthrough Nocardia infection occurred in five patients receiving daily double-strength (160/800 mg) TMP-SMX as prophylaxis. Half of the patients had comorbid CMV infection at diagnosis. The most common site involved was the lung. TMP-SMX was the most frequently used antimicrobial agent for treating Nocardia infection (9 of 10); it was administered as single-drug therapy (4 of 10) or as combination therapy with other antimicrobials (5 of 10). Overall mortality was 60% with 30% attributable mortality within a mean of 3.3 ± 7.7 weeks after a diagnosis of Nocardia. TMP-SMX prophylaxis did not appear to protect against Nocardia but did appear to be associated with less severe disease. Overall outcomes remain poor, and infection can occur outside the traditional window.
Sections du résumé
BACKGROUND
BACKGROUND
Data on Nocardia infection in kidney transplant patients remain limited.
METHODS
METHODS
A chart review of patients with a history of kidney transplant and one positive culture for Nocardia between 1999 and 2019 was performed.
RESULTS
RESULTS
Ten patients (0.1%) had a Nocardia infection. Eight were deceased donor kidney transplant recipients, and the mean age at the time of transplant was 56.0 ± 14.5 years. Nocardia infection occurred at a median of 12 months (range, 6-102) after transplant with half of the cases within 1 year. Breakthrough Nocardia infection occurred in five patients receiving daily double-strength (160/800 mg) TMP-SMX as prophylaxis. Half of the patients had comorbid CMV infection at diagnosis. The most common site involved was the lung. TMP-SMX was the most frequently used antimicrobial agent for treating Nocardia infection (9 of 10); it was administered as single-drug therapy (4 of 10) or as combination therapy with other antimicrobials (5 of 10). Overall mortality was 60% with 30% attributable mortality within a mean of 3.3 ± 7.7 weeks after a diagnosis of Nocardia.
DISCUSSION
CONCLUSIONS
TMP-SMX prophylaxis did not appear to protect against Nocardia but did appear to be associated with less severe disease. Overall outcomes remain poor, and infection can occur outside the traditional window.
Substances chimiques
Anti-Bacterial Agents
0
Trimethoprim, Sulfamethoxazole Drug Combination
8064-90-2
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13192Informations de copyright
© 2019 Wiley Periodicals, Inc.
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