Risk factors for Nocardia infection among allogeneic hematopoietic cell transplant recipients: A case-control study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation.

Nocardiosis is a rare but life-threatening infection after hematopoietic cell transplantation (HCT). We aimed at identifying risk factors for nocardiosis after allogeneic HCT and clarifying the effect of trimethoprim-sulfamethoxazole prophylaxis on its occurrence. We performed a retrospective multicenter case-control study of patients diagnosed with nocardiosis after allogeneic HCT between January 2000 and December 2018. For each case, two controls were matched by center, transplant date, and age group. Multivariable analysis was conducted using conditional logistic regression to identify potential risk factors for nocardiosis. Kaplan-Meier survival curves of cases and controls were compared using log-rank tests. Sixty-four cases and 128 controls were included. Nocardiosis occurred at a median of 9 months after allogeneic HCT (interquartile range: 5-18). After adjustment for potential confounders in a multivariable model, Nocardia infection was associated with tacrolimus use (adjusted odds ratio [aOR] 9.9, 95% confidence interval [95% CI]: 1.6-62.7), lymphocyte count <500/µL (aOR 8.9, 95% CI: 2.3-34.7), male sex (aOR 8.1, 95% CI: 2.1-31.5), recent use of systemic corticosteroids (aOR 7.9, 95% CI: 2.2-28.2), and recent CMV infection (aOR 4.3, 95% CI: 1.2-15.9). Conversely, use of trimethoprim-sulfamethoxazole prophylaxis was associated with a significantly decreased risk of nocardiosis (aOR 0.2, 95% CI: 0.1-0.8). HCT recipients who developed nocardiosis had a significantly decreased survival, as compared with controls (12-month survival: 58% and 90%, respectively; p<0.0001). We identified six factors independently associated with the occurrence of nocardiosis among allogeneic HCT recipients. In particular, trimethoprim-sulfamethoxazole prophylaxis was found to protect against nocardiosis.

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Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Julien De Greef, Dina Averbuch, Laura Tondeur, Amélie Duréault, Tsila Zuckerman, Xavier Roussel, Christine Robin, Alienor Xhaard, Simona Pagliuca, Yves Beguin, Carmen Botella-Garcia, Nina Khanna, Amandine Le Bourgeois, Jens Van Praet, Aloysius Ho, Nicolaus Kröger, Sophie Ducastelle Leprêtre, Damien Roos-Weil, Mahmoud Aljurf, Nicole Blijlevens, Igor Wolfgang Blau, Kristina Carlson, Matthew Collin, Arnold Ganser, Alban Villate, Johannes Lakner, Sonja Martin, Arnon Nagler, Ron Ram, Anna Torrent, Maria Stamouli, Malgorzata Mikulska, Lidia Gil, Lotus Wendel, Gloria Tridello, Nina Knelange, Rafael de la Camara, Olivier Lortholary, Arnaud Fontanet, Jan Styczynski, Johan Maertens, Julien Coussement, David Lebeaux