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Transplant recipients with nocardiosis face 10-fold greater mortality
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Solid organ transplant patients with nocardiosis had a 10-fold greater 1-year mortality compared with control transplant recipients, researchers in Europe found.
“Although several reports have indicated that nocardiosis is associated with increased mortality in solid organ transplant recipients, a precise assessment of its impact on outcome is still lacking,” David Lebeaux, MD, PhD, of the Université Paris Descartes, Paris, and colleagues wrote.
Lebeaux and colleagues noted that reported nocardiosis mortality rates in patients after undergoing organ transplantation varied from 0 to 70%.
“Improved understanding of the impact of nocardiosis on outcomes after standard organ transplantation and of factors associated with outcomes may help delineate a group of patients requiring a specific initial diagnostic work-up, treatment and/or follow-up.”
The researchers reviewed data on 117 solid organ transplant recipients with nocardiosis who participated in a multicenter European case-control study. All patients were diagnosed between 2000 and 2014 and compared to 233 controls. Lebeaux and colleagues identified factors associated with 1-year mortality using multivariable conditional logistic regression.
Transplant recipients with nocardiosis had 1-year mortality rate of 16.2%, a 10-fold greater rate than control transplant recipients (1.3%; P < .001), the researchers wrote. Other factors associated with 1-year mortality were a history of tumors (OR = 1.4; 95% CI, 1.1-1.8), donor age (OR = 1.0046; 95% CI, 1.0007-1.0083) and invasive fungal infection in the 6-month period preceding nocardiosis (OR = 1.3; 95% CI, 1.1-1.5). Lebeaux and colleagues reported that patients with acute rejection in the year preceding nocardiosis experienced improved survival (OR = 0.85; 95% CI, 0.73-0.98). Eighty-eight percent (n = 15) of the 17 patients who received short-course antibiotics were cured. One (5.9%) of those patients died within the first year, the researchers wrote, whereas another relapsed (5.9%).
Lebeaux and colleagues wrote that the study was limited by its retrospective nature and lack of information on tapering of immunosuppressive drugs or therapy compliance.
“In our European cohort, 1-year all-cause mortality was more than 10 times higher in the 117 solid organ transplant recipients with nocardiosis than in control transplant recipients,” the researchers wrote. “Our findings support the suggestion that short-course antibiotic treatment may be a strategy for further study.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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