Risk factors, clinical characteristics, and outcome of nocardia infection in organ transplant recipients: A matched case-control study

被引:267
作者
Peleg, Anton Y.
Husain, Shahid
Qureshi, Zubair A.
Silveira, Fernanda P.
Sarumi, Molade
Shutt, Kathleen A.
Kwak, Eun J.
Paterson, David L.
机构
[1] Beth Israel Deaconess Med Ctr, Dept Infect Dis, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Boston, MA 02215 USA
[3] Univ Pittsburgh, Med Ctr, Div Infect Dis, Pittsburgh, PA USA
关键词
D O I
10.1086/514340
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Risk factors for Nocardia infection in organ transplant recipients have not been formally assessed in the current era of transplantation. Methods. We performed a matched case-control study (1: 2 ratio) between January 1995 and December 2005. Control subjects were matched for transplant type and timing. Univariate matched odds ratios were determined and conditional logistic regression was performed to identify independent risk factors. Clinical and microbiological characteristics of all case patients were reviewed. Results. Among 5126 organ transplant recipients, 35 (0.6%) were identified as having cases of Nocardia infection. The highest frequency was among recipients of lung transplants (18 [3.5%] of 521 patients), followed by recipients of heart (10 [2.5%] of 392), intestinal (2 [1.3%] of 155), kidney (3 [0.2%] of 1717), and liver ( 2 [0.1%] of 1840) transplants. In a comparison of case patients with 70 matched control subjects, receipt of high-dose steroids (odds ratio, 27; 95% confidence interval, 3.2-235; P = .003) and cytomegalovirus disease (odds ratio, 6.9; 95% confidence interval, 1.02-46; P = . 047) in the preceding 6 months and a high median calcineurin inhibitor level in the preceding 30 days (odds ratio, 5.8; 95% confidence interval, 1.5-22; P = .012) were found to be independent risk factors for Nocardia infection. The majority of case patients (27 [77%] of 35) had pulmonary disease only. Seven transplant recipients ( 20%) had disseminated disease. Nocardia nova was the most common species ( found in 17 [49%] of the patients), followed by Nocardia farcinica (9 [28%]), Nocardia asteroides ( 8 [23%]), and Nocardia brasiliensis (1 [3%]). Of the 35 case patients, 24 (69%) were receiving trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia prophylaxis. Thirty-one case patients (89%) experienced cure of their Nocardia infection. Conclusions. Receipt of high-dose steroids, history of cytomegalovirus disease, and high levels of calcineurin inhibitors are independent risk factors for Nocardia infection in organ transplant recipients. Our study provides insights into the epidemiology of Nocardia infection in the current era, a period in which immunosuppressive and prophylactic regimens have greatly evolved.
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页码:1307 / 1314
页数:8
相关论文
共 35 条
[1]  
AHERN MJ, 1978, YALE J BIOL MED, V51, P513
[2]  
[Anonymous], AM J TRANSPLANT S10
[3]   NOCARDIOSIS IN RENAL-TRANSPLANT RECIPIENTS UNDERGOING IMMUNOSUPPRESSION WITH CYCLOSPORINE [J].
ARDUINO, RC ;
JOHNSON, PC ;
MIRANDA, AG .
CLINICAL INFECTIOUS DISEASES, 1993, 16 (04) :505-512
[4]  
BACH MC, 1973, LANCET, V1, P180
[5]   NOCARDIA SPECIES - HOST-PARASITE RELATIONSHIPS [J].
BEAMAN, BL ;
BEAMAN, L .
CLINICAL MICROBIOLOGY REVIEWS, 1994, 7 (02) :213-264
[6]   Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy [J].
Brown-Elliott, BA ;
Brown, JM ;
Conville, PS ;
Wallace, RJ .
CLINICAL MICROBIOLOGY REVIEWS, 2006, 19 (02) :259-+
[7]   In vitro activities of linezolid against multiple Nocardia species [J].
Brown-Elliott, BA ;
Ward, SC ;
Crist, CJ ;
Mann, LB ;
Wilson, RW ;
Wallace, RJ .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2001, 45 (04) :1295-1297
[8]   Diagnostic standards and classification of tuberculosis in adults and children [J].
Dunlap, NE ;
Bass, J ;
Fujiwara, P ;
Hopewell, P ;
Horsburgh, CR ;
Salfinger, M ;
Simone, PM .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 161 (04) :1376-1395
[9]   RISK FACTOR-ANALYSIS IN RENAL-TRANSPLANTATION - GUIDELINES FOR MANAGEMENT OF TRANSPLANT RECIPIENT [J].
FINKELSTEIN, FO ;
BLACK, HR .
AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 1974, 267 (03) :159-169
[10]   NOCARDIOSIS IN LIVER-TRANSPLANTATION - VARIATION IN PRESENTATION, DIAGNOSIS AND THERAPY [J].
FORBES, GM ;
HARVEY, FAH ;
PHILPOTTHOWARD, JN ;
OGRADY, JG ;
JENSEN, RD ;
SAHATHEVAN, M ;
CASEWELL, MW ;
WILLIAMS, R .
JOURNAL OF INFECTION, 1990, 20 (01) :11-19