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Nocardia infections in the transplanted host
Marion Hemmersbach-Miller1, Jason E Stout1, Michael H Woodworth2
1Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Summary
Nocardia infections are a late complication in transplant recipients, with poor outcomes, especially in hematopoietic cell transplant (HCT) patients. Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis did not prevent these infections or select for resistant strains.
Area of Science:
- Infectious Diseases
- Transplant Medicine
- Microbiology
Background:
- Nocardia are opportunistic pathogens primarily affecting immunocompromised individuals.
- Limited data exists on Nocardia infections in transplant recipients.
Purpose of the Study:
- To investigate the epidemiology and outcomes of Nocardia infections in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients.
- To assess the impact of trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis on Nocardia infections.
Main Methods:
- Retrospective chart review of transplant recipients with Nocardia infection from 1996-2013.
- Analysis of patient demographics, infection timing, site, and outcomes.
- Evaluation of TMP-SMX prophylaxis use and resistance patterns.
Main Results:
- 51 patients (14 HCT, 37 SOT) developed Nocardia infections.
- Lung was the most common infection site; infections occurred earlier in HCT recipients.
- Overall outcomes were poor, particularly in HCT recipients (29% cure rate); heart transplant recipients showed better survival.
Conclusions:
- Nocardia infections represent a late post-transplant complication.
- TMP-SMX prophylaxis did not prevent Nocardia infections or lead to resistance.
- Outcomes for Nocardia infections in transplant recipients remain challenging.
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