Nocardia infection in kidney transplant recipients: A single-center experience

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.