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Published on: April 12, 2021
Antibiotic Tolerability in Nocardia Infection Among Kidney Transplant Recipients: A Multicenter Cohort Study
M Pérez-Mir1, C Canal Girol1, L Escolà-Vergé2,3
1Transplant Nephrology Unit, Department of Nephrology, Fundació Puigvert, Barcelona, Spain.
Summary
Nocardia infections in kidney transplant recipients are severe, with common antibiotics like trimethoprim-sulfamethoxazole and linezolid showing poor tolerability. Tedizolid offers a safer alternative for these high-risk patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Nocardia infection is a serious complication for kidney transplant recipients, associated with high rates of illness and death.
- Limited data exists on the tolerability of antibiotics used to treat Nocardia infections in this vulnerable patient group.
Purpose of the Study:
- To analyze the clinical features, treatment approaches, and antibiotic tolerability in kidney transplant recipients with Nocardia infection.
- To identify effective and safe treatment options for Nocardia infections in kidney transplant recipients.
Main Methods:
- A retrospective, multicenter study was conducted across six Spanish transplant centers.
- Data from 26 kidney transplant recipients diagnosed with Nocardia infection were analyzed.
Main Results:
- Pulmonary involvement was the most frequent presentation, with infections occurring beyond the first post-transplant year in most cases.
- Trimethoprim-sulfamethoxazole and linezolid demonstrated poor tolerability, leading to discontinuation in 80% and 90% of patients, respectively, due to adverse events like hyperkalemia, metabolic acidosis, acute kidney injury, and myelotoxicity.
- Tedizolid, used in 38.4% of cases, showed better tolerability with only 20% discontinuation and no reported relapses, alongside a 30.8% overall mortality rate primarily due to infection.
Conclusions:
- This study highlights the poor tolerability of trimethoprim-sulfamethoxazole and linezolid in kidney transplant recipients with Nocardia infection, emphasizing the need for alternative treatments.
- Tedizolid emerged as a promising option with a favorable safety profile, potentially suitable as a first-line treatment for high-risk kidney transplant patients.
- Further prospective research is recommended to validate these findings and inform clinical guidelines for managing Nocardia infections in kidney transplant recipients.
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