Nocardia Infection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study
Nocardia Infection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study
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DOI：
10.1093/cid/ciw241
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发表时间：
2016-08-01
影响因子：
11.8
通讯作者：
Jacobs, Frederique
中科院分区：
文献类型：
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作者：
Coussement, Julien;Lebeaux, David;Jacobs, Frederique
背景。诺卡菌病是一种罕见的、危及生命的机会性感染，在实体器官移植（SOT）后影响0.04%至3.5%的患者。本研究的目的是确定SOT后诺卡菌感染的危险因素，并描述这些患者诺卡菌病的表现。我们在欧洲36个中心（法国、比利时、瑞士、荷兰、西班牙）对2000年至2014年间SOT后诊断为诺卡菌病的成年患者进行了回顾性病例对照研究。每例2例对照受试者按机构、移植日期和移植器官匹配。采用条件logistic回归进行多变量分析，以确定诺卡病的危险因素。诺卡菌病117例，对照组234例。诺卡菌病发生的中位时间为移植后17.5个月（范围2-244个月）。在多变量分析中，诊断前一个月钙调磷酸酶抑制剂谷水平高（比值比[OR]， 6.11； 95%可信区间[CI]， 2.58-14.51）、诊断时他克莫司的使用（OR, 2.65; 95% CI, 1.17-6.00）和皮质类固醇剂量（OR, 1.12; 95% CI, 1.03-1.22）、患者年龄（OR, 1.04; 95% CI, 1.02-1.07）和SOT后重症监护病房的住院时间（OR, 1.04; 95% CI, 1.00-1.09）与诺卡菌病的发展独立相关；低剂量复方新诺明预防诺卡菌病未见效果。与其他诺卡菌相比，farcinica诺卡菌更常与脑、皮肤和皮下组织感染相关。30例中枢神经系统诺卡菌病患者中，13例（43.3%）无神经系统症状。我们确定了SOT后诺卡菌病的5个危险因素。低剂量复方新诺明对诺卡菌感染无预防作用。这些发现可能有助于改善对移植受者的管理。
Background. Nocardiosis is a rare, life-threatening opportunistic infection, affecting 0.04% to 3.5% of patients after solid organ transplant (SOT). The aim of this study was to identify risk factors for Nocardia infection after SOT and to describe the presentation of nocardiosis in these patients.Methods. We performed a retrospective case-control study of adult patients diagnosed with nocardiosis after SOT between 2000 and 2014 in 36 European (France, Belgium, Switzerland, the Netherlands, Spain) centers. Two control subjects per case were matched by institution, transplant date, and transplanted organ. A multivariable analysis was performed using conditional logistic regression to identify risk factors for nocardiosis.Results. One hundred and seventeen cases of nocardiosis and 234 control patients were included. Nocardiosis occurred at a median of 17.5 (range, 2-244) months after transplant. In multivariable analysis, high calcineurin inhibitor trough levels in the month before diagnosis (odds ratio [OR], 6.11; 95% confidence interval [CI], 2.58-14.51), use of tacrolimus (OR, 2.65; 95% CI, 1.17-6.00) and corticosteroid dose (OR, 1.12; 95% CI, 1.03-1.22) at the time of diagnosis, patient age (OR, 1.04; 95% CI, 1.02-1.07), and length of stay in the intensive care unit after SOT (OR, 1.04; 95% CI, 1.00-1.09) were independently associated with development of nocardiosis; low-dose cotrimoxazole prophylaxis was not found to prevent nocardiosis. Nocardia farcinica was more frequently associated with brain, skin, and subcutaneous tissue infections than were other Nocardia species. Among the 30 cases with central nervous system nocardiosis, 13 (43.3%) had no neurological symptoms.Conclusions. We identified 5 risk factors for nocardiosis after SOT. Low-dose cotrimoxazole was not found to prevent Nocardia infection. These findings may help improve management of transplant recipients.