Nocardia Infections in Hematopoietic Cell Transplant Recipients : A Multicenter International Retrospective Study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation
© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissionsoup.com..
BACKGROUND: Nocardiosis is rare after hematopoietic cell transplantation (HCT). Little is known regarding its presentation, management, and outcome in this population.
METHODS: This retrospective international study reviewed nocardiosis episodes in HCT recipients (1/1/2000-31/12/2018; 135 transplant centers; 33 countries) and described their clinical, microbiological, radiological, and outcome characteristics.
RESULTS: We identified 81 nocardiosis episodes in 74 allo- and 7 auto-HCT recipients. Nocardiosis occurred a median of 8 (IQR: 4-18) months post-HCT. The most frequently involved organs were lungs (70/81; 86%) and brain (30/81; 37%); 29 (36%) patients were afebrile; 46/81 (57%) had disseminated infections. The most common lung imaging findings were consolidations (33/68; 49%) or nodules (32/68; 47%); brain imaging findings were multiple brain abscesses (19/30; 63%). Ten of 30 (33%) patients with brain involvement lacked neurological symptoms. Fourteen of 48 (29%) patients were bacteremic. Nocardia farcinica was the most common among molecularly identified species (27%; 12/44). Highest susceptibility rates were reported to linezolid (45/45; 100%), amikacin (56/57; 98%), trimethoprim-sulfamethoxazole (57/63; 90%), and imipenem (49/57; 86%). One-year and last follow-up (IQR: 4-42.5 months) all-cause mortality were 40% (32/81) and 52% (42/81), respectively. In the multivariable analysis, underlying disease not in complete remission (HR: 2.81; 95% CI: 1.32-5.95) and prior bacterial infection (HR: 3.42; 95% CI: 1.62-7.22) were associated with higher 1-year all-cause mortality.
CONCLUSIONS: Nocardiosis is a late post-HCT infection usually manifesting as a pulmonary disease with frequent dissemination, brain infection, and bacteremia. Brain imaging should be performed in HCT recipients with nocardiosis regardless of neurological symptoms. Overall mortality is high.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:75 |
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| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - 75(2022), 1 vom: 24. Aug., Seite 88-97 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Averbuch, Diana [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-Bacterial Agents |
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| Anmerkungen: |
Date Completed 29.08.2022 Date Revised 30.08.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/cid/ciab866 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Nocardia Infections in Hematopoietic Cell Transplant Recipients |b A Multicenter International Retrospective Study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Nocardiosis is rare after hematopoietic cell transplantation (HCT). Little is known regarding its presentation, management, and outcome in this population | ||
| 520 | |a METHODS: This retrospective international study reviewed nocardiosis episodes in HCT recipients (1/1/2000-31/12/2018; 135 transplant centers; 33 countries) and described their clinical, microbiological, radiological, and outcome characteristics | ||
| 520 | |a RESULTS: We identified 81 nocardiosis episodes in 74 allo- and 7 auto-HCT recipients. Nocardiosis occurred a median of 8 (IQR: 4-18) months post-HCT. The most frequently involved organs were lungs (70/81; 86%) and brain (30/81; 37%); 29 (36%) patients were afebrile; 46/81 (57%) had disseminated infections. The most common lung imaging findings were consolidations (33/68; 49%) or nodules (32/68; 47%); brain imaging findings were multiple brain abscesses (19/30; 63%). Ten of 30 (33%) patients with brain involvement lacked neurological symptoms. Fourteen of 48 (29%) patients were bacteremic. Nocardia farcinica was the most common among molecularly identified species (27%; 12/44). Highest susceptibility rates were reported to linezolid (45/45; 100%), amikacin (56/57; 98%), trimethoprim-sulfamethoxazole (57/63; 90%), and imipenem (49/57; 86%). One-year and last follow-up (IQR: 4-42.5 months) all-cause mortality were 40% (32/81) and 52% (42/81), respectively. In the multivariable analysis, underlying disease not in complete remission (HR: 2.81; 95% CI: 1.32-5.95) and prior bacterial infection (HR: 3.42; 95% CI: 1.62-7.22) were associated with higher 1-year all-cause mortality | ||
| 520 | |a CONCLUSIONS: Nocardiosis is a late post-HCT infection usually manifesting as a pulmonary disease with frequent dissemination, brain infection, and bacteremia. Brain imaging should be performed in HCT recipients with nocardiosis regardless of neurological symptoms. Overall mortality is high | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a central nervous system infection | |
| 650 | 4 | |a hematopoietic cell transplantation | |
| 650 | 4 | |a mortality | |
| 650 | 4 | |a nocardiosis | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a De Greef, Julien |e verfasserin |4 aut | |
| 700 | 1 | |a Duréault, Amelie |e verfasserin |4 aut | |
| 700 | 1 | |a Wendel, Lotus |e verfasserin |4 aut | |
| 700 | 1 | |a Tridello, Gloria |e verfasserin |4 aut | |
| 700 | 1 | |a Lebeaux, David |e verfasserin |4 aut | |
| 700 | 1 | |a Mikulska, Malgorzata |e verfasserin |4 aut | |
| 700 | 1 | |a Gil, Lidia |e verfasserin |4 aut | |
| 700 | 1 | |a Knelange, Nina |e verfasserin |4 aut | |
| 700 | 1 | |a Zuckerman, Tsila |e verfasserin |4 aut | |
| 700 | 1 | |a Roussel, Xavier |e verfasserin |4 aut | |
| 700 | 1 | |a Robin, Christine |e verfasserin |4 aut | |
| 700 | 1 | |a Xhaard, Alienor |e verfasserin |4 aut | |
| 700 | 1 | |a Aljurf, Mahmoud |e verfasserin |4 aut | |
| 700 | 1 | |a Beguin, Yves |e verfasserin |4 aut | |
| 700 | 1 | |a Le Bourgeois, Amandine |e verfasserin |4 aut | |
| 700 | 1 | |a Botella-Garcia, Carmen |e verfasserin |4 aut | |
| 700 | 1 | |a Khanna, Nina |e verfasserin |4 aut | |
| 700 | 1 | |a Van Praet, Jens |e verfasserin |4 aut | |
| 700 | 1 | |a Kröger, Nicolaus |e verfasserin |4 aut | |
| 700 | 1 | |a Blijlevens, Nicole |e verfasserin |4 aut | |
| 700 | 1 | |a Ducastelle Leprêtre, Sophie |e verfasserin |4 aut | |
| 700 | 1 | |a Ho, Aloysius |e verfasserin |4 aut | |
| 700 | 1 | |a Roos-Weil, Damien |e verfasserin |4 aut | |
| 700 | 1 | |a Yeshurun, Moshe |e verfasserin |4 aut | |
| 700 | 1 | |a Lortholary, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Fontanet, Arnaud |e verfasserin |4 aut | |
| 700 | 1 | |a de la Camara, Rafael |e verfasserin |4 aut | |
| 700 | 1 | |a Coussement, Julien |e verfasserin |4 aut | |
| 700 | 1 | |a Maertens, Johan |e verfasserin |4 aut | |
| 700 | 1 | |a Styczynski, Jan |e verfasserin |4 aut | |
| 700 | 0 | |a European Study Group for Nocardia in Hematopoietic Cell Transplantation |e verfasserin |4 aut | |
| 700 | 1 | |a Arat, M |e investigator |4 oth | |
| 700 | 1 | |a Blau, I W |e investigator |4 oth | |
| 700 | 1 | |a Bron, D |e investigator |4 oth | |
| 700 | 1 | |a Carlson, K |e investigator |4 oth | |
| 700 | 1 | |a Collin, M |e investigator |4 oth | |
| 700 | 1 | |a Cordonnier, C |e investigator |4 oth | |
| 700 | 1 | |a Ganser, A |e investigator |4 oth | |
| 700 | 1 | |a Gruhn, B |e investigator |4 oth | |
| 700 | 1 | |a Junghanss, C |e investigator |4 oth | |
| 700 | 1 | |a Marchand, T |e investigator |4 oth | |
| 700 | 1 | |a Martin, S |e investigator |4 oth | |
| 700 | 1 | |a Milone, G A |e investigator |4 oth | |
| 700 | 1 | |a Nagler, A |e investigator |4 oth | |
| 700 | 1 | |a Pagliuca, S |e investigator |4 oth | |
| 700 | 1 | |a Ram, R |e investigator |4 oth | |
| 700 | 1 | |a Ribera, J M |e investigator |4 oth | |
| 700 | 1 | |a de la Serna, J |e investigator |4 oth | |
| 700 | 1 | |a Stamouli, M |e investigator |4 oth | |
| 700 | 1 | |a Villate, A |e investigator |4 oth | |
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