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

Averbuch, D; De Greef, J; Dureault, A; Wendel, L; Tridello, G; Lebeaux, D; Mikulska, M; Gil, L; Knelange, N; Zuckerman, T; Roussel, X; Robin, C; Xhaard, A; Aljurf, M; Beguin, Y; Le Bourgeois, A; Botella-Garcia, C; Khanna, N; Van Praet, J; Kroger, N; Blijlevens, N; Ducastelle Lepretre, S; Ho, A; Roos-Weil, D; Yeshurun, M; Lortholary, O; Fontanet, A; de la Camara, R; Coussement, J; Maertens, J; Styczynski, J; European Study Group for Nocardia in Hematopoietic Cell Transplantation

Author(s): Averbuch, D; De Greef, J; Dureault, A; Wendel, L; Tridello, G; Lebeaux, D; Mikulska, M; Gil, L; Knelange, N; Zuckerman, T; Roussel, X; Robin, C; Xhaard, A; Aljurf, M; Beguin, Y; Le Bourgeois, A; Botella-Garcia, C; Khanna, N; Van Praet, J; Kroger, N; Blijlevens, N; Ducastelle Lepretre, S; Ho, A; Roos-Weil, D; Yeshurun, M; Lortholary, O; Fontanet, A; de la Camara, R; Coussement, J; Maertens, J; Styczynski, J; European Study Group for Nocardia in Hematopoietic Cell Transplantation;
Details: Publication Year 2022-08-24,Volume 75,Issue #1,Page 88-97
Journal Title: Clinical Infectious Diseases
Publication Type: Research article
Abstract: 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.
Keywords: Anti-Bacterial Agents/therapeutic use; *Bacteremia/drug therapy; Bone Marrow; *Communicable Diseases/drug therapy; *Hematopoietic Stem Cell Transplantation/adverse effects; Humans; *Lung Diseases/microbiology; *Nocardia; *Nocardia Infections/diagnosis/drug therapy/epidemiology; Retrospective Studies; Transplant Recipients; central nervous system infection; hematopoietic cell transplantation; mortality; nocardiosis
Department(s): Infectious Diseases
PubMed ID: 34596213
Publisher's Version: https://doi.org/10.1093/cid/ciab866
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-09-26 05:45:20

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