Majeed Aneela, Beatty Norman, Iftikhar Ahmad, Mushtaq Adeela, Fisher Julia, Gaynor Pryce, Kim Jeeyong C, Marquez Jose L, Mora Francisco E, Georgescu Anca, Zangeneh Tirdad
Division of Infectious Diseases, Department of Medicine, The University of Arizona, Tucson, AZ, USA.
Division of Hematology & Oncology, Department of Medicine, The University of Arizona, Tucson, AZ, USA.
Transpl Infect Dis. 2018 Aug;20(4):e12904. doi: 10.1111/tid.12904. Epub 2018 May 9.
Nocardiosis is a life-threatening opportunistic infection. Solid organ transplant (SOT) recipients are at higher risk (incidence 0.04%-3.5%) of developing nocardiosis. Rate of nocardiosis in the Southwestern US may be high due to environmental factors.
We performed a retrospective review study on 54 SOT patients diagnosed with Nocardia between 1997 and 2016 at our center. To explore the association of various risk factors with both the development of disseminated disease and mortality, a series of Fisher's exact tests was used.
Incidence of nocardiosis in SOT patients was 2.65%. Fisher's exact tests revealed no association between development of disseminated disease and the following variables: transplant rejection (P = 1), elevated tacrolimus levels (P = .4), and CMV viremia (P = .06). Also, we did not find any association between mortality and the variables we evaluated: type of transplant, transplant rejection, renal failure, disseminated nocardia, and patient's age. Overall mortality and 1-year mortality were 17% and 11%.
Based on our findings, daily 1 DS TMP/SMX prophylaxis did not appear to provide reliable protection against nocardiosis. However, we could not state definitely that TMP/SMX prophylaxis was or wasn't protective because of lack control group. None of the Fisher's exact tests revealed associations between the tested risk factors and either disease dissemination or mortality. This could be due to a true lack of association between the variables in each pair. However, it is also likely that our relatively small sample size limited our power to detect underlying relationships that may be present. Compared with other studies, 1-year mortality was lower at our institution (11% vs 16%).
诺卡菌病是一种危及生命的机会性感染。实体器官移植（SOT）受者发生诺卡菌病的风险更高（发病率为0.04%-3.5%）。由于环境因素，美国西南部的诺卡菌病发病率可能较高。
我们对1997年至2016年期间在我们中心被诊断为诺卡菌的54例SOT患者进行了一项回顾性研究。为了探讨各种危险因素与播散性疾病发生和死亡率之间的关联，我们使用了一系列Fisher精确检验。
SOT患者中诺卡菌病的发病率为2.65%。Fisher精确检验显示，播散性疾病的发生与以下变量之间无关联：移植排斥反应（P = 1）、他克莫司水平升高（P = 0.4）和巨细胞病毒（CMV）（P = 0.06）。此外，我们没有发现死亡率与我们评估的变量之间存在任何关联：移植类型、移植排斥反应、肾衰竭、播散性诺卡菌病和患者年龄。总体死亡率和1年死亡率分别为17%和11%。
根据我们的研究结果，每日1双倍剂量的甲氧苄啶/磺胺甲噁唑（TMP/SMX）预防似乎不能提供可靠的诺卡菌病防护。然而，由于缺乏对照组，我们不能肯定地说TMP/SMX预防有或没有保护作用。Fisher精确检验均未显示所测试的危险因素与疾病播散或死亡率之间存在关联。这可能是由于每对变量之间确实缺乏关联。然而，也有可能是我们相对较小的样本量限制了我们检测可能存在的潜在关系的能力。与其他研究相比，我们机构的1年死亡率较低（11%对16%）。
