Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Transpl Infect Dis. 2021 Dec;23(6):e13753. doi: 10.1111/tid.13753. Epub 2021 Nov 12.
Immunocompromised individuals are at risk for Nocardia infection, with a recurrence rate of approximately 5%. Solid organ transplant (SOT) recipients often receive secondary prophylaxis due to their requirement of lifelong immunosuppression. However, data supporting this practice is sparse. We sought to evaluate Nocardia recurrence in SOT recipients, specifically evaluating secondary prophylaxis.
We conducted a retrospective cohort study of SOT recipients diagnosed with nocardiosis from 2000 through 2020. We included adult SOT recipients who completed their course of Nocardia therapy and had at least 6 months of posttherapy follow-up. The primary outcome was Nocardia recurrence, which included relapse and reinfection.
One hundred two patients met inclusion criteria. Sixty-six (64.7%) were male and mean age was 58.6 ± 11.7 years. Most common SOT types were kidney (46.1%), heart (18.6%), kidney-pancreas (11.8%), and lung (10.8%). Most common sites of infection were lung (85.3%), skin (17.6%), and brain (14.7%). Secondary prophylaxis was utilized in 53 (52.0%) patients. Trimethoprim-sulfamethoxazole (TMP-SMX) single-strength daily was the most common prophylaxis agent and dose. Five patients (4.9%) experienced Nocardia recurrence, three of which were receiving secondary prophylaxis at time of recurrence. Two recurrences were with the same Nocardia species. Factors associated with recurrence were lung transplantation (p = .011), chronic lung disease (p = .032), and treatment ≤120 days (p = .006). Time from treatment completion to recurrence ranged from 107 to 875 days.
Nocardia recurrence in SOT recipients is an uncommon event. TMP-SMX secondary prophylaxis is incompletely protective and recurrence may be dependent upon other factors. Further study of secondary prophylaxis is warranted.
免疫功能低下的个体存在感染诺卡氏菌的风险，复发率约为 5%。由于需要终身接受免疫抑制治疗，实体器官移植（SOT）受者常需接受二级预防。然而，支持这种做法的数据很少。我们旨在评估 SOT 受者的诺卡氏菌复发情况，特别是评估二级预防。
我们对 2000 年至 2020 年期间诊断为诺卡氏菌病的 SOT 受者进行了回顾性队列研究。我们纳入了完成诺卡氏菌治疗且治疗后有至少 6 个月随访的成年 SOT 受者。主要结局是诺卡氏菌复发，包括复发和再感染。
102 例患者符合纳入标准。66 例（64.7%）为男性，平均年龄为 58.6 ± 11.7 岁。最常见的 SOT 类型是肾（46.1%）、心（18.6%）、肾-胰腺（11.8%）和肺（10.8%）。最常见的感染部位是肺（85.3%）、皮肤（17.6%）和脑（14.7%）。53 例（52.0%）患者接受了二级预防。TMP-SMX 单强度日剂量是最常用的预防药物和剂量。5 例（4.9%）患者发生诺卡氏菌复发，其中 3 例在复发时接受二级预防。2 例复发为同种诺卡氏菌。与复发相关的因素包括肺移植（p=0.011）、慢性肺部疾病（p=0.032）和治疗时间≤120 天（p=0.006）。从治疗完成到复发的时间为 107 至 875 天。
SOT 受者的诺卡氏菌复发是一种罕见事件。TMP-SMX 二级预防不完全有效，复发可能取决于其他因素。需要进一步研究二级预防。
