Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Transpl Infect Dis. 2023 Oct;25(5):e14097. doi: 10.1111/tid.14097. Epub 2023 Jun 28.
Specific pretransplant infections have been associated with poor posttransplant outcomes. However, the impact of pretransplant Nocardia isolation has not been studied.
We performed a retrospective study from three centers in Arizona, Florida, and Minnesota of patients with Nocardia infection or colonization who subsequently underwent solid organ or hematopoietic stem cell transplantation from November 2011 through April 2022. Outcomes included posttransplant Nocardia infection and mortality.
Nine patients with pretransplant Nocardia were included. Two patients were deemed colonized with Nocardia, and the remaining seven had nocardiosis. These patients underwent bilateral lung (N = 5), heart (N = 1), heart-kidney (N = 1), liver-kidney (N = 1), and allogeneic stem cell transplantation (N = 1) at a median of 283 (interquartile range [IQR] 152-283) days after Nocardia isolation. Two (22.2%) patients had disseminated infection, and two were receiving active Nocardia treatment at the time of transplantation. One Nocardia isolate was resistant to trimethoprim-sulfamethoxazole (TMP-SMX) and all patients received TMP-SMX prophylaxis posttransplant, often for extended durations. No patients developed posttransplant nocardiosis during a median follow-up of 1.96 (IQR 0.90-6.33) years. Two patients died during follow-up, both without evidence of nocardiosis.
This study did not identify any episodes of posttransplant nocardiosis among nine patients with pretransplant Nocardia isolation. As patients with the most severe infections may have been denied transplantation, further studies with larger sample sizes are needed to better analyze any impact of pretransplant Nocardia on posttransplant outcomes. However, among patients who receive posttransplant TMP-SMX prophylaxis, these data suggest pretransplant Nocardia isolation may not impart a heightened risk of posttransplant nocardiosis.
特定的移植前感染与移植后不良结局有关。然而，移植前诺卡氏菌分离的影响尚未得到研究。
我们对 2011 年 11 月至 2022 年 4 月期间在亚利桑那州、佛罗里达州和明尼苏达州的三个中心接受过诺卡氏菌感染或定植且随后接受实体器官或造血干细胞移植的患者进行了回顾性研究。结果包括移植后诺卡氏菌感染和死亡率。
纳入了 9 例移植前诺卡氏菌的患者。2 例患者被认为是诺卡氏菌定植，其余 7 例患者患有诺卡氏菌病。这些患者在分离出诺卡氏菌后中位 283（四分位距 [IQR]152-283）天进行了双侧肺（N=5）、心脏（N=1）、心肾（N=1）、肝肾（N=1）和异基因干细胞移植（N=1）。2 例（22.2%）患者发生播散性感染，2 例患者在移植时正在接受诺卡氏菌的积极治疗。1 种诺卡氏菌分离株对甲氧苄啶-磺胺甲恶唑（TMP-SMX）耐药，所有患者在移植后均接受 TMP-SMX 预防，通常持续较长时间。在中位随访 1.96（IQR0.90-6.33）年期间，没有患者发生移植后诺卡氏菌病。2 例患者在随访期间死亡，均无诺卡氏菌病的证据。
本研究未发现 9 例移植前分离出诺卡氏菌的患者中有任何移植后发生诺卡氏菌病的病例。由于最严重感染的患者可能被拒绝移植，因此需要进一步的研究，以更大的样本量来更好地分析移植前诺卡氏菌对移植后结局的影响。然而，在接受移植后 TMP-SMX 预防的患者中，这些数据表明移植前诺卡氏菌分离可能不会增加移植后诺卡氏菌病的风险。
