Nocardia infections in solid organ transplantation: Guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation

Restrepo, Alejandro; Clark, Nina M.

doi:10.1111/ctr.13509

Cited by 130 publications

(142 citation statements)

References 148 publications

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“…TMP‐SMX remains the first‐line antimicrobial in the treatment of Nocardia infection . Experts recommend at least initial combination therapy with other agents, such as carbapenems, amikacin, and linezolid . In our cohort, TMP‐SMX monotherapy versus combination therapy did not seem to be associated with a difference in outcomes.…”

Section: Discussionmentioning

confidence: 61%

Nocardia infection in kidney transplant recipients: A single‐center experience

Matchett

Djamali

Mandelbrot

et al. 2019

Transplant Infectious Dis

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Background: Data on Nocardia infection in kidney transplant patients remain limited. Methods: A chart review of patients with a history of kidney transplant and one positive culture for Nocardia between 1999 and 2019 was performed. Results: Ten patients (0.1%) had a Nocardia infection. Eight were deceased donor kidney transplant recipients, and the mean age at the time of transplant was 56.0 ± 14.5 years. Nocardia infection occurred at a median of 12 months (range, 6-102) after transplant with half of the cases within 1 year. Breakthrough Nocardia infection occurred in five patients receiving daily double-strength (160/800 mg) TMP-SMX as prophylaxis. Half of the patients had comorbid CMV infection at diagnosis.The most common site involved was the lung. TMP-SMX was the most frequently used antimicrobial agent for treating Nocardia infection (9 of 10); it was administered as single-drug therapy (4 of 10) or as combination therapy with other antimicrobials (5 of 10). Overall mortality was 60% with 30% attributable mortality within a mean of 3.3 ± 7.7 weeks after a diagnosis of Nocardia.Discussion: TMP-SMX prophylaxis did not appear to protect against Nocardia but did appear to be associated with less severe disease. Overall outcomes remain poor, and infection can occur outside the traditional window.

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Section: Discussionmentioning

confidence: 61%

Nocardia infection in kidney transplant recipients: A single‐center experience

Matchett

Djamali

Mandelbrot

et al. 2019

Transplant Infectious Dis

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“…Nocardiosis is a well-recognized, albeit rare, complication of SOT. [6][7][8]25,54,91,92,[122][123][124][125][126] A retrospective review of 5,136 SOT recipients (SOTRs) at the University of Pittsburgh from January 1995 to December 2005 identified only 35 cases of nocardiosis (incidence: 0.6%). 54 In that study, nocardiosis was most common in lung transplant recipients (LTRs) and HTRs (3.5 and 2.5%, respectively), followed by intestine (1.3%), kidney (0.2%), and liver (0.1%) transplant recipients.…”

Section: Solid Organ Transplantmentioning

confidence: 99%

“…The choice of antimicrobial agent(s) and duration of therapy must take into account the site and severity of infection, degree of immunodeficiency or immunosuppression, antimicrobial susceptibility tests, and tolerance or adverse effects of antimicrobials(s). Sulfonamides (typically TMP-SMX) have been the mainstay of therapy for nocardiosis for more than 60 years, 1,37,126 but alternative agents may be required in regions where TMP-SMX resistance is high 105 or for species with higher rates of resistance to sulfonamides (e.g., N. pseudobrasiliensis, N. transvalensis, and N. farcinica). 37,52,53,56,102,243,244 Additionally, intolerance to sulfonamides may be problematic in some patients, particularly HIV-infected and organ-transplant recipients; adverse effects of TMP-SMX may include myelosuppression, nephrotoxicity, and significant drug interactions.…”

Section: Therapymentioning

confidence: 99%

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Nocardia spp.: A Rare Cause of Pneumonia Globally

Lynch

Reid

Clark

2020

Semin Respir Crit Care Med

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AbstractMembers of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

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“…Nocardia species belongs to actinomycetes, which can be found in the environment, especially water, soil and decaying vegetation [1,2]. These pathogens are usually the opportunistic, but may cause infections in immunocompromised patients [3], or rarely in immunocompetent individuals [4].…”

Section: Introductionmentioning

confidence: 99%

Nocardia farcinica meningitis in a patient with high-grade astrocytoma

Nasri

Fakhim

Barać³

et al. 2019

J Infect Dev Ctries

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We describe a case of 91-year-old male with astrocytoma who developed meningitis caused by Nocardia farcinica. He had a past medical history of anaplastic astrocytoma grade III. Endocranial computed tomography (CT) scan revealed mass lesion in the left occipital region associated with perilesional edema, without evidence of midline shift issue. The analyses of cerebrospinal fluid (CSF) revealed neutrophilic pleocytosis, hyperproteinorrachia and hypoglycorrhachia. Combined antimicrobial therapy was initiated (vancomycin, meropenem, acyclovir). CSF culture revealed Nocardia farcinica. Susceptibility testing revealed intermediate sensitivity to meropenem and antibiotic treatment was switched to trimethoprim-sulfamethoxazole and imipenem. After 7 days of treatment the patient developed progressive dyspnea. The chest CT scan revealed bilateral pleural effusion and alveolar infiltrate mostly in the right lobe. Ceftriaxone was added to the therapy, but the outcome was lethal. Nocardia spp. should be considered as differential diagnosis in the patients with brain tumor or meningitis in the setting of immune suppression and corticosteroid use. CSF cultures should be incubated longer with aim to allow fastidious organisms to grow, such as Nocardia spp.

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Nocardia infections in solid organ transplantation: Guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation

Cited by 130 publications

References 148 publications

Nocardia infection in kidney transplant recipients: A single‐center experience

Nocardia infection in kidney transplant recipients: A single‐center experience

Nocardia spp.: A Rare Cause of Pneumonia Globally

Nocardia farcinica meningitis in a patient with high-grade astrocytoma

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