Nocardia infections in hematopoietic cell transplant recipients: a multicenter international retrospective study of the Infectious Diseases Working Party (IDWP) of the European Society for Blood and Marrow Transplantation (EBMT).

Averbuch, Diana;De Greef, Julien;Duréault, Amelie;Wendel, Lotus;European Study Group for Nocardia in Hematopoietic Cell Transplantation;et.al.
(2022) Clinical infectious diseases — Vol. 75, n° 1, p. 88-97 (2022)

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Authors
  • Averbuch, Diana
    Co-first author
  • De Greef, Julienorcid-logoUCLouvain
    Co-first author
  • Duréault, Amelie
    Author
  • Wendel, Lotus
    Author
  • European Study Group for Nocardia in Hematopoietic Cell Transplantation
    Collaborator
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Abstract
BACKGROUND: Nocardiosis is rare after hematopoietic cell transplantation (HCT). Little is known regarding its presentation, management, and outcome in this population. METHODS: In this retrospective international study, we reviewed nocardiosis episodes in HCT recipients (01.01.2000-31.12.2018; 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 at 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%); and brain imaging findings were multiple brain abscesses (19/30; 63%). 10/30 (33%) patients with brain involvement lacked neurological symptoms. 14/48 (29%) patients were bacteremic. N. 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 one-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.
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Averbuch, D., De Greef, J., Duréault, 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., et al. (2022). Nocardia infections in hematopoietic cell transplant recipients: a multicenter international retrospective study of the Infectious Diseases Working Party (IDWP) of the European Society for Blood and Marrow Transplantation (EBMT). Clinical infectious diseases, 75(1), 88-97. https://doi.org/10.1093/cid/ciab866 (Original work published 2022)