Risk factors for Nocardia infection among allogeneic hematopoietic cell transplant recipients: A case-control study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation.

De Greef, Julien;Averbuch, Dina;Tondeur, Laura;Duréault, Amélie;Lebeaux, David;et.al.
(2024) Journal of Infection — Vol. 88, n° 6, p. 106162 [1-7] (2024)

Files

2024_De_Greef_J_Infect.pdf
  • Open Access
  • Adobe PDF
  • 787.13 KB
Download

Details

Authors
  • De Greef, Julienorcid-logoUCLouvain
    Co-first author
  • Averbuch, Dina
    Co-first author
  • Tondeur, Laura
    Author
  • Duréault, Amélie
    Author
  • Lebeaux, David
    Author
Show more
Abstract
OBJECTIVES: Nocardiosis is a rare but life-threatening infection after hematopoietic cell transplantation (HCT). We aimed at identifying risk factors for nocardiosis after allogeneic HCT and clarifying the effect of trimethoprim-sulfamethoxazole prophylaxis on its occurrence. METHODS: We performed a retrospective multicenter case-control study of patients diagnosed with nocardiosis after allogeneic HCT between January 2000 and December 2018. For each case, two controls were matched by center, transplant date, and age group. Multivariable analysis was conducted using conditional logistic regression to identify potential risk factors for nocardiosis. Kaplan-Meier survival curves of cases and controls were compared using log-rank tests. RESULTS: Sixty-four cases and 128 controls were included. Nocardiosis occurred at a median of 9 months after allogeneic HCT (interquartile range: 5-18). After adjustment for potential confounders in a multivariable model, Nocardia infection was associated with tacrolimus use (adjusted odds ratio [aOR] 9.9, 95 % confidence interval [95 % CI]: 1.6-62.7), lymphocyte count < 500/µL (aOR 8.9, 95 % CI: 2.3-34.7), male sex (aOR 8.1, 95 % CI: 2.1-31.5), recent use of systemic corticosteroids (aOR 7.9, 95 % CI: 2.2-28.2), and recent CMV infection (aOR 4.3, 95 % CI: 1.2-15.9). Conversely, use of trimethoprim-sulfamethoxazole prophylaxis was associated with a significantly decreased risk of nocardiosis (aOR 0.2, 95 % CI: 0.1-0.8). HCT recipients who developed nocardiosis had a significantly decreased survival, as compared with controls (12-month survival: 58 % and 90 %, respectively; p < 0.0001). CONCLUSIONS: We identified six factors independently associated with the occurrence of nocardiosis among allogeneic HCT recipients. In particular, trimethoprim-sulfamethoxazole prophylaxis was found to protect against nocardiosis.
Affiliations

Citations

  • APA
  • Chicago
  • FWB

De Greef, J., Averbuch, D., Tondeur, L., Duréault, A., Zuckerman, T., Roussel, X., Robin, C., Xhaard, A., Pagliuca, S., Beguin, Y., Botella-Garcia, C., Khanna, N., Le Bourgeois, A., Van Praet, J., Ho, A., Kröger, N., Ducastelle Leprêtre, S., Roos-Weil, D., Aljurf, M., et al. (2024). Risk factors for Nocardia infection among allogeneic hematopoietic cell transplant recipients: A case-control study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation. Journal of Infection, 88(6), 106162 [1-7]. https://doi.org/10.1016/j.jinf.2024.106162 (Original work published 2024)