2307. Risk Factors for Nocardia Infection in Heart Transplant Patients
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Solid Organ Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Nocardia poser.pdf (124.8 kB)
  • Background: Infections related to Nocardia species occur more commonly in immunosuppressed patients, including solid organ transplant recipients. At our institution, we observed an increased incidence of Nocardiainfection in heart transplant recipients from 2011 – 2013.

    Methods: We performed a matched case-control study of heart transplant patients who received care at Vanderbilt University Medical Center between 2003 and 2013. Control patients were matched for duration of post-transplant follow up that corresponded to the time of the case patient’s Nocardia infection diagnosis. To identify risk factors associated with Nocardia infection, conditional logistic regression was performed to determine odds ratio (OR).

    Results: Among 331 heart transplant recipients, 11 (3%) developed infections from Nocardia spp. The incidence rose from 2.5 cases per 100 transplants from 2003 – 2010 to 4.5 cases per 100 transplants from 2011 – 2013. In comparison to 60 controls, cases were more likely to have elevated blood levels of calcineurin inhibitors (OR 6.7; 95% confidence interval [CI] 1.2-36.2) and more likely to have coinciding cytomegalovirus (CMV) infection (OR 9.9; CI 1.01-98), CMV disease (OR 13.9; CI 1.4-133), as well as a history of invasive fungal infection (OR 24.9; CI 2.9-214). Control patients were more likely to have an absolute lymphocyte count above 1000 cells/mcL (OR 0.09; CI 0.01-0.8) and to take more tablets per week of sulfamethoxazole/trimethoprim as prophylaxis (OR 0.5 per tablet per week; CI 0.26-0.97). Heart recipients who were transplanted from 2011 – 2013 were significantly more likely to have received antithymocyte globulin induction, higher dosages of corticosteroids, and to have lower lymphocyte counts compared to those transplanted prior to 2011.

    Conclusion: We observed an increased incidence of Nocardia infections in heart transplant recipients beginning in 2011. Compared to controls, infected patients had elevated levels of calcineurin inhibitors, significantly lower absolute lymphocyte counts, and more infections with fungus and CMV. The data suggest that intensified immunosuppression for heart transplant recipients resulted in a significant increase in Nocardia infections.

    Caroline Cohen, M.D.1, Lora Thomas, M.D., M.P.H.2, Geraldine Miller, MD2 and Victoria Burke, M.D.3, (1)Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, (2)Vanderbilt University, Nashville, TN, (3)Infectious Diseases, LSU Health Sciences Center, New Orleans, LA

    Disclosures:

    C. Cohen, None

    L. Thomas, None

    G. Miller, None

    V. Burke, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.