2330. Nocardia infections in the transplanted host
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Stem Cell Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Nocardia spp are uncommon pathogens that disproportionately afflict immunocompromised hosts. Patients who have undergone solid organ or hematopoietic cell transplant (HCT) are at particularly high risk, but epidemiologic and outcome data for Nocardia infections in transplant patients are limited.
We examined a retrospective cohort of all patients between 1996-2013 (inclusive) at an academic transplant center undergoing a solid organ or HCT with at least one culture that grew Nocardia.
During the study period 52 patients were infected with Nocardia after transplant: 15 heart transplants (incidence 17.9/1000 transplants), 15 lung transplants (11.4/1000), 15 HCT (3.0/1000), 5 kidney transplants (2.9/1000), 1 heart-lung transplant (38.5/1000), and 1 liver transplant (1.1/1000). Subjects had a mean age of 58 years (range 1-73), 73% were male, and predominantly white (71%) or African-American (25%). The median time from transplant to Nocardia diagnosis was 268 days (range 3-2920 days), although this varied depending on the type of transplant: 452 days for lung transplants (range 3-2507); 894 days for kidney transplants (range 108-2920), 239 days for heart transplants (range 54-1452), and 153 days for HCT (range 33-1054).
Presentation varied widely: 19% had <1 week of symptoms, 35% had symptoms for 1 week-1 month, 19% had symptoms for 1-3 months, and 8% had >3 months of symptoms (symptom duration was unknown for 19%). The lung was most often affected (85%), followed by the skin (14%) and the brain (10%); 36% of patients had infection at multiple sites. Surgical (25%) and radiographically-guided (12%) biopsies were often necessary for diagnosis. Death prior to treatment completion was common (27/52, 44%).
37% of the patients were taking trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis at the time of Nocardia diagnosis, but none of these patients had a Nocardia isolate with in vitro resistance to this agent.
Nocardia infection is a serious but uncommon complication in the transplanted host with a high mortality rate. It generally occurs in the late post-transplant period, but may occur while patients are still on TMP/SMX prophylaxis despite susceptibility to this agent.
Marion Hemmersbach-Miller, MD PhD, Jennifer Saullo, MD PharmD, Michael Woodworth, MD, Gary Cox, MD and Jason Stout, MD MHS, Duke University Medical Center, Durham, NC
None M. Woodworth,
None G. Cox,
None J. Stout,