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, Lauraet al.
[en] [en] 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.
Disciplines :
Hematology
Author, co-author :
De Greef, Julien ; Department of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
Averbuch, Dina; Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel
Tondeur, Laura; Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, 75015 Paris, France
Duréault, Amélie; Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France
Zuckerman, Tsila; Rambam Health Care Campus, Haifa, Israel, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Roussel, Xavier; Department of Hematology, University of Franche-Comte, INSERM UMR1098, Besançon University Hospital, Besançon, France
Robin, Christine; Department of Hematology, Henri Mondor University Hospital, Creteil, France
Xhaard, Alienor ; Hematology-Transplantation, Hospital St-Louis, Paris Diderot University, Paris, France
Pagliuca, Simona ; Hematology Department, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
Beguin, Yves ; Université de Liège - ULiège > Département des sciences cliniques
Botella-Garcia, Carmen; Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
Khanna, Nina; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland
Le Bourgeois, Amandine; Centre Hospitalier Universitaire Nantes, Nantes, France
Van Praet, Jens; Department of Nephrology and Infectious Diseases, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Brugge, Belgium
Ho, Aloysius ; Singapore General Hospital, Singapore
Kröger, Nicolaus ; Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany
Ducastelle Leprêtre, Sophie; Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
Roos-Weil, Damien; Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
Aljurf, Mahmoud; King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
Blijlevens, Nicole ; Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
Blau, Igor Wolfgang; Campus Virchow Klinikum CVK, Berlin, Germany
Carlson, Kristina ; Dept of Haematology, University Hospital, Uppsala, Sweden
Collin, Matthew; Nordern Centre for Bone Marrow Transplantation Freeman Hospital - Adult HSCT Unit, Newcastle, United Kingdom
Ganser, Arnold; Department of Hematology Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
Villate, Alban; Service d'hématologie et thérapie cellulaire, Centre Hospitalier Universitaire de Tours, Université de Tours, Tours, France
Lakner, Johannes; Medical Clinic III, University Medical Center, Rostock, Germany
Nagler, Arnon ; Chaim Sheba Medical Center, Tel Hashomer, Israel
Ram, Ron ; Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Torrent, Anna ; ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Badalona, Spain
Stamouli, Maria; Attikon University General Hospital, Athens, Greece
Mikulska, Malgorzata; Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
Gil, Lidia; European Society for Blood and Marrow Transplantation (EBMT), Leiden Study Unit, Leiden, the Netherlands
Wendel, Lotus; European Society for Blood and Marrow Transplantation (EBMT), Leiden Study Unit, Leiden, the Netherlands
Tridello, Gloria; European Society for Blood and Marrow Transplantation (EBMT), Leiden Study Unit, Leiden, the Netherlands
Knelange, Nina ; European Society for Blood and Marrow Transplantation (EBMT), Leiden Study Unit, Leiden, the Netherlands
de la Camara, Rafael ; Hospital de la Princesa, Madrid, Spain, Infectious Diseases Working Party, EBMT, Spain
Lortholary, Olivier; Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France
Fontanet, Arnaud; Emerging Diseases Epidemiology Unit, Institut Pasteur, Université Paris Cité, 75015 Paris, France, Unité PACRI, Conservatoire National des Arts et Métiers, 75003 Paris, France
Styczynski, Jan; Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
Maertens, Johan ; Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
Coussement, Julien; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia, Service de Maladies Infectieuses et Tropicales, Centre Hospitalier universitaire de Guadeloupe, Les Abymes, Guadeloupe, France. Electronic address: julien.coussement@chu-guadeloupe.fr
Lebeaux, David ; Institut Pasteur, Université Paris Cité, CNRS UMR 6047, Genetics of Biofilms Laboratory, 75015 Paris, France, Département de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Saint-Louis, Lariboisière, F-75010 Paris, France
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