Nocardia Infections in Hematopoietic Cell Transplant Recipients: A Multicenter International Retrospective Study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation.

Autor:	Averbuch D; Pediatric Infectious Diseases, Faculty of Medicine, Hebrew University of Jerusalem, Hadassah Medical Center, Jerusalem, Israel., De Greef J; Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium., Duréault A; Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France., Wendel L; European Society for Blood and Marrow Transplantation (EBMT) Data Office, Leiden, The Netherlands., Tridello G; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Lebeaux D; Université de Paris, Paris, France.; Service de Microbiologie, Unité Mobile d'Infectiologie, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France., Mikulska M; Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy., Gil L; University of Medical Sciences, Poznan, Poland., Knelange N; European Society for Blood and Marrow Transplantation (EBMT) Data Office, Leiden, The Netherlands., Zuckerman T; Rambam Medical Center, Haifa, Israel., Roussel X; Hematology Department, University Hospital of Besançon, Besançon, France., Robin C; Henri Mondor University Hospital, Creteil, France., Xhaard A; Hematology-Transplantation, Hospital St-Louis, Paris Diderot University, Paris, France., Aljurf M; King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia., Beguin Y; Centre Hospitalier Universitaire of Liège and University of Liège, Liège, Belgium., Le Bourgeois A; Centre Hospitalier Universitaire Nantes, Nantes, France., Botella-Garcia C; Centre Hospitalier Universitaire Bordeaux, Bordeaux, France., Khanna N; Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland., Van Praet J; Department of Nephrology and Infectious Diseases, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Brugge, Belgium., Kröger N; Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany., Blijlevens N; Radboud University Medical Center, Nijmegen, The Netherlands., Ducastelle Leprêtre S; Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France., Ho A; Singapore General Hospital, Singapore., Roos-Weil D; Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France., Yeshurun M; Institution of Hematology, Rabin Medical Center, Petah Tikva, Israel.; Sacker School of Medicine, Tel Aviv University, Tel Aviv, Israel., Lortholary O; Paris University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine IHU Imagine, Necker Enfants Malades University Hospital, Paris, France.; National Reference Center for Invasive Mycoses and Antifungals, Molecular Mycology Unit, CNRS UMR 2000, Institut Pasteur, Paris, France., Fontanet A; Institut Pasteur, Emerging Diseases Epidemiology Unit, Global Health Department, Paris, France.; Pasteur-Cnam risques infectieux et émergents Unit, Conservatoire National des Arts et Métiers, Paris, France., de la Camara R; Hospital de la Princesa, Madrid, Spain., Coussement J; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.; National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia., Maertens J; Department of Hematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgiumand., Styczynski J; Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2022 Aug 24; Vol. 75 (1), pp. 88-97.
DOI:	10.1093/cid/ciab866
Abstrakt:	Background: Nocardiosis is rare after hematopoietic cell transplantation (HCT). Little is known regarding its presentation, management, and outcome in this population. Methods: This retrospective international study reviewed nocardiosis episodes in HCT recipients (1/1/2000-31/12/2018; 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 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%); brain imaging findings were multiple brain abscesses (19/30; 63%). Ten of 30 (33%) patients with brain involvement lacked neurological symptoms. Fourteen of 48 (29%) patients were bacteremic. Nocardia 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 1-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. (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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