Rungmei Marak , Abdullah , Manas Behera , Anupma Kaul , Dharmendra Bhadauria , Narayan Prasad , Manas Patel , Ravi Kushwaha , Monika Yachha
{"title":"肾移植受者的诺卡氏菌病:一家三级医疗中心的经验。","authors":"Rungmei Marak , Abdullah , Manas Behera , Anupma Kaul , Dharmendra Bhadauria , Narayan Prasad , Manas Patel , Ravi Kushwaha , Monika Yachha","doi":"10.1016/j.trim.2024.102041","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Kidney transplant recipients are at increased risk of opportunistic infections, including <em>Nocardia</em>. The incidence of nocardiosis in kidney transplant recipients is 0.4–1.3%. The data regarding its epidemiology and outcomes is limited.</p></div><div><h3>Methods</h3><p>This was a 10-year retrospective observational study from January 2012 to December 2021 at a tertiary care center in northern India, in which all kidney transplant recipients with <em>Nocardia</em> infection were included and followed.</p></div><div><h3>Results</h3><p>12 (1.1%) patients had a <em>Nocardia</em> infection among the 1108 kidney transplant recipients. All were living donor kidney transplant recipients, and the mean age at diagnosis was 48.67 ± 12.60 years. <em>Nocardia</em> infection occurred at a median of 26 months (range 4–235) post-transplantation, with 4 (33.1%) of the cases occurring within a year of transplant. Breakthrough infection occurred in 7 (58.3%) patients on cotrimoxazole prophylaxis. 41.7% (<em>n</em> = 5) cases had an episode of rejection in the preceding year of <em>Nocardia</em> diagnosis. Concurrent cytomegalovirus (CMV) infection was present in one (8.3%) case. The lung was the most frequently involved organ. Microscopy was positive in all the cases; while culture was positive in 10 cases, and antimicrobial susceptibility testing (AST) were performed for these isolates. The majority (60%) of isolates were resistant to cotrimoxazole. All tested isolates remained susceptible to Amikacin, Imipenem, and Linezolid. No patients experienced <em>Nocardia</em> recurrence after completion of antibiotic therapy. The mortality at 12 months was 66.7% (<em>n</em> = 4), and only one death was <em>Nocardia</em>-related.</p></div><div><h3>Conclusion</h3><p><em>Nocardia</em> may cause a late-manifesting infection beyond the traditional window. The cotrimoxazole prophylaxis may not be sufficient for <em>Nocardia</em> prevention.</p></div>","PeriodicalId":23304,"journal":{"name":"Transplant immunology","volume":"84 ","pages":"Article 102041"},"PeriodicalIF":1.6000,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nocardiosis in kidney transplant recipients: A tertiary care center experience\",\"authors\":\"Rungmei Marak , Abdullah , Manas Behera , Anupma Kaul , Dharmendra Bhadauria , Narayan Prasad , Manas Patel , Ravi Kushwaha , Monika Yachha\",\"doi\":\"10.1016/j.trim.2024.102041\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>Kidney transplant recipients are at increased risk of opportunistic infections, including <em>Nocardia</em>. The incidence of nocardiosis in kidney transplant recipients is 0.4–1.3%. The data regarding its epidemiology and outcomes is limited.</p></div><div><h3>Methods</h3><p>This was a 10-year retrospective observational study from January 2012 to December 2021 at a tertiary care center in northern India, in which all kidney transplant recipients with <em>Nocardia</em> infection were included and followed.</p></div><div><h3>Results</h3><p>12 (1.1%) patients had a <em>Nocardia</em> infection among the 1108 kidney transplant recipients. All were living donor kidney transplant recipients, and the mean age at diagnosis was 48.67 ± 12.60 years. <em>Nocardia</em> infection occurred at a median of 26 months (range 4–235) post-transplantation, with 4 (33.1%) of the cases occurring within a year of transplant. Breakthrough infection occurred in 7 (58.3%) patients on cotrimoxazole prophylaxis. 41.7% (<em>n</em> = 5) cases had an episode of rejection in the preceding year of <em>Nocardia</em> diagnosis. Concurrent cytomegalovirus (CMV) infection was present in one (8.3%) case. The lung was the most frequently involved organ. Microscopy was positive in all the cases; while culture was positive in 10 cases, and antimicrobial susceptibility testing (AST) were performed for these isolates. The majority (60%) of isolates were resistant to cotrimoxazole. All tested isolates remained susceptible to Amikacin, Imipenem, and Linezolid. No patients experienced <em>Nocardia</em> recurrence after completion of antibiotic therapy. The mortality at 12 months was 66.7% (<em>n</em> = 4), and only one death was <em>Nocardia</em>-related.</p></div><div><h3>Conclusion</h3><p><em>Nocardia</em> may cause a late-manifesting infection beyond the traditional window. The cotrimoxazole prophylaxis may not be sufficient for <em>Nocardia</em> prevention.</p></div>\",\"PeriodicalId\":23304,\"journal\":{\"name\":\"Transplant immunology\",\"volume\":\"84 \",\"pages\":\"Article 102041\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-03-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplant immunology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0966327424000571\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplant immunology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0966327424000571","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Nocardiosis in kidney transplant recipients: A tertiary care center experience
Introduction
Kidney transplant recipients are at increased risk of opportunistic infections, including Nocardia. The incidence of nocardiosis in kidney transplant recipients is 0.4–1.3%. The data regarding its epidemiology and outcomes is limited.
Methods
This was a 10-year retrospective observational study from January 2012 to December 2021 at a tertiary care center in northern India, in which all kidney transplant recipients with Nocardia infection were included and followed.
Results
12 (1.1%) patients had a Nocardia infection among the 1108 kidney transplant recipients. All were living donor kidney transplant recipients, and the mean age at diagnosis was 48.67 ± 12.60 years. Nocardia infection occurred at a median of 26 months (range 4–235) post-transplantation, with 4 (33.1%) of the cases occurring within a year of transplant. Breakthrough infection occurred in 7 (58.3%) patients on cotrimoxazole prophylaxis. 41.7% (n = 5) cases had an episode of rejection in the preceding year of Nocardia diagnosis. Concurrent cytomegalovirus (CMV) infection was present in one (8.3%) case. The lung was the most frequently involved organ. Microscopy was positive in all the cases; while culture was positive in 10 cases, and antimicrobial susceptibility testing (AST) were performed for these isolates. The majority (60%) of isolates were resistant to cotrimoxazole. All tested isolates remained susceptible to Amikacin, Imipenem, and Linezolid. No patients experienced Nocardia recurrence after completion of antibiotic therapy. The mortality at 12 months was 66.7% (n = 4), and only one death was Nocardia-related.
Conclusion
Nocardia may cause a late-manifesting infection beyond the traditional window. The cotrimoxazole prophylaxis may not be sufficient for Nocardia prevention.
期刊介绍:
Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.