Table 1:
Baseline characteristics and univariable analyses of 12-month mortality in 125 solid organ transplant recipients with nocardiosis
| Alive at 12 months (N = 104) | Died within 12 months (N = 21) | Total (N = 125) | P value | |
|---|---|---|---|---|
| Age, y, mean (SD) | 58.1 (11.6) | 59.3 (11.0) | 58.3 (11.5) | 0.647 |
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| Male sex | 71 (68.3) | 12 (57.1) | 83 (66.4) | 0.325 |
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| Race | 0.730 | |||
| - American Indian or Alaska Native | 5 (4.8) | 0 (0.0) | 5 (4.0) | |
| - Asian | 5 (4.8) | 2 (9.5) | 7 (5.6) | |
| - Black or African American | 9 (8.7) | 3 (14.3) | 12 (9.6) | |
| - Hispanic White | 12 (11.5) | 2 (9.5) | 14 (11.2) | |
| - Non-Hispanic White | 72 (69.2) | 14 (66.7) | 86 (68.8) | |
| - Unknown | 1 (1.0) | 0 (0.0) | 1 (0.8) | |
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| Type of transplant | 0.009 | |||
| - Kidney | 48 (46.2) | 6 (28.6) | 54 (43.2) | |
| - Liver | 5 (4.8) | 6 (28.6) | 11 (8.8) | |
| - Heart | 20 (19.2) | 3 (14.3) | 23 (18.4) | |
| - Lung | 10 (9.6) | 4 (19.0) | 14 (11.2) | |
| - Pancreas | 3 (2.9) | 1 (4.8) | 4 (3.2) | |
| - Multiorgana | 18 (17.3) | 1 (4.8) | 19 (15.2) | |
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| Charlson comorbidity index, median (IQR) | 3.0 (2.0, 4.0) | 4.0 (3.0, 5.0) | 3.0 (2.0, 4.0) | 0.061 |
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| Diabetes mellitus | 53 (51.0) | 9 (42.9) | 62 (49.6) | 0.498 |
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| Chronic kidney disease | 66 (63.5) | 13 (61.9) | 79 (63.2) | 0.893 |
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| Dialysis | 3 (2.9) | 5 (23.8) | 8 (6.4) | 0.003 |
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| History of tumor | 10 (9.6) | 4 (19.0) | 14 (11.2) | 0.252 |
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| eGFR, mL/min/1.73 m2, mean (SD)b | 53.3 (24.0) | 50.4 (26.9) | 52.9 (24.3) | 0.515 |
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| Leukocyte count, x109, mean (SD) | 8.7 (5.2) | 9.9 (9.0) | 8.9 (6.0) | 0.550 |
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| Neutrophil count, x109, mean (SD)c | 7.1 (4.8) | 8.4 (8.4) | 7.3 (5.6) | 0.749 |
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| Lymphocyte count, x109, mean (SD)c | 0.7 (0.6) | 0.7 (0.6) | 0.7 (0.6) | 0.729 |
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| Maintenance immunosuppression | ||||
| - Cyclosporine | 3 (2.9) | 1 (4.8) | 4 (3.2) | 0.526 |
| - Tacrolimus | 97 (93.3) | 19 (90.5) | 116 (92.8) | 0.646 |
| - Sirolimus | 1 (1.0) | 0 (0.0) | 1 (0.8) | 1 |
| - Mycophenolate | 90 (86.5) | 16 (76.2) | 106 (84.8) | 0.313 |
| - Azathioprine | 4 (3.8) | 2 (9.5) | 6 (4.8) | 0.265 |
| - Belatacept | 1 (1.0) | 0 (0.0) | 1 (0.8) | 1 |
| - Prednisone | 98 (94.2) | 20 (95.2) | 118 (94.4) | 1 |
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| Acute rejection within 6 months | 20 (19.2) | 7 (33.3) | 27 (21.6) | 0.158 |
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| CMV infection within 6 months | 10 (9.6) | 4 (19.0) | 14 (11.2) | 0.252 |
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| TMP-SMX prophylaxis at diagnosis | 26 (25.0) | 8 (38.1) | 34 (27.2) | 0.219 |
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| IFI within 6 months | 13 (12.5) | 0 (0.0) | 13 (10.4) | 0.123 |
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| Time from transplantation, days, median (IQR) | 457.5 (149.3, 1607.5) | 341 (192.0, 1179.0) | 400.0 (155.0, 1487.0) | 0.604 |
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| Nocardia farcinica d | 18 (18.8) | 8 (40.0) | 26 (20.8) | 0.072 |
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| Disseminated Infection | 25 (24.0) | 8 (38.1) | 33 (26.4) | 0.183 |
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| Brain MRI performed | 72 (69.2) | 12 (57.1) | 84 (67.2) | 0.282 |
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| Site of infection | ||||
| - Lung | 91 (87.5) | 20 (95.2) | 111 (88.8) | 0.461 |
| - Pleural space | 4 (3.8) | 4 (19.0) | 8 (6.4) | 0.027 |
| - CNS | 14 (13.5) | 4 (19.0) | 18 (14.4) | 0.503 |
| - Bloodstream | 8 (7.7) | 5 (23.8) | 13 (10.4) | 0.043 |
| - Endocarditis | 2 (1.9) | 0 (0.0) | 2 (1.6) | 1 |
| - Skin/soft tissue | 22 (21.2) | 4 (19.0) | 26 (20.8) | 1 |
| - Osteoarticular | 2 (1.9) | 1 (4.8) | 3 (2.4) | 0.427 |
| - Othere | 6 (5.8) | 3 (14.3) | 9 (7.2) | 0.175 |
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| Coinfectionf | 26 (25.0) | 9 (42.9) | 35 (28.0) | 0.096 |
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| Time from symptom onset to presentation, days, median (IQR) | 11.0 (6.0, 21.0) | 7.0 (4.0, 9.0) | 10.0 (5.0, 18.0) | 0.005 |
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| Time from presentation to treatment initiation, days, mean (SD) | 3.0 (1.0, 7.0) | 5.0 (1.0, 11.0) | 3.0 (1.0, 8.0) | 0.347 |
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| ICU admission | 11 (10.6) | 8 (38.1) | 19 (15.2) | 0.004 |
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| Surgical intervention | 19 (18.3) | 3 (14.3) | 22 (17.6) | 1 |
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| Decrease in immunosuppression | 48 (47.1) | 11 (52.4) | 59 (48.0) | 0.657 |
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| Number of antibiotics used, mean (SD) | 2.0 (0.7) | 2.5 (0.7) | 2.1 (0.8) | 0.011 |
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| Number of active antibiotics, mean (SD)g | 1.7 (0.7) | 2.0 (0.8) | 1.8 (0.8) | 0.157 |
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| ≥ 2 antibiotics within first 4 weeks | 77 (74.0) | 20 (95.2) | 97 (77.6) | 0.042 |
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| Initial treatment | ||||
| - Sulfa antibiotic | 78 (75.0) | 14 (66.7) | 92 (73.6) | 0.429 |
| - Carbapenem | 32 (30.8) | 14 (66.7) | 46 (36.8) | 0.002 |
| - Fluoroquinolone | 23 (22.1) | 5 (23.8) | 28 (22.4) | 1 |
| - Macrolide | 9 (8.7) | 2 (9.5) | 11 (8.8) | 1 |
Data are n (%) unless otherwise specified. Bold values indicate P < 0.05.
Abbreviations: CMV, cytomegalovirus; CNS, central nervous system; eGFR, estimated glomerular filtration rate; IFI, invasive fungal infection; IQR, interquartile range; MRI, magnetic resonance imaging; SD, standard deviation; y, years
Multiorgan transplant recipients included kidney-pancreas (11), kidney-liver (4), heart-kidney (3), and heart-lung (1). From this group, only 1 kidney-pancreas recipient died within 12 months.
n = 117, excluding those requiring dialysis.
n = 124
n = 116, excluding 9 patients whose Nocardia isolate was not identified to a species level.
Other sites of infection included pelvic abscess (3), lymphadenitis (3), muscle abscess (2), and peritonitis (1).
Coinfections included 40 organisms from 35 patients comprised of 12 fungi, 9 Gram-negative bacteria, 8 CMV, 4 Gram-positive bacteria, 4 respiratory viruses, and 3 Clostridioides difficile infection.
n = 121, excluding those without valid antibiotic susceptibility test results.