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Nocardiosis in renal transplant patients
  1. Maya Gibson1,
  2. Nianlan Yang2,3,
  3. Jennifer L Waller2,
  4. Lufei Young4,
  5. Wendy B Bollag5,
  6. Mufaddal Kheda1,
  7. Azeem Mohammed1,
  8. Stephanie L Baer1,6
  1. 1Department of Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
  2. 2Department of Biostatistics and Epidemiology, Augusta University, Augusta, Georgia, USA
  3. 3Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, Alabama, USA
  4. 4College of Nursing, Augusta University, Augusta, Georgia, USA
  5. 5Department of Dermatology, Medical College of Georgia, Augusta, Georgia, USA
  6. 6Infection Control and Epidemiology, Augusta VA Medical Center, Augusta, Georgia, USA
  1. Correspondence to Dr Stephanie L Baer, 1 Freedom Way (235), Augusta, GA 30904, USA; stephanie.baer{at}va.gov

Abstract

Renal transplant patients are immunosuppressed and are at increased risk of opportunistic infections, including Nocardia infection. In renal transplant patients, information on the incidence and risk factors associated with nocardiosis is limited. To address the incidence and risk factors associated with nocardiosis in a large renal transplant population, we used the US Renal Data System (USRDS). Sequelae of allograft failure or rejection after infection were also examined. Demographics, clinical risk factors, Nocardia diagnosis, and allograft failure following Nocardia infection were queried in USRDS renal transplant patients using International Classification of Diseases, Ninth Revision (ICD-9) codes in billing claims and Centers for Medicare and Medicaid Services Form 2728. Generalized linear models were used to determine the risk factors associated with nocardiosis, and Cox proportional hazards models were used to examine the association of risk factors with graft failure among patients with Nocardia infection. Of 203,233 renal transplant recipients identified from 2001 to 2011, 657 (0.32%) were diagnosed with Nocardia infection. Pneumonia was the most frequent presentation (15.2%), followed by brain abscess (8.4%). Numerous factors associated with increased Nocardia infection included age >65 years (OR=2.10, 95% CI 1.71 to 2.59), history of transplant failure (OR=1.28, CI 1.02 to 1.60) or history of rejection (OR=4.83, CI 4.08 to 5.72), receipt of a deceased donor transplant (OR=1.23, CI 1.03 to 1.46), and treatment with basiliximab (OR=1.25, CI 1.00 to 1.55), cyclosporine (OR=1.30, CI 1.03 to 1.65), tacrolimus (OR=2.45, CI 2.00 to 3.00), or thymoglobulin (OR=1.89, CI 1.59 to 2.25). In patients with nocardiosis administration of antithymocyte globulin (HR=2.76), chronic obstructive pulmonary disease (HR=2.47), and presentation of Nocardia infection with brain abscess (HR=1.85) were associated with an increased risk of graft failure. This study provides new information to enhance early recognition and targeted treatment of nocardiosis in renal transplant patients.

  • kidney transplantation
  • immunosuppression

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Twitter @StephanieBaerMD

  • Contributors All authors have contributed to the preparation of this manuscript.

  • Funding The study is supported by the Augusta University Medical Scholars Program (MG), a grant from Dialysis Clinic (MK, JLW, and AM), and the Translational Research Program of the Department of Medicine, Augusta University.

  • Disclaimer The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US Government. The contents do not represent the views of the Department of Veterans Affairs or the US Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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