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 [UCL] (Co-premier auteur) Averbuch, Dina (Co-premier auteur) Tondeur, Laura Duréault, Amélie Zuckerman, Tsila Roussel, Xavier Robin, Christine Xhaard, Alienor Pagliuca, Simona Beguin, Yves Botella-Garcia, Carmen Khanna, Nina Le Bourgeois, Amandine Van Praet, Jens Ho, Aloysius Kröger, Nicolaus Ducastelle Leprêtre, Sophie Roos-Weil, Damien Aljurf, Mahmoud Blijlevens, Nicole Blau, Igor Wolfgang Carlson, Kristina Collin, Matthew Ganser, Arnold Villate, Alban Lakner, Johannes Martin, Sonja Nagler, Arnon Ram, Ron Torrent, Anna Stamouli, Maria Mikulska, Malgorzata Gil, Lidia Wendel, Lotus Tridello, Gloria Knelange, Nina de la Camara, Rafael Lortholary, Olivier Fontanet, Arnaud Styczynski, Jan Maertens, Johan Coussement, Julien Lebeaux, David et al.[show all]

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.