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Pulmonary Nocardiosis in Renal Transplant Recipients From Pakistan: Risk Factors, Clinical Presentation, and Mortality.
- Source :
-
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation [Exp Clin Transplant] 2024 Aug; Vol. 22 (8), pp. 607-612. - Publication Year :
- 2024
-
Abstract
- Objectives: Nocardia is an opportunistic infection among renal transplant recipients with an incidence of <1% but high mortality. Data from Pakistan are scarce. Our aim was to find the risk factors, clinical and radiographic findings, antimicrobial sensitivity, and outcomes of Nocardia infection among renal transplant recipients in Pakistan.<br />Materials and Methods: All adult renal transplant recipients diagnosed with nocardiosis between 2013 and 2020 were included. The cases were matched 1:2 with controls based on sex, age (±1 year), and transplant date (±1 year). Risk factors, clinical features, antibiotic sensitivities and outcomes were analyzed.<br />Results: A total of 48 patients developed nocardiosis. Around 25% of patients presented with disseminated disease. Median time from transplant to disease development was 2.68 years. High-dose methylprednisolone and presence of cytomegalovirus infection within 90 days of disease development were independent risk factors for Nocardia infection. The mortality rate was 20%. Central nervous system disease and cytomegalovirus infection within 90 days were significantly associated with mortality. The most susceptible drugs were co-trimoxazole and linezolid. Imipenem susceptibility was only 20%.<br />Conclusions: High-dose methylprednisolone and cytomegalovirus infection were independent risk factors for Nocardia infection. Central nervous system disease was associated with mortality. Nocardia species were highly resistant to ceftriaxone and imipenem in our patient population.
- Subjects :
- Humans
Risk Factors
Pakistan epidemiology
Male
Female
Adult
Middle Aged
Treatment Outcome
Time Factors
Retrospective Studies
Cytomegalovirus Infections diagnosis
Cytomegalovirus Infections mortality
Cytomegalovirus Infections epidemiology
Risk Assessment
Methylprednisolone administration & dosage
Immunosuppressive Agents adverse effects
Nocardia Infections diagnosis
Nocardia Infections mortality
Nocardia Infections epidemiology
Nocardia Infections drug therapy
Nocardia Infections microbiology
Kidney Transplantation adverse effects
Kidney Transplantation mortality
Opportunistic Infections mortality
Opportunistic Infections immunology
Opportunistic Infections diagnosis
Opportunistic Infections microbiology
Opportunistic Infections epidemiology
Opportunistic Infections drug therapy
Anti-Bacterial Agents therapeutic use
Immunocompromised Host
Subjects
Details
- Language :
- English
- ISSN :
- 2146-8427
- Volume :
- 22
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 39254072
- Full Text :
- https://doi.org/10.6002/ect.2024.0119