Nocardia infections in the transplanted host

Transpl Infect Dis. 2018 Aug;20(4):e12902. doi: 10.1111/tid.12902. Epub 2018 May 7.


Background: Nocardia are uncommon pathogens that disproportionately afflict the immunocompromised host. Epidemiology and outcome data of Nocardia infections in transplant recipients are limited.

Methods: We performed a retrospective chart review of all patients at Duke University Hospital with a history of solid organ transplant (SOT) or hematopoietic cell transplant (HCT) and at least one positive culture for Nocardia between 1996 and 2013. Our aim was to describe the epidemiology and outcomes of Nocardia infections in the transplanted host.

Results: During the 18-year study period, 51 patients (14 HCT and 37 SOT recipients) had Nocardia infection. Nocardia incidence was stable during the study period in all populations except heart transplants, whose incidence declined. Infection occurred earlier in the HCT group than the SOT group (median time to diagnosis of 153 and 370 days, respectively). In both groups, the most common site involved was the lung. Outcomes were overall poor, especially in the HCT group with a cure rate of 29%. Heart transplant recipients had significantly better overall survival (P < .05) than other patients. Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis did not provide complete protection from Nocardia infections, nor did it appear to select for resistant Nocardia isolates.

Conclusions: Infections with Nocardia are typically a late post-transplant complication. The use of TMP-SMX prophylaxis was not associated with TMP-SMX-resistant Nocardia. Overall outcomes remain poor.

Keywords: Nocardia; epidemiology; hematopoietic cell transplantation; immunocompromised host; solid organ transplantation; transplant recipients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis*
  • Child
  • Child, Preschool
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Immunocompromised Host*
  • Incidence
  • Infant
  • Male
  • Middle Aged
  • Nocardia / isolation & purification
  • Nocardia Infections / epidemiology*
  • Nocardia Infections / immunology
  • Nocardia Infections / microbiology
  • Organ Transplantation / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • Young Adult


  • Anti-Bacterial Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination