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Volume 28, Number 11—November 2022
CME ACTIVITY - Synopsis

Multispecies Outbreak of Nocardia Infections in Heart Transplant Recipients and Association with Climate Conditions, Australia

Jonathan Li, Cindy Lau, Naomi Anderson, Fay Burrows, Feras Mirdad, Lilibeth Carlos, Andrew J. Pitman, Kavitha Muthiah, David R. Darley, David Andresen, Peter Macdonald, Deborah Marriott1, and Nila J. Dharan1Comments to Author 
Author affiliations: St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia (J. Li, C. Lau, N. Anderson, F. Burrows, F. Mirdad, L. Carlos, K. Muthiah, D.R. Darley, D. Andresen, P. Macdonald, D. Marriott, N.J. Dharan); Australian Research Council Centre of Excellence for Climate Extremes and Climate Change Research Centre, at UNSW Sydney, Sydney, New South Wales(A.J. Pitman); Victor Chang Cardiac Research Institute, Darlinghurst (K. Muthiah, P. Macdonald); UNSW Sydney, Sydney (D.R. Darley, N.J. Dharan); University of Notre Dame, Sydney (D. Andresen)

Main Article

Table 1

Clinical characteristics of heart and lung transplant recipients with confirmed Nocardia infection, Greater Sydney, New South Wales, Australia, June 2015–March 2021*

Characteristic
 Heart transplant, n = 16
 Lung transplant, n = 7
 p value
 All patients, n = 23
Median age at Nocardia diagnosis, y (range)
 61 (38–71)
 59 (50–70)
 0.98
 61 (38–71)
Sex
M 10 (62.5) 5 (71.4) 0.68 15 (65.2)
F
 6 (37.5)
 2 (28.6)
 0.68
 8 (34.8)
Median no. months from transplant to Nocardia diagnosis (range) 4.8 (3–19) 22.8 (5–263) <0.01 6.3 (3–263)
CMV, donor positive/recipient negative
 4 (25.0)
 0
 0.17
 4 (17.4)
Episodes of organ rejection from date of transplant to diagnosis of Nocardia
Any grade† 16 (100) 3 (42.9) <0.01 19 (82.6)
<2R/A3 6 (37.5) 3 (42.9) 0.81 9 (39.1)
>2R/A3
 10 (62.5)
 0
 <0.01
 10 (43.4)
Diabetic at time of diagnosis 13 (81.3) 2 (28.6) <0.01 15 (65.2)
Received intravenous immunoglobulin therapy
 7 (43.8)
 6 (85.7)
 0.06
 13 (56.5)
Respiratory virus <6 mo before Nocardia 9 (56.3) 6 (85.7) 0.17 15 (65.2)
CMV DNA detected by PCR <6 mo before Nocardia 6 (37.5)‡ 1 (14.3)§ 0.27 7 (30.4)
Significant CMV viremia <6 mo before Nocardia¶
 4 (25.0)
 1 (14.3)
 0.57
 5 (21.7)
Medications received
Sulfamethoxazole/trimethoprim prophylaxis 13 (81.3) 7 (100) 0.22 20 (87.0)
Azithromycin prophylaxis 1 (6.3) 7 (100) <0.01 8 (34.8)
Induction with basiliximab 16 (100) 2/5 (40.0) <0.01 18/21 (85.7)
Tacrolimus immunosuppression 16 (100) 7 (100) 1 23 (100)
Mycophenolic acid immunosuppression 16 (100) 5/5 (100) 1 21/21 (100)
Prednisone immunosuppression 16 (100) 5/5 (100) 1 21/21 (100)

*Values are no. (%) patients except as indicated. Denominators are indicated for categories in which only some patients had data available. CMV, cytomegalovirus. †Defined as >1R on endomyocardial biopsy for heart transplant rejections and >A1 on bronchial biopsy for lung transplant rejections in accordance with International Society of Heart and Lung Transplantation 2004 and 2007 grading guidelines. ‡Among heart transplant recipients, the highest CMV PCR values (IU/mL) included: 1,169 copies 3 mo before Nocardia diagnosis; 16,271 4 mo before Nocardia diagnosis; 4,446 3 mo before Nocardia diagnosis; 27,1942 within a month before Nocardia diagnosis; 324 within a month before Nocardia diagnosis; and 103 within 1 month before Nocardia diagnosis. §The highest CMV PCR value (IU/mL) was 1,240 within a month before Nocardia diagnosis. ¶Defined as CMV PCR copies >1,000 IU/mL.

Main Article

1These authors contributed equally to this article.

Page created: September 20, 2022
Page updated: October 21, 2022
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