Abstract
Nocardia is an opportunistic pathogen that most frequently affects the lungs. Evidence is limited regarding the risk factors for nocardiosis. The current study assessed clinical correlates of nocardiosis. A retrospective study was conducted based on medical records of consecutive adult patients (N = 60) with nocardiosis hospitalized during 2007–2018 at a tertiary hospital in central Israel. A matched comparison group of 120 patients was randomly selected among hospitalized patients with community-acquired pneumonia. Multivariable conditional logistic regression models were fitted. Immunosuppressive pharmacotherapy was positively associated with nocardiosis (matched odds ratio [OR] 4.40, 95% confidence interval [CI] 2.25–8.62, p < 0.001), particularly corticosteroid therapy (matched OR 4.69, 95% CI 2.45–8.99, p < 0.001). Systemic corticosteroid therapy was strongly associated with pulmonary nocardiosis (matched OR 5.90, 95% CI 2.75–12.66, p < 0.001). The positive association between solid organ transplantation and nocardiosis was attenuated following adjustment for systemic corticosteroids in a multivariable model. The association between corticosteroid therapy and nocardiosis appeared stronger in patients with chronic pulmonary disease (OR 5.74, 95% CI 2.75–12.66, p < 0.001) than in the pooled analysis of all nocardiosis cases. In conclusion, corticosteroid therapy was strongly correlated with nocardiosis, particularly among individuals with chronic pulmonary disease and in pulmonary nocardiosis.
Highlights
Nocardia is an opportunistic pathogen that most frequently affects the lungs
A European multicenter case–control study conducted among solid organ transplantation (SOT) recipients (SOTR) showed that corticosteroid dosage was related to the risk of nocardiosis, and a strong positive association was found between high calcineurin inhibitor and nocardiosis[1]
We compared the correlates between patients with nocardiosis and hospitalized patients with pneumonia, enabling the assessment of clinical correlates of nocardiosis beyond the propensity to develop pulmonary bacterial infection in general
Summary
Nocardia is an opportunistic pathogen that most frequently affects the lungs. Evidence is limited regarding the risk factors for nocardiosis. Evidence on the independent contribution of each of these conditions to nocardiosis risk remains limited, since most studies were case-series and lacked a comparison group. It is unclear if the likelihood of nocardiosis is related to the underlying disease itself or to the immunosuppression therapy administered against it. As corticosteroid therapy is the standard of care for many conditions that might be associated with nocardiosis, such as SOT, chronic pulmonary diseases and cancer, the independent role of each factor, warrant further investigation. The current study aimed to assess clinical correlates of nocardiosis, and was designed to identify their contribution to the development of nocardiosis, beyond the risk of pneumonia requiring hospitalization
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