Investigating an Association Between Trimethoprim/Sulfamethoxazole Prophylaxis and Development of Nocardiosis in Solid Organ Transplant Recipients Restricted; Files Only

Jain, Shilpa (Spring 2023)

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Background: Nocardiosis in the solid organ transplant (SOT) recipient can lead to severe disease with a mortality of up to 30%. Guidelines suggest prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMX) may be used for prevention of nocardiosis in this population; however, there is a lack of consensus as to the efficacy of TMP/SMX as a nocardiosis prevention strategy. The objective of this study was to examine an association between TMP/SMX prophylaxis and development of nocardiosis in SOT recipients.

Methods: A retrospective, matched case-control study of adult SOT patients diagnosed with nocardiosis following transplantation at Emory University in Atlanta, Georgia was performed. Cases diagnosed with nocardiosis between January 2008 and December 2019 were included. Cases and controls were matched 1:1 on the basis of age, gender, year of transplant, and organ transplanted. Crude and multivariable models were constructed to examine an association between TMP/SMX prophylaxis and development of nocardiosis.

Results: Forty cases and 40 controls were included in the analysis. The majority of patients in our study received kidney or kidney/pancreas transplants (57.5%), followed by lung (22.5%), heart (12.5%), and liver (7.5%). Both crude and multivariable models revealed TMP/SMX to be protective against development of nocardiosis post solid organ transplant. More specifically, the odds of developing nocardiosis were 3.6 times higher for those not on TMP/SMX prophylaxis, than for those who were on prophylaxis, controlling for length of ICU stay post-transplant, prednisone use, and tacrolimus use, as well as matching factors (OR 0.28; 95% CI [0.018, 2.085]).

Conclusion: TMP/SMX prophylaxis was found to have a protective, non-statistically significant effect against development of nocardiosis in SOT recipients. This contributes significantly to the current literature in which the effect of TMP/SMX prophylaxis on nocardiosis in the SOT population is poorly understood.

Table of Contents

Chapter 1. Background Literature Review                                                                                   1


Student Contribution                                                                                                                       7


Chapter 2. Journal Article                                                                                                                8


Chapter 3. Future Directions/Public Health Implications                                                        31

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