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Mejia-Chew C, Carver PL, Rutjanawech S, Camargo LFA, Fernandes R, Belga S, Daniels SA, Müller NJ, Burkhard S, Theodoropoulos NM, Postma DF, van Duijn PJ, Fariñas MC, González-Rico C, Hand J, Lowe A, Bodro M, Vanino E, Cruz AF, Ramos A, Makek MJ, Mjahed RB, Manuel O, Kamar N, Calvo-Cano A, Carrasco LR, Muñoz P, Rodríguez S, Pérez-Recio S, Sabé N, Álvarez RR, Silva JT, Mularoni A, Vidal E, Alonso-Titos J, Del Rosal T, Classen AY, Goss CW, Agarwal M, López-Medrano F. Risk Factors for Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients: A Multinational Case-Control Study. Clin Infect Dis 2023; 76:e995-e1003. [PMID: 35879465 DOI: 10.1093/cid/ciac608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/10/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Risk factors for nontuberculous mycobacteria (NTM) infections after solid organ transplant (SOT) are not well characterized. Here we aimed to describe these factors. METHODS Retrospective, multinational, 1:2 matched case-control study that included SOT recipients ≥12 years old diagnosed with NTM infection from 1 January 2008 to 31 December 2018. Controls were matched on transplanted organ, NTM treatment center, and post-transplant survival greater than or equal to the time to NTM diagnosis. Logistic regression on matched pairs was used to assess associations between risk factors and NTM infections. RESULTS Analyses included 85 cases and 169 controls (59% male, 88% White, median age at time of SOT of 54 years [interquartile range {IQR} 40-62]). NTM infection occurred in kidney (42%), lung (35%), heart and liver (11% each), and pancreas transplant recipients (1%). Median time from transplant to infection was 21.6 months (IQR 5.3-55.2). Most underlying comorbidities were evenly distributed between groups; however, cases were older at the time of NTM diagnosis, more frequently on systemic corticosteroids and had a lower lymphocyte count (all P < .05). In the multivariable model, older age at transplant (adjusted odds ratio [aOR] 1.04; 95 confidence interval [CI], 1.01-1.07), hospital admission within 90 days (aOR, 3.14; 95% CI, 1.41-6.98), receipt of antifungals (aOR, 5.35; 95% CI, 1.7-16.91), and lymphocyte-specific antibodies (aOR, 7.73; 95% CI, 1.07-56.14), were associated with NTM infection. CONCLUSIONS Risk of NTM infection in SOT recipients was associated with older age at SOT, prior hospital admission, receipt of antifungals or lymphocyte-specific antibodies. NTM infection should be considered in SOT patients with these risk factors.
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Affiliation(s)
- Carlos Mejia-Chew
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Peggy L Carver
- College of Pharmacy, The University of Michigan, Ann Arbor, Michigan, USA
| | - Sasinuch Rutjanawech
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Sara Belga
- Division of Infectious Diseases, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Shay-Anne Daniels
- Division of Infectious Diseases, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Nicolas J Müller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Sara Burkhard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Nicole M Theodoropoulos
- Department of Medicine, Division of Infectious Diseases & Immunology, UMass Chan Medical School, Worchester, Massachusetts, USA
| | - Douwe F Postma
- Department of Internal Medicine and Infectious Diseases, University Medical Center Groningen, The Netherlands
| | - Pleun J van Duijn
- Department of Clinical Microbiology, University Medical Center Groningen, The Netherlands
| | - María Carmen Fariñas
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Spain.,CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Claudia González-Rico
- Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Spain.,CIBERINFEC (CB21/13/00068), ISCIII, Madrid, Spain
| | - Jonathan Hand
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Adam Lowe
- Department of Infectious Diseases, Ochsner Medical Center, New Orleans, Louisiana, USA
| | | | - Elisa Vanino
- Infectious Diseases Unit, IRCCS Policlinico Sant'Orsola, University of Bologna, Italy.,Infectious Diseases Unit, Ravenna Hospital, AUSL Romagna, Italy
| | - Ana Fernández Cruz
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Antonio Ramos
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Ribal Bou Mjahed
- Lausanne University Hospital (CHUV), University of Lausanne, Switzerland
| | - Oriol Manuel
- Lausanne University Hospital (CHUV), University of Lausanne, Switzerland
| | - Nassim Kamar
- Department of Nephrology and Organs Transplantation, Toulouse Rangueil University, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Disease (Infinity), Paul Sabatier University, Toulouse, France
| | - Antonia Calvo-Cano
- Infectious Disease Department, University Hospital Badajoz, Badajoz, Spain
| | | | | | | | - Sandra Pérez-Recio
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Sabé
- Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Tiago Silva
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Alessandra Mularoni
- IRCC-ISMETT, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Elisa Vidal
- Infectious Diseases Service, Reina Sofia University Hospital, Madrid, Spain
| | - Juana Alonso-Titos
- Nephrology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Teresa Del Rosal
- Pediatric Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - Annika Y Classen
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Charles W Goss
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mansi Agarwal
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación del Hospital 12 de Octubre (imas12), School of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
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Lazaro E, Coureau G, Guedj J, Blanco P, Pellegrin I, Commenges D, Dabis F, Moreau JF, Pellegrin JL, Thiébaut R. Change in T-Lymphocyte Count after Initiation of Highly Active Antiretroviral Therapy in HIV-Infected Patients with History of Mycobacterium Avium Complex Infection. Antivir Ther 2006. [DOI: 10.1177/135965350601100313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To compare changes in CD4+, CD8+ and total lymphocyte counts after initiation of highly active anti-retroviral therapy (HAART) between HIV-infected patients with and without a recent history of Mycobacterium avium complex (MAC) infection. Method Matched exposed-non-exposed retrospective cohort study. Results Fifty-one patients with a recent history of MAC infection (MAC+) started a combination of at least three antiretroviral drugs. They were individually matched to 145 patients without any history of MAC infection (MAC-) according to CD4+ T-cell count (±30 cells/mm3), previous experience of antiretroviral treatment, AIDS clinical stage at the time of HAART initiation (baseline), age (±10 years) and gender. MAC+ and MAC- patients presented comparable median levels of total lymphocytes (488 vs 688/mm3, P=0.09), CD4+ (11 vs 16/mm3, P=0.15), CD8+ count (359 vs 386/mm3, P=0.39) and plasma HIV RNA (5.3 vs 5.1 log10 copies/ml, P=0.22) at baseline. After 6 months on HAART, the median increase of CD4+ T-cell count was 28 cells/mm3 (interquartile range [IQR]: 1–63) in MAC+ and 72 cells/mm3 (IQR: 34–120) in MAC- patients ( P<0.0001), whereas the percentage of CD4+ T cells was not significantly different between the two groups ( P=0.13). Comparable differences were observed for total lymphocytes and CD8+ T cells ( P<0.001). The 6 months decline of plasma HIV RNA was not significantly different according to MAC exposure (-1.6 in MAC+ vs -1.8 log10 copies/ml in MAC- patients, P=0.65). Results were confirmed after adjustment for other characteristics than the matching variables and after taking into account potential informative bias due to unbalanced number of deaths between the two groups. Conclusion MAC infection at the time of HAART initiation is an important deleterious factor for immune reconstitution. A better understanding of the underlying mechanism and an evaluation of additional treatment strategies are necessary to help immune restoration in such circumstances.
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Affiliation(s)
- Estibaliz Lazaro
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Gaelle Coureau
- INSERM U593 - ISPED, Victor Segalen University, Bordeaux, France
| | - Jérémie Guedj
- INSERM E0338 - ISPED, Victor Segalen University, Bordeaux, France
| | - Patrick Blanco
- CNRS UMR5164 CIRID, Victor Segalen University, Bordeaux, France
- Department of Virology and Immunology, Bordeaux University Hospital, Bordeaux, France
| | - Isabelle Pellegrin
- Department of Virology and Immunology, Bordeaux University Hospital, Bordeaux, France
| | - Daniel Commenges
- INSERM E0338 - ISPED, Victor Segalen University, Bordeaux, France
| | - François Dabis
- INSERM U593 - ISPED, Victor Segalen University, Bordeaux, France
| | - Jean-François Moreau
- CNRS UMR5164 CIRID, Victor Segalen University, Bordeaux, France
- Department of Virology and Immunology, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Luc Pellegrin
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Rodolphe Thiébaut
- INSERM U593 - ISPED, Victor Segalen University, Bordeaux, France
- INSERM E0338 - ISPED, Victor Segalen University, Bordeaux, France
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