Volume 23, Number 3—March 2017
Dispatch
Rhodococcus Infection in Solid Organ and Hematopoietic Stem Cell Transplant Recipients1
Table 1
Clinical characteristics, treatment, and outcome for 18 patients infected with Rhodococcus spp, United States*
Patient age, y/sex | Residence | Transplant, underlying disease | Time from transplant to infection | Clinical feature | Lung pathology | Immunosuppression at infection | Antimicrobial drug treatment | Treatment duration | Outcome at 90 d† |
---|---|---|---|---|---|---|---|---|---|
76/M | Wisconsin | Kidney, obstructive uropathy | 4 y | Pneumonia (productive cough, chest pain) | Chronic inflammation and reactive changes | Tacrolimus, prednisone | Ertapenem, levofloxacin → moxifloxacin | 12 mo | Partial response |
57/F | Iowa | Heart, ischemic cardiomyopathy | 5 mo | Catheter-associated bacteremia | NT | Sirolimus, MMF, prednisone | Vancomycin, levofloxacin → levofloxacin | 7 mo | Complete response |
76/M | Minnesota | Heart, ischemic cardiomyopathy | 20 y | Pacemaker pocket wound infection | NT | Cyclosporine, MMF, prednisone | TMP/SMX | 2 mo | Complete response |
59/F | Massachusetts | Double lung, usual interstitial pneumonia | 8 mo | Bacteremia | NT | Cyclosporine, prednisone | Vancomycin → azithromycin | 60 mo | Complete response |
45/M | Massachusetts | Double lung, lymphangiolyomatosis | 5 y | Pneumonia (fever, dyspnea), bacteremia | NT | Tacrolimus, MMF, prednisone | Vancomycin, meropenem → azithromycin, rifampin | 8 mo | Unknown response |
78/F | Massachusetts | Kidney, diabetic nephropathy | 7 y | Pneumonia (productive cough) | Small chronic granulomas admixed with reactive bronchial cells | Tacrolimus, MMF, prednisone | Moxifloxacin → doxycycline | 14 mo | Stable disease |
53/M | Michigan | Heart, ischemic cardiomyopathy | 10 mo | Pneumonia (cough), bacteremia | NT | Tacrolimus, MMF, prednisone | Vancomycin → levofloxacin, azithromycin | 5 mo | Partial response |
54/M | Michigan | Kidney, glomerulopathy | 4 mo | Pneumonia (cough) | NT | Tacrolimus, MMF, prednisone | Meropenem, azithromycin, meropenem | 3 mo | Partial response |
68/M | Florida | Heart, ischemic cardiomyopathy | 3 mo | Pneumonia (fever) | NT | Tacrolimus, MMF | Vancomycin, imipenem, TMP/SMX → imipenem, ciprofloxacin | 11 mo | Partial response |
53/M | Florida | Liver, alcoholic cirrhosis | 34 mo | Catheter-associated bacteremia | NT | Sirolimus, MMF | Vancomycin, ceftriaxone | 3 mo | Complete response |
67/F | Pennsylvania | Left lung, idiopathic pulmonary fibrosis | 5 y | Pneumonia (cough, dyspnea) | NT | Tacrolimus, MMF, prednisone | Vancomycin, azithromycin | 2 mo | Complete response |
51/M | Nebraska | Double lung, scleroderma with pulmonary fibrosis | 22 mo | Pneumonia (fever, cough, dyspnea, chest pain) | NT | Tacrolimus, MMF, prednisone | Minocycline, azithromycin → azithromycin, linezolid | 6 mo | Partial response |
14/M | California | Allogeneic HSCT, acute myeloid leukemia | 6 mo | Catheter-associated bacteremia | NT | Tacrolimus, prednisone | Linezolid | 2 wk | Complete response |
61/M | Mississippi | Allogeneic HSCT, chronic lymphocytic leukemia | 54 mo | Pneumonia (fever, dyspnea), bacteremia | Acute pulmonary inflammation | Prednisone | Meropenem, tigecycline → ertapenem, TMP/SMX, tigecycline | 6 mo | Stable response, disease relapse at 9 mo |
65/F | Texas | Allogeneic HSCT, follicular lymphoma | 8 mo | Pneumonia | Focal tissue, eosinophilia, and Masson bodies; organizing pneumonia | None | Gatifloxacin, azithromycin | 2 mo | Complete response |
3/M | Texas | Autologous HSCT, neuroblastoma | 2 mo | Bacteremia | NT | None | Vancomycin, gatifloxacin | 1 mo | Complete response |
63/M | Texas | Allogeneic HSCT, acute myeloid leukemia | 4 mo | Catheter-associated bacteremia | NT | Tacrolimus, prednisone for GVHD | Vancomycin | 1 mo | Complete response |
53/F | Texas | Allogeneic HSCT, chronic myelogenous leukemia | 4 mo | Pneumonia (fever, dyspnea, productive cough, chest pain), bacteremia | NT | Sirolimus for GVHD | Tigecycline, TMP/SMX, piperacillin/tazobactam → levofloxacin, TMP/SMX, piperacillin/tazobactam | 2 wk | Died of respiratory failure/ARDS at day 13 |
*ARDS, acute respiratory distress syndrome; GVHD, graft-versus-host disease; MMF, mycophenolate mofetil; NT, not tested; TMP/SMX, trimethoprim/sulfamethoxazole; →, change in treatment regimen.
†Outcome (response to treatment) was categorized as complete (resolution of all attributable signs, symptoms, and radiographic abnormalities); partial (clinical improvement and >50% improvement in radiographic abnormalities); stable (no improvement in clinical manifestations and <50% improvement in radiographic findings); or failure (deterioration of condition or death).
1Results from this study were presented in part at IDWeek 2012, October 17–21, 2012, San Diego, California, USA.
2Current affiliation: University of Manchester, Manchester, UK.