Risk Factors for Nontuberculous Mycobacteria Infections in Solid Organ Transplant Recipients: A Multinational Case-Control Study
Carlos Mejia-Chew, Peggy L. Carver, Sasinuch Rutjanawech, Luís Fernando Aranha Camargo, Ruan Fernandes, Sara Belga, Shay-Anne Daniels, N Müller, Sara Burkhard, Nicole Theodoropoulos, Douwe F. Postma, Pleun J. van Duijn, María Carmen Fariñas, Claudia González-Rico, Jonathan Hand, Adam J. Lowe, Marta Bodro, Elisa Vanino, Ana Fernández‐Cruz, António Ramos, Mateja Janković Makek, Ribal Bou Mjahed, Oriol Manuel, Nassim Kamar, Antonia Calvo‐Cano, Laura Rueda Carrasco, Patricia Muñóz, Sara Rodríguez Fernández, Sandra Pérez‐Recio, Núria Sabé, Regino Rodríguez, José Tiago Silva, Alessandra Mularoni, Elisa Vidal, Juana Alonso-Titos, Teresa del Rosal, Annika Y. Claßen, Charles W. Goss, Mansi Agarwal, Francisco López‐Medrano
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.