Evaluation of the Incidence of Nocardia Infection in Solid Organ Transplant Recipients on Trimethoprim-Sulfamethoxazole for Opportunistic Infection Prophylaxis.

This article focuses on evaluating the incidence of Nocardia infection in solid organ transplant (SOT) recipients receiving trimethoprim-sulfamethoxazole (TMP-SMX) versus alternative agents for opportunistic infection (OI) prophylaxis. In a retrospective study of 791 adult SOT patients, those receiving TMP-SMX, the preferred prophylactic agent for Pneumocystis jiroveci pneumonia and toxoplasmosis, had a significantly lower incidence of nocardiosis (0.3%) compared to those on alternative agents (3.4%). The study found that most patients switched from TMP-SMX due to adverse effects could tolerate re-challenge with TMP-SMX, suggesting many adverse effects may be temporary. The findings support TMP-SMX’s protective role against nocardiosis in SOT recipients and highlight the need for protocols to reassess TMP-SMX use after adverse events resolve.