Nocardia at UNC Hospitals, 2007 – 2016: An Analysis of Mortality According to Antibiotic Treatment

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  • January 10, 2020
Creator
  • Saunders, Eleanor
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
Abstract
  • Objectives: To examine the epidemiology of all laboratory cases of Nocardiosis and to compare one-year mortality after treatment with first-line trimethoprim/sulfamethoxazole (TMP/SMX) for more than 2 weeks with treatment using other antibiotics (with a <2 week trial of TMP/SMX). Methods: We retrospectively analyzed treatments and outcomes of all adult patients with a first clinical sample positive for Nocardia tested at UNC Hospitals McLendon Clinical Laboratories in Chapel Hill, North Carolina between January 2007 and December 2016 (N=112). We used Fisher’s exact test to compare clinical and diagnostic characteristics of samples. We compared one-year all-cause mortality between two antibiotic treatment groups using a log-rank test. Results: One-year mortality was 2.6% greater (95 % CI -22.4 – 27.6) in the ≥2 weeks TMP/SMX group (7/31) than in the <2 weeks TMP/SMX group (3/15), a statistically insignificant difference. The log-rank test of one-year mortality between these groups produced an insignificant p-value of 0.7208. Conclusions. Treatment with TMP/SMX, though the gold standard, does not produce a statistically significant improvement in one-year all-cause mortality and causes substantial toxicity to a subset of patients. This warrants further study in which results could be pooled from multiple centers for a non-inferiority trial of alternative antibiotic regimens (e.g. imipenem or amikacin).
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  • In Copyright
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  • Track: HC&P
  • Paper type: Research or research design
Advisor
  • Tolleson-Rinehart, Sue
Reviewer
  • Lachiewicz, Anne
Degree
  • Master of Public Health
Academic concentration
  • Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2017
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  • caca45b9-7a14-4075-b4be-a3cdcdee6153

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