2601. A 14-year retrospective study of pulmonary nocardiosis in AIDS patients, Northeastern Thailand

Abstract

Abstract Background Nocardiosis is an opportunistic infection in immunocompromised individuals, particularly patients with acquired immune deficiency syndrome (AIDS). Clinical manifestations of nocardiosis are wide-ranging but the most common is pneumonia. Methods This 14 year retrospective study included Nocardia species infected adult patients (≥15 years) with at least 28 days of treatment follow-up. This study aims to compare clinical manifestations and survival analysis of cultured confirmed pulmonary nocardiosis among AIDS and non-AIDS patients. Results From 2009 to 2022, 237 patients had culture confirmed Nocardia species infection, of which 22 were excluded from this study because 13 had cutaneous nocardiosis and nine had pulmonary nocardiosis with follow-up less than 28 days. A total of 215 confirmed pulmonary nocardiosis were recruited to the analysis, 97(45.1%) were HIV-infected and 118 (54.9%) were non-HIV. All HIV-infected patient has CD4 count below 200 cell/mm3 (range 1-198, 1-15%), known as AIDS. Most of them were male with a mean age of 37 (range 15-83) years. One hundred fifty of the 215 (69.7%) patients underwent brain imaging. Sixteen cases (10.7%) had brain abscess. Disseminated nocardiosis (brain abscess, bacteremia, cutaneous abscess) was found in equal proportions in AIDS (15/97, 15.5%) and non-AIDS patients (17/118, 14.4%), while pulmonary nocardiosis with local invasion (empyema thoracis, pericardial effusion) was more common in AIDS (11/97, 11.3%) than non-AIDS patients (9/118, 7.6%). Overall and 28 days mortality were 116 (53.9%) and 88 (40.9%), respectively. In Cox’s proportional hazard analysis, AIDS was the independent factor associated with 28 days mortality in pulmonary nocardiosis (adjusted HR 2.62; 95%CI, 1.38 to 4.98) and those who underwent brain imaging (adjusted HR 2.75; 95%CI, 1.23 to 6.15) after adjusted by sex, age, duration of illness, respiratory failure, shock, multi-lobar pneumonia, disseminated nocardiosis, and combination antibiotic therapy. Conclusion Pulmonary nocardiosis is a serious opportunistic infection in AIDS patient and has shown significantly higher mortality than non-AIDS. Therefore, nocardiosis should always be considered as a cause of pneumonia in AIDS patients in order to prompt aggressive treatment. Disclosures Yupin Suputtamongkol, MD, Abbott Labs: Grant/Research Support|Abbott Labs: Mahidol University is partner in the Abbott Pandemic Defense Coalition