Nocardiosis: a single-center experience and literature review.

Abstract

Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, anincreasingincidence has been described whereby data about epidemiology and prognosis are essential. A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January2019 to January2023, at a Terciary Hospital in Portugal. Nocardiosis was considered in18cases with a median age of63.8-years-old. At least one immunosuppressive cause was identified in70% of patients. Five patients had Disseminated Nocardiosis (DN). The lung was the most common site of clinical disease (77.8%) and Nocardia was most commonly identified in respiratory tract samples. The most frequently isolated species were Nocardia nova/africana (n=7) followed by Nocardia cyriacigeorgica (n=3) and Nocardia pseudobrasiliensis (n=3). The majority of the patients (94.4%) received antibiotic therapy, of whom as many as55.6% were treated with monotherapy. The most frequently prescribed antibiotic was trimethoprim-sulfamethoxazole. Selected antimicrobial agents were generally effective, with linezolid and cotrimoxazole(100%Susceptibility [S]) and amikacin(94% S) having the most activity againstNocardiaspecies. The median (IQR) duration of treatment was 24.2 (1‒51.4) weeks for DN; The overall one-year case fatality was 33.3% (n=6) and was higher in the DN (66.7%). No recurrence was observed. Nocardiosis is an emerging infectious disease with a poor prognosis, particularly in DN. This review offers essential epidemiological insights and underscores the importance of gaining a better understanding of the microbiology of nocardiosis. Such knowledge can lead to the optimization of antimicrobial therapy and, when necessary, guide appropriate surgical interventions to prevent unfavorable outcomes.