Retrospective Analysis of Antimicrobial Susceptibility Profiles of
            <i>Nocardia</i>
            Species from a Tertiary Hospital and Reference Laboratory, 2011 to 2017

Nocardia spp. is an environmental filamentous Gram-positive bacterium that may cause infections in humans and, despite recent progress, many challenges remain regarding the management of nocardiosis. This review aims at describing most recently published data regarding the diagnosis, treatment and follow-up of patients with invasive nocardiosis. As nocardiosis mainly affects patients with cell-mediated immunity defects, a comprehensive workup is mandatory in case of invasive nocardiosis occurring in ”apparently healthy patients”. Indeed, invasive nocardiosis might reveal an unknown primary immunodeficiency or the presence of anti-GM-CSF autoantibodies. Even if the diagnosis of nocardiosis mostly relies on direct examination and bacterial culture, a genus-specific PCR may be used for the detection of Nocardia , when directly performed on a clinical sample. Brain imaging should always be performed, even in the absence of neurological symptoms. Cotrimoxazole (trimethoprim/sulfamethoxazole), linezolid, parenteral cephalosporins, carbapenems and amikacin may be used as initial antibiotics to treat nocardiosis. Cotrimoxazole or linezolid can be used as monotherapy in selected patients without brain involvement. Although treatment duration has historically been set to at least 6 months in the absence of central nervous system involvement, shorter durations (<120 days) seem to be associated with a favourable outcome.

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“…Results of Antibiotic Susceptibility Testing Among Nocardia Isolates According to Their Species3,48,49,[67][68][69] …”

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confidence: 99%

Invasive Nocardiosis: Disease Presentation, Diagnosis and Treatment – Old Questions, New Answers?

Lafont¹,

Conan²,

Rodríguez-Nava³

et al. 2020

IDR

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“…There are currently no formal treatment guidelines for managing Nocardia infections, which highlights the need for future research and the development of treatment protocols based on randomized controlled trials. Treatment of Nocardia infections is highly individualized, and susceptibility testing is key as antimicrobial resistance is common among different Nocardia species [ 19 ]. Monotherapy is typically sufficient for immunocompetent hosts with systemic or cutaneous infection; however, in immunocompromised patients or in patients with pulmonary or disseminated infection, double or triple therapy is often warranted [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Sulfonamide antimicrobials, such as TMP-SMX, are the treatment agents of choice. Nocardia farcinica has been noted to have increased antibiotic resistance compared to other strains, with resistance to beta-lactams and aminoglycosides but susceptibility to amoxicillin-clavulanic acid, amikacin, moxifloxacin, linezolid, and TMP-SMX and variable susceptibility toward imipenem and ciprofloxacin [ 19 ]. Before antibiotic susceptibility tests return, empiric therapy of TMP-SMX, amikacin, and either ceftriaxone or imipenem is usually initiated [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Nocardia farcinica Brain Abscess in an Immunocompetent Host With Pulmonary Alveolar Proteinosis: A Case Report and Review of the Literature

Grond¹,

Schaller

Kalinowski³

et al. 2020

Cureus

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A 55-year-old immunocompetent male presented with new-onset seizures and acute respiratory failure requiring intubation and a stay in the medical intensive care unit. Magnetic Resonance Imaging (MRI) of the brain revealed ring-enhancing lesions, and Computed Tomography (CT) chest showed ground-glass opacity. The patient underwent craniotomy and bronchoscopy, followed by culture of the purulent aspirate from lesions in the brain and bronchoalveolar lavage (BAL). After extensive infectious workup, the patient was diagnosed with a Nocardia farcinica brain abscess plus underlying pulmonary alveolar proteinosis (PAP). Based on a recommendation from an infectious disease expert, the patient was treated with trimethoprim-sulfamethoxazole (TMP/SMX). This case highlights the importance of understanding that, though rare, infections such as nocardiosis can present in immunocompetent patients and cause severe morbidity.

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“…Wang et al [17], 2014 Texas, USA 132 cases, 138 strains: N. nova (27), N. cyriacigeorgica (25), N. farcinica (19), N. abscessus (11), others (56) Cancer patients: respiratory samples (101), skin and soft tissue (16), blood (13), others (8) Li et al [20], 2015 Beijing, China 24 cases of autoimmune disease, 33 isolates of Nocardia spp. Pulmonary (25), skin (7), brain (1) Hashemi-Shahraki et al [68], 2015 Iran 127 cases: N. cyriacigeorgica (35), N. asteroides (30), N. farcinica (26), N. otitidiscaviarum (12), N. abscessus (10) Pulmonary (66) (27) Shannon et al [19], 2016 Florida, USA 15 cases in 10 years HSCT recipients: pulmonary (87%), disseminated (47%), blood (27%)…”

Section: Neurological Casesmentioning

confidence: 99%

Nocardiosis: A Neglected Disease

Duggal

Chugh²

2020

Med Princ Pract

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is a global problem, though more common in the tropics; disease frequency is increasing due to increases in traveling and immunocompromised patients. • Pulmonary nocardiosis is the commonest presentation but no part of the body is exempt. • Diagnosis can be made by simple microscopy; however, culture and molecular methods provide a definitive diagnosis. • Nocardiae are resistant to many antibiotics, but effective chemotherapies are available in most cases.

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Retrospective Analysis of Antimicrobial Susceptibility Profiles of Nocardia Species from a Tertiary Hospital and Reference Laboratory, 2011 to 2017

Cited by 58 publications

References 14 publications

Invasive Nocardiosis: Disease Presentation, Diagnosis and Treatment – Old Questions, New Answers?

Invasive Nocardiosis: Disease Presentation, Diagnosis and Treatment – Old Questions, New Answers?

Nocardia farcinica Brain Abscess in an Immunocompetent Host With Pulmonary Alveolar Proteinosis: A Case Report and Review of the Literature

Nocardiosis: A Neglected Disease

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