Introduction

Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, an increasing incidence has been described whereby data about epidemiology and prognosis are essential.

Methods

A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January 2019 to January 2023, at a Terciary Hospital in Portugal.

Results

Nocardiosis was considered in 18 cases with a median age of 63.8-years-old. At least one immunosuppressive cause was identified in 70% 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 as 55.6% 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 against Nocardia species. 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.

Conclusion

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.

中文翻译：

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诺卡氏菌病：单中心经验和文献综述

介绍

诺卡氏菌病是由诺卡氏菌引起的一种罕见的细菌感染。然而，据描述，发病率不断增加，因此流行病学和预后数据至关重要。

方法

在诺卡氏菌阳性患者中进行了一项回顾性描述性研究。文化，从 2019 年 1 月到 2023 年 1 月，在葡萄牙的一家三级医院。

结果

18例考虑诺卡氏菌病，中位年龄63.8岁。70% 的患者至少发现一种免疫抑制原因。五名患者患有播散性诺卡氏菌病（DN）。肺部是最常见的临床疾病部位（77.8%），诺卡氏菌在呼吸道样本中最常见。最常分离的物种是诺卡氏菌 nova/africana ( n  = 7)，其次是诺卡氏菌 (Nocardia cyriacigeorgica) ( n  = 3) 和诺卡氏菌( n  = 3)。大多数患者（94.4%）接受了抗生素治疗，其中多达55.6%接受了单一疗法。最常用的抗生素是甲氧苄啶-磺胺甲恶唑。选定的抗菌药物总体上是有效的，其中利奈唑胺和复方新诺明（100% 敏感性 [S]）和阿米卡星 (94% S) 对诺卡氏 菌具有最强的活性 。DN 的中位治疗时间 (IQR) 为 24.2 (1-51.4) 周；一年总体病死率为 33.3% ( n  = 6)，DN 中的病死率更高 (66.7%)。未观察到复发。

结论

诺卡氏菌病是一种新出现的传染病，预后较差，尤其是在 DN 中。这篇综述提供了重要的流行病学见解，并强调了更好地了解诺卡氏菌病微生物学的重要性。这些知识可以优化抗菌治疗，并在必要时指导适当的手术干预，以防止不良结果。