Retrospective analysis of nocardiosis in a general hospital from 1998 to 2017

Abstract

Objectives: To describe the epidemiological, clinical, microbiological, and therapeutic characteristics of Nocardiosis patients treated in a general hospital.

Patients and methods: Monocentric retrospective analysis of patients presenting with Nocardia-positive biological sample from January 1, 1998 to May 1, 2017.

Results: We identified nine cases of Nocardia infections. Risk factors were oral corticosteroid therapy (n=3), solid cancer (n=2), hematological cancer (n=1), COPD (n=1). No risk factor was identified in patients with isolated cutaneous presentation (n=2). Disseminated presentations (n=3) were observed in patients receiving corticosteroid therapy (n=2) and presenting with ENT cancer (n=1). Identified Nocardia species were Nocardia nova (n=4), Nocardia cyriacigeorgica (n=2), Nocardia abscessus (n=1), Nocardia brasiliensis (n=1), and Nocardia asteroides (n=1). The median diagnostic time was 17 days. Antibiotic therapy was prolonged and included trimethoprim-sulfamethoxazole in 6/9 cases. The overall one-year case fatality was high (3/8). No recurrence was observed. We identified two cases of respiratory colonization with N. abscessus and N. cyriacigeorgica in COPD patients.

Conclusion: Nocardiosis can occur both in immunocompetent and immunocompromised patients. It is a severe infection, with a miscellaneous clinical spectrum and complex treatments. Greater knowledge of nocardiosis is required from physicians for optimal medical care.

Keywords: Antibiothérapie; Antibiotic therapy; Colonisation; Colonization; Immunodeficiency; Immunodépression; Linezolid; Linézolide; Nocardia.