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. 2022 Feb 15;66(2):e0189021.
doi: 10.1128/AAC.01890-21. Epub 2021 Dec 13.

Nocardiosis in Japan: a Multicentric Retrospective Cohort Study

Akane Takamatsu  1 , Takashi Yaguchi  2 , Yasuaki Tagashira  3 , Akira Watanabe  2 , Hitoshi Honda  1 ; Japan Nocardia Study Group
Affiliations

Nocardiosis in Japan: a Multicentric Retrospective Cohort Study

Akane Takamatsu et al. Antimicrob Agents Chemother. .

Abstract

Nocardia species cause a broad spectrum of infections, especially in immunocompromised patients. Given its relative rarity, data on the prognosis and distribution of nocardiosis from a large cohort are scarce. The present study aimed to scrutinize the clinical features and outcomes of nocardiosis in Japan, including 1-year mortality and microbiological data. The present multicentric, retrospective cohort study enrolled patients aged ≥18 years with nocardiosis diagnosed between January 2010 and December 2017 and recorded their clinical and microbiological characteristics. Factors associated with 1-year mortality were also determined using Cox proportional hazard analysis. In total, 317 patients were identified at 89 hospitals. Almost half (155/317, 48.9%) were receiving immunosuppressive agents, and 51 had disseminated nocardiosis (51/317, 16.1%). The 1-year all-cause mortality rate was 29.4% (80/272; lost to follow-up, n = 45). The most frequently isolated species was Nocardia farcinica (79/317, 24.9%) followed by the Nocardia nova complex (61/317, 19.2%). Selected antimicrobial agents were generally effective, with linezolid (100% susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. In Cox proportional hazard analysis, factors independently associated with 1-year mortality were a Charlson comorbidity index score of ≥5 (adjusted hazard ratio [aHR], 3.61; 95% confidence interval [CI], 1.95 to 6.71, P < 0.001) and disseminated nocardiosis (aHR, 1.79; 95%CI, 1.01 to 3.18, P = 0.047). The presence of advanced comorbidities and disseminated infection, rather than variations in antimicrobial therapy or Nocardia species, was independently associated with 1-year mortality.

Keywords: 1-year mortality; Nocardia; antimicrobial susceptibilities; nocardiosis.

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Conflict of interest statement

The authors declare no conflict of interest.

We all declare no conflicts of interest. All the authors have submitted the ICMJE form for the disclosure of potential conflicts of interest. Any conflict that the editors consider relevant to this article is disclosed here.

Figures

FIG 1
FIG 1
One-year Kaplan-Meier survival curves of patients with nocardiosis from the initiation of treatment. (A) Overall (n = 317). (B) Stratified by Charlson comorbidity index score. The adjusted hazard ratio for 1-year mortality was 3.61 (P < 0.001). (C) Stratified by infection site. The adjusted hazard ratio for 1-year mortality was 1.79 (P = 0.047).
See this image and copyright information in PMC

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