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Abstract：
BACKGROUND: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：诺卡氏菌病是一种罕见的由诺卡氏菌引起的细菌感染。然而,已经描述了发病率的增加，因此有关流行病学和预后的数据至关重要。
方法：在诺卡氏菌属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Terciary医院。
结果：18例患者的中位年龄为63.8岁。在70％的患者中至少发现了一种免疫抑制原因。5例患者患有播散性心脏病（DN）。肺部是临床疾病最常见的部位（77.8％），诺卡氏菌在呼吸道样本中最常见。最常见的分离物种是诺卡氏菌/非洲诺卡氏菌（n=7），其次是纳卡氏菌（n=3）和假性诺卡氏菌（n=3）。大部分患者（94.4%）接受抗生素治疗，其中高达55.6%的患者接受单一疗法治疗。最常用的抗生素是甲氧苄啶-磺胺甲恶唑。选定的抗菌药物通常是有效的，利奈唑胺和复方新诺明（100％敏感性[S]）和阿米卡星（94％S）对诺卡氏菌属物种的活性最高。DN的中位治疗时间（IQR）为24.2（1-51.4）周；一年的总病死率为33.3％（n=6），DN更高（66.7％）。没有观察到复发。
结论：诺卡病是一种新出现的感染性疾病，预后较差，尤其是DN。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心病微生物学的重要性。这些知识可以导致抗菌治疗的优化，必要时,指导适当的手术干预措施，以防止不利的结果。
方法：在诺卡氏菌属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Terciary医院。
结果：18例患者的中位年龄为63.8岁。在70％的患者中至少发现了一种免疫抑制原因。5例患者患有播散性心脏病（DN）。肺部是临床疾病最常见的部位（77.8％），诺卡氏菌在呼吸道样本中最常见。最常见的分离物种是诺卡氏菌/非洲诺卡氏菌（n=7），其次是纳卡氏菌（n=3）和假性诺卡氏菌（n=3）。大部分患者（94.4%）接受抗生素治疗，其中高达55.6%的患者接受单一疗法治疗。最常用的抗生素是甲氧苄啶-磺胺甲恶唑。选定的抗菌药物通常是有效的，利奈唑胺和复方新诺明（100％敏感性[S]）和阿米卡星（94％S）对诺卡氏菌属物种的活性最高。DN的中位治疗时间（IQR）为24.2（1-51.4）周；一年的总病死率为33.3％（n=6），DN更高（66.7％）。没有观察到复发。
结论：诺卡病是一种新出现的感染性疾病，预后较差，尤其是DN。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心病微生物学的重要性。这些知识可以导致抗菌治疗的优化，必要时,指导适当的手术干预措施，以防止不利的结果。
