Clinical Investigation
Clinical Spectrum and Outcome of Nocardia Infection: Experience of 15-Year Period From a Single Tertiary Medical Center

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Abstract

Introduction

Nocardiosis, although very rare, is considered as an important opportunistic infection; however, recent literature is limited. This study describes all cases of nocardial infection treated in the authors’ hospital to provide more information about clinical manifestations, species isolated, treatment and outcome of patients with nocardiosis.

Methods

A retrospective review of the clinical features and outcome of nocardial infections was conducted during a 15-year period (1996–2010) at Rambam Health Care Campus.

Results

The study included 53 patients with nocardial infection, 43 of them had underlying immunodeficiency. The most common clinical form was pulmonary nocardiosis with and without dissemination (60%), followed by skin and soft tissue infection (21%), bacteremia (11%) and pertonitis (5%). Resistance to trimethoprim/sulfamethoxazile was detected in 15% of isolates; to imipenem in 5% and to ciprofloxacin in 65%. Overall mortality was 25% (13/53), mainly observed in patients with pulmonary involvement (37.5%).

Conclusions

Nocardiosis is a rare infection and mainly affects immunocompromised patients. Higher index of suspicion is needed for earlier diagnosis and treatment to improve prognosis.

Section snippets

Patient Population

This study was undertaken at Rambam Health Care Campus, a 1000-bed tertiary care center, university-affiliated hospital. Records of patients who were diagnosed with nocardiosis between January 1, 1996, and December 1, 2010, were reviewed. Patients were identified through a search of computerized data from the microbiology laboratory and clinical records. The following data were gathered for each patient: patient’s age and gender, underlying diseases, immunosuppressive therapies, clinical and

RESULTS

During the 15-year period (1996–2010), Nocardia sp. was isolated from 63 patients. Records of 62 of the 63 cases were available for review. Fifty-three patients had nocardiosis. The remaining 9 patients were colonized with Nocardia sp. without clinical disease, and no further analysis was performed on these patients. The median patients’ age was 59 years (range, 2–32 years), and men represented the majority of cases (38/53, 72%). The incidence rate of the disease calculated per 1,00,000 admissions

DISCUSSION

Previous reports indicate a possible increase in the incidence of nocardial infection.6., 7., 8. In contrast, this study revealed that nocardiosis remained infrequent and at constant incidence rate of about 2 to 6 cases a year during the last decade. Notably, this study was carried out in a 1000-bed tertiary university-affiliated medical center and included significant immunocompromised patient population.

Most patients were men, similar to most published reports.1., 2., 4., 7., 10., 11., 12., 13.

CONCLUSION

Nocardiosis is still a rather rare infection and mainly affects immunocompromised patients. The incidence of the infection remains stable in our hospital during the last decade. Most of the patients survive the infection, when diagnosis is obtained on time. Pulmonary infection in immunocompromised patients is responsible for the subset of patients with the highest mortality.

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