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Nocardiosis in Quebec, Canada, 1988-2008
J Tremblay1, L Thibert, I Alarie
1Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Canada.
Summary
Nocardia infections are rare but increasing in Quebec, Canada. Antimicrobial resistance, particularly to trimethoprim-sulfamethoxazole, is a growing concern for immunosuppressed patients.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Nocardia is an uncommon pathogen, with immunosuppression being a primary risk factor.
- Increasing rates of immunosuppression globally necessitate understanding Nocardia incidence and antimicrobial susceptibility trends.
Purpose of the Study:
- To evaluate temporal changes in the annual incidence of nocardiosis in Quebec, Canada.
- To assess the evolving antimicrobial susceptibility profiles of etiological agents of nocardiosis.
Main Methods:
- Retrospective analysis of Nocardia isolates submitted to the provincial public health laboratory of Quebec from 1997-2008.
- Calculation of population incidence rates from 1997 onwards.
- In vitro susceptibility testing for a subset of isolates.
Main Results:
- A significant increase in the annual incidence of Nocardia infection/colonization from 0.33 to 0.87 per 100,000 inhabitants was observed between 1997-1998 and 2007-2008 (p<0.001).
- Nocardia farcinica was predominant in invasive infections.
- 43% of isolates showed non-susceptibility to trimethoprim-sulfamethoxazole, while amikacin and linezolid remained effective.
Conclusions:
- Nocardiosis incidence has progressively increased in Quebec since 1997.
- The rising non-susceptibility to trimethoprim-sulfamethoxazole challenges its role as an empirical treatment for severe nocardiosis in immunosuppressed patients.
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