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[Clinical and bacteriological aspects of nocardiasis. 9 cases]
F Bani-Sadr1, M Hamidou, F Raffi
1Service de Médecine interne Pr Grolleau, Hôtel-Dieu, Rouen.
Insights
Nocardial infections can be localized or disseminated, particularly in immunocompromised individuals. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the primary treatment, even when in vitro resistance is observed.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Nocardial infections present differently in immunocompetent versus immunocompromised patients.
- Understanding treatment efficacy and antibiotic sensitivity is crucial for managing Nocardia infections.
Observation:
- A retrospective study analyzed 9 cases of nocardial infections diagnosed between 1991 and 1994.
- Six patients were immunocompromised, experiencing disseminated infections affecting lungs, brain, skin, and eyes.
- Three immunocompetent patients presented with localized infections, including mycetoma and joint/lung involvement.
Findings:
- Nocardia asteroides, N. farcinica, and N. caviae were identified.
- In vitro antibiotic sensitivities varied, with amikacin and imipenem showing broad effectiveness.
- Trimethoprim-sulfamethoxazole (TMP-SMX) was the most effective treatment, even in a case with in vitro resistance.
Implications:
- TMP-SMX is confirmed as the gold standard for treating nocardial infections.
- Clinical outcomes may not always align with in vitro antibiotic sensitivity data.
- Further research into Nocardia treatment strategies is warranted.
Objectives:
Nocardial infection is usually localized in the immunocompetent patient and occurs as an opportunistic disseminated infection in about half of the cases in immunoincompetents patients.
Methods:
We report a retrospective assessment of 9 cases of nocardial infection diagnosed between January 1991 and February 1994.
Results:
Six of the patients were immunodepressed: 3 had a disseminated infection with pulmonary (n = 2), brain (n = 2), skin (n = 3) and/or ocular (n = 1) localizations. There were 3 immunocompetent patients with an isolated local infection: skin and bone mycetoma, knee joint and lung. Diagnosis was made on samples obtained invasively in 7 patients. Nocardia asteroides was isolated in 5 patients, N. farcinica in 3 and N. caviae in 1. These organisms showed in vitro sensitivity to amoxicillin-clavulanic acid 5/9, cefotaxime 5/9 (0/3 for N. farcinica), imipeneme 7/9, amikacin 8/8, minocyclin 5/8, pefloxacin 0/8 and trimethoprime-sulfamethoxazol (TMP-SMX) 3/9. Clinical outcome was favourable in all cases and was not always correlated with laboratory sensitivity.
Conclusion:
TMP-SMX remains the reference antibiotic. For one patient, only TMP-SMX (resistant in vitro) was effective; with all the other antibiotic tried (sensitive in vivo) treatment failed.