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Secular trends of nocardia infection over 15 years in a tertiary care hospital

¹ Division of Infectious Diseases, Department of Internal Medicine, University of Geneva Hospitals, 1211Geneva, Switzerland
² Clinical Microbiology Laboratory, Division of Infectious Diseases, University of Geneva Hospitals

Correspondence to:
Dr J Garbino
Division of Infectious Diseases, Department of Internal Medicine, University Hospitals of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland; Jorge.Garbino{at}hcuge.ch Aims: To assess the incidence of nocardia infection over 15 years in a tertiary care hospital.

Methods: Over a 15 year period, Nocardia spp were isolated from 20 patients hospitalised at the Geneva University Hospitals, Switzerland.

Results: Sixteen patients had one or more underlying conditions. The median time between symptom onset and diagnosis was 30 days. The most common initial unconfirmed diagnosis was pulmonary tuberculosis (four). The lung was involved in 16 cases, followed by the central nervous system (two) and skin (two); one patient had disseminated infection. The most common species identified was N asteroides. In vitro susceptibility testing was performed on 14 of 20 strains. All strains were susceptible to imipenem and amikacin. Initial treatment with trimethoprim/sulfamethoxazole (TMP/SMX) was started in 14 patients, although five patients had to be switched to another treatment because of side effects or lack of efficacy. A cure was observed in 15 patients, death in three, and relapse or complications in two.

Conclusions: Nocardiosis can become a severe infection and mainly affects profoundly immunocompromised patients. Differential diagnosis often delays the time to diagnosis, which worsens the outcome. New diagnostic tools, such as the polymerase chain reaction, could provide more rapid and reliable results. TMT/SMX was the most commonly prescribed treatment, but needed to be changed for another treatment because of side effects or lack of efficacy in a considerable proportion of patients. Imipenem should be used as an alternative treatment for severely ill patients, and the sulfa combination for less severe infections.

Abbreviations: BMT, bone marrow transplantation; CNS, central nervous system; HIV, human immunodeficiency virus; LDH, lactate dehydrogenase; TMP/SMX, trimethoprim/sulfamethoxazole

Keywords: Nocardia spp; nocardosis; antibiotherapy; immunodeficiency