E M Le Coustumier1, E Denes2, C Martin3, P Weinbreck2. 1. Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Service de médecine interne A et polyclinique, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France. Electronic address: eve.lc@free.fr. 2. Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France. 3. Laboratoire de bactériologie-virologie-hygiène, centre de biologie et recherche en santé, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
Abstract
INTRODUCTION: Nocardiosis are uncommon. The diagnosis may be difficult, with significant morbidity and mortality, often occurring on frail patients. Few data are available in France. METHODS: A retrospective single center study was conducted from 2002 to 2014 and included all patients with at least one positive microbiological sample for Nocardia with a follow-up in our hospital. RESULTS: Nineteen patients, including 15 men, were included with a mean age of 58 years (25-85). Seventeen had a risk factor (lung diseases [13], corticosteroids [12], solid neoplasia [2], HIV infection [2], diabetes mellitus [3], kidney transplant [2], lymphopenia [1]). Infections' locations were: pulmonary (12), brain (3), skin (2), lymph node (1) and corneal (1). The slow growth leads to a median of 35 days for a positive result (3-95). Nine species were identified. Fifteen patients (79%) received one or more lines of antibiotics including: cotrimoxazole (9), amoxicillin (7) cefotaxime/ceftriaxone (7) imipenem (3), or amikacin (3). The average duration of antibiotic therapy was 207 days. Four patients did not receive antibiotics due to a late result or a bacterial co-infection masking nocardiosis. Five patients died (26%) including 2 with cerebral nocardiosis. Six patients were cured, 4 suffered a relapse, 4 had an unknown evolution, and 1 was still treated. CONCLUSION: Our study shows that nocardiosis is a disease difficult to treat. A better understanding of this type of infection is necessary.
INTRODUCTION:Nocardiosis are uncommon. The diagnosis may be difficult, with significant morbidity and mortality, often occurring on frail patients. Few data are available in France. METHODS: A retrospective single center study was conducted from 2002 to 2014 and included all patients with at least one positive microbiological sample for Nocardia with a follow-up in our hospital. RESULTS: Nineteen patients, including 15 men, were included with a mean age of 58 years (25-85). Seventeen had a risk factor (lung diseases [13], corticosteroids [12], solid neoplasia [2], HIV infection [2], diabetes mellitus [3], kidney transplant [2], lymphopenia [1]). Infections' locations were: pulmonary (12), brain (3), skin (2), lymph node (1) and corneal (1). The slow growth leads to a median of 35 days for a positive result (3-95). Nine species were identified. Fifteen patients (79%) received one or more lines of antibiotics including: cotrimoxazole (9), amoxicillin (7) cefotaxime/ceftriaxone (7) imipenem (3), or amikacin (3). The average duration of antibiotic therapy was 207 days. Four patients did not receive antibiotics due to a late result or a bacterial co-infection masking nocardiosis. Five patients died (26%) including 2 with cerebral nocardiosis. Six patients were cured, 4 suffered a relapse, 4 had an unknown evolution, and 1 was still treated. CONCLUSION: Our study shows that nocardiosis is a disease difficult to treat. A better understanding of this type of infection is necessary.
Authors: T Durand; F Vautrin; E Bergeron; V Girard; S Polsinelli; V Monnin; G Durand; O Dauwalder; O Dumitrescu; F Laurent; V Rodríguez-Nava Journal: Eur J Clin Microbiol Infect Dis Date: 2019-11-22 Impact factor: 3.267