Nocardiosis over 20years in a tertiary care hospital
Abstract number: P1730
Ambrosioni J., Bouchuiguir-Wafa K., Garbino J.
Objectives: The aim of the study was to review and characterise the cases of nocardiosis identified in our institution between January 1989 and December 2008.
Methods: Retrospective analysis of all cases with emphasis on clinical presentation, diagnosis, treatment and outcome. Analysis of the antimicrobial susceptibility patterns of all the identified strains.
Results: During the study period 28 cases were identified; 25 were considered infections and included for analysis and 3 cases were not included because they were considered as colonisation in patients with chronic obstructive pulmonary disease, cystic fibrosis and bronchiectasis.
The highest number of cases (n = 4) was identified in 2008. The median age was 54.3 years old and 60% were male. The most frequent underlying diseases in patients with infection were cancer in 20%, solid organ transplantation 20%, HIV infection 12% and diabetes mellitus 12%; 32% received steroid therapy within one month before the diagnosis of Nocardia infection. Clinical presentations were pulmonary in 72% followed by cutaneous 12%, cerebral 8%, disseminated 4% and articular 4%. The species isolated were N. asteroides in 52%, N. asteroides complex in 16%, N. farcinica 8%, N. nova and N. brasiliensis 4% in each and Nocardia spp. in 16% of cases. Clinical outcome was cure or improvement in 80%, treatment failures in 4%, relapses in 4% and death in 12%.
Sensitivity tests showed that amikacin was active in 20/20 of tested strains, imipenem in 20/22, trimethoprim-sulphamethoxazole (TMS) in 19/22, minocycline in 7/7, ciprofloxacine in 8/13 and ceftriaxone in 6/9. Two tested strains were sensitive to linezolide; one strain was sensitive to imipenem but resistant to ertapenem. TMS was the initial antibiotic treatment in 15 patients. In 6 cases (40%) it was switched to another treatment due to intolerance or lack of efficacy.
Conclusions:Nocardia infection is increasing in our centre. It must be considered an opportunistic infection in our centre since most of the patients presented immunosuppression as a predisposing factor. TMS presented a good in vitro activity, but it was frequently switched to another antibiotic due to intolerance or lack of efficacy. Susceptibility tests showed that amikacin plus imipenem cover Nocardia spp. isolated in our institution. This combination could be considered the treatment of choice for nocardiosis. Sensitivity to imipenem cannot be extrapolated to other carbapenems.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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