The Clinical Characteristic and Management of patients with nocardiosis in a tertiary hospital in China

Abstract

Background Nocardiosis is an uncommon opportunistic bacterial infection caused by Nocardia spp., and its incidence has increased significantly in recent years. This study aimed to summarize the clinical characteristics and management of nocardiosis to provide a reference for clinical diagnosis and treatment. Methods This retrospective study was conducted based on the medical records of nocardiosis patients between January 2015 and December 2021 in a tertiary hospital in China. Results Overall, 44 patients with nocardiosis were included in this analysis including 26 males and 18 females with a mean age of 50.4 ± 13.2 years. Connective tissue disease (CTD) was the most common underlying disease (16/44). Twenty-six patients were given immunosuppressive therapy. The most frequent infection sites were the lungs (17/44) and skin and soft tissue (8/44). Common symptoms included cough (23/44), expectoration (18/44), fever (15/44), and subcutaneous abscesses (15/44). Average microbiology laboratory detection time was 4.8 days. Twenty-nine patients were managed only with antimicrobial treatment, and 14 patients received both antimicrobial and surgical therapies. Trimethoprim-sulfamethoxazole (TMP-SMX) was the most commonly used antibiotic (31/44). Thirty-five patients were cured or improved, 6 patients were discharged from the hospital due to poor prognosis, and 1 patient died. Conclusion Clinicians should be alert to immunocompromised patients, especially those with CTD, and tend to pulmonary or cutaneous infections. Smear microscopic examination and prolonged culture time may aid Nocardia identification. Patients with nocardiosis can be treated with antimicrobials or surgical therapy. TMP-SMX remains the mainstay treatment, and its early and prompt use may improve nocardiosis outcome.