The species distribution and antimicrobial resistance profiles of Nocardia species in China: A systematic review and meta-analysis

Abstract

Background Nocardia species can cause local or disseminated infection. Prompt diagnosis and appropriate treatment of nocardiosis are required, because it can cause significant morbidity and mortality. Knowledge of local species distribution and susceptibility patterns is important to appropriate empiric therapy. However, knowledge on the epidemiology and antimicrobial susceptibility profiles of clinical Nocardia species remains limited in China. Methods The data of isolation of Nocardia species were collected from databases such as Pubmed, Web of Science, Embase as well as Chinese databases (CNKI, Wanfang and VIP). Meta-analysis was performed using RevMan 5.3 software. Random effect models were used and tested with Cochran’s Q and I2 statistics taking into account the possibility of heterogeneity between studies. Results In total, 791 Nocardia isolates were identified to 19 species levels among all the recruited studies. The most common species were N. farcinica (29.1%, 230/791), followed by N. cyriacigeorgica (25.3%, 200/791), N. brasiliensis (11.8%, 93/791) and N. otitidiscaviarum (7.8%, 62/791). N. farcinica and N. cyriacigeorgica are widely distributed, N. brasiliensis mainly prevalent in the Southern, N. otitidiscaviarum mainly distributed in the east coastal provinces of China. Totally, 70.4% (223/317) Nocardia were cultured from respiratory tract specimens, 16.4% (52/317) from extra-pulmonary specimens, and 13.3% (42/317) from disseminated infection. The proportion of susceptible isolates as follows: linezolid 99.5% (197/198), amikacin 96.0% (190/198), trimethoprim-sulfamethoxazole 92.9% (184/198), imipenem 64.7% (128/198). Susceptibility varied by species of Nocardia. Conclusions N. farcinica and N. cyriacigeorgica are the most frequently isolated species, which are widely distributed in China. Pulmonary nocardiosis is the most common type of infection. Trimethoprim-sulfamethoxazole can still be the preferred agent for initial Nocardia infection therapy due to the low resistance rate, linezolid and amikacin could be an alternative to treat nocardiosis or a choice in a combination regimen.

Abdominal Abscesses Caused by Nocardia farcinica in an Immunocompromised Patient: A Case Report and Literature Review

“… 41 Imipenem has varying sensitivity to various species of Nocardia , with a good sensitivity rate of 90.1% to N. cyriacigeorgica , while it showed a relatively low sensitivity rate to N. farcinica (45.5%). 41 For immunocompetent patients, a 6-month course of antibacterial treatment is generally recommended, whereas immunosuppressed patients or those with disseminated CNS lesions typically require at least 6–12 months of treatment. 5 The continuous presence or recurrence of Nocardia infection is often attributed to the use of insensitive antibiotics or inadequate treatment.…”

“…A study on the distribution of Nocardia species and drug resistance in China showed that TMP-SMX was the most active drug against Nocardia isolated in China, and it could be used as the primary drug for treating Nocardia infections even without species identification or antibiotic susceptibility testing. 41 Linezolid and amikacin are also effective drugs against most Nocardia species, with activity of 99.5% and 96.0%, respectively. 41 Imipenem has varying sensitivity to various species of Nocardia , with a good sensitivity rate of 90.1% to N. cyriacigeorgica , while it showed a relatively low sensitivity rate to N. farcinica (45.5%).…”

“… 41 Linezolid and amikacin are also effective drugs against most Nocardia species, with activity of 99.5% and 96.0%, respectively. 41 Imipenem has varying sensitivity to various species of Nocardia , with a good sensitivity rate of 90.1% to N. cyriacigeorgica , while it showed a relatively low sensitivity rate to N. farcinica (45.5%). 41 For immunocompetent patients, a 6-month course of antibacterial treatment is generally recommended, whereas immunosuppressed patients or those with disseminated CNS lesions typically require at least 6–12 months of treatment.…”

Discovery of Novel Diagnostic Biomarkers for Common Pathogenic Nocardia through Pan- genome and Comparative Genome Analysis, with Preliminary Validation

“…Nocardia species are gram-positive, aerobic, weakly acid-resistant actinomycetes that are widely distributed in natural environments such as soil, freshwater, and dust [1]. Nocardia is known to cause nocardiosis, a group of serious opportunistic infections that primarily cause lung and skin infections affecting individuals of varying immune status [2,3]. In recent years, there has been a notable increase in the number of reported Nocardia infections in both immunocompromised and immunocompetent populations [4,5], and lack of timely and accurate treatment can lead to worsening clinical symptoms and high mortality [6][7][8].…”

“…Our goal is to improve the identi cation of Nocardia infections in clinical settings. Firstly, A summary of commonly isolated Nocardia species was conducted: N. farcinica is prevalent in China, South Africa, Belgium, and France [3,[19][20][21]; N. cyriacigeorgica is common in Spain and Iran [22,23]; and N. nova has the highest isolation rate in the United States and Australia [24,25]. Based on this valuable insight, our comprehensive study focused on these common species.…”