Retrospective analysis of nocardiosis in a general hospital from 1998 to 2017

Abstract Objectives To describe the epidemiological, clinical, microbiological, and therapeutic characteristics of Nocardiosis patients treated in a general hospital. Patients and methods Monocentric retrospective analysis of patients presenting with Nocardia-positive biological sample from January 1, 1998 to May 1, 2017. Results We identified nine cases of Nocardia infections. Risk factors were oral corticosteroid therapy ( n  = 3), solid cancer ( n  = 2), hematological cancer ( n  = 1), COPD ( n  = 1). No risk factor was identified in patients with isolated cutaneous presentation ( n  = 2). Disseminated presentations ( n  = 3) were observed in patients receiving corticosteroid therapy ( n  = 2) and presenting with ENT cancer ( n  = 1). Identified Nocardia species were Nocardia nova ( n  = 4), Nocardia cyriacigeorgica ( n  = 2), Nocardia abscessus ( n  = 1), Nocardia brasiliensis ( n  = 1), and Nocardia asteroides ( n  = 1). The median diagnostic time was 17 days. Antibiotic therapy was prolonged and included trimethoprim-sulfamethoxazole in 6/9 cases. The overall one-year case fatality was high (3/8). No recurrence was observed. We identified two cases of respiratory colonization with N .  abscessus and N .  cyriacigeorgica in COPD patients. Conclusion Nocardiosis can occur both in immunocompetent and immunocompromised patients. It is a severe infection, with a miscellaneous clinical spectrum and complex treatments. Greater knowledge of nocardiosis is required from physicians for optimal medical care.