title: Clinical characteristics, microbiology, and outcomes for patients with lung and disseminated nocardiosis in a tertiary hospital.
abstract: OBJECTIVE
  Nocardia are ubiquitous in the environment worldwide and cause a variety of infections. Clinical manifestations and outcomes of nocardiosis can vary with different populations, host immunity, and presentations. The purpose of this study was to analyze the differences in clinical characteristics, antimicrobial susceptibility, and outcomes for patients with skin, lung, and disseminated nocardiosis.
  
  
  METHODS
  We conducted a retrospective survey of culture-proven nocardial infections in 81 patients with invasive nocardiosis over an 18-year period at the National Taiwan University Hospital. The clinical syndromes included skin infections (n = 44), localized pulmonary infections (n = 24), and disseminated infections (n = 13).
  
  
  RESULTS
  Disseminated nocardiosis included lung and brain involvement (7 patients), brain and skin involvement (2 patients), localized brain abscess (1 patient), lung involvement with bacteremia (1 patient), lymphadenitis (1 patient), and liver cirrhosis with spontaneous nocardial peritonitis (1 patient). Eleven (14%) of all patients died due to nocardiosis. In comparison with those with skin infections, patients with lung and disseminated nocardiosis tended to have chronic lung disease, malignancy, concomitant bacteremia, were often misdiagnosed as having tuberculosis, were receiving immunosuppressive treatments, and demonstrated an increased mortality. Nocardia strains isolated from patients with lung infections or disseminated infections tended to have lower in vitro antimicrobial susceptibility than those isolated from skin infections [cefotaxime: 67% (lung) vs. 86% (skin); trimethoprim/sulfamethoxazole: 75% (disseminated) vs. 97% (skin)].
  
  
  CONCLUSIONS
  These results highlight the protean disease manifestations and antimicrobial susceptibility of Nocardia and indicate the need to address the option of combined antimicrobial therapy for lung and disseminated nocardiosis.
authors.affiliation: Department of Internal Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.
authors.forename: Hua-Kung
authors.initials: HK
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Statistics, National Taipei University, New Taipei City, Taiwan.
authors.forename: Mong-Hong
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Department of Statistics, National Taipei University, New Taipei City, Taiwan.
authors.forename: Wagner S
authors.initials: WS
authors.lastname: Lin
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: changsc@ntu.edu.tw.
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008171:Lung Diseases / Q000188:drug therapy*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009615:Nocardia / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000150:complications* / Q000175:diagnosis*; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D013624:Taiwan; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents
keywords: antimicrobial susceptibility; lung and disseminated nocardiosis; outcomes