title: Nocardiosis in 132 patients with cancer: microbiological and clinical analyses.
abstract: OBJECTIVE
  To correlate the microbiological and clinical features of infections caused by Nocardia species.
  
  
  METHODS
  We determined the species and drug susceptibility of 138 Nocardia strains isolated from 132 patients at the University of Texas M. D. Anderson Cancer Center (Houston, TX) from 2002 through 2012 and analyzed the clinical features.
  
  
  RESULTS
  The 132 patients included 82 men and 50 women with a mean age of 59.1 years. All except two had underlying cancer, and 47 (35.6%) also received a stem cell transplant. These patients experienced 136 episodes of Nocardia infection, including pulmonary infection, abscess of deep skin and soft tissue, bacteremia and dissemination, and brain abscess. The 138 Nocardia strains involved 27 species, of which 20 species have been described since 2000. Common species included Nocardia nova, Nocardia cyriacigeorgica, Nocardia farcinica, and Nocardia abscessus, together accounting for 59.4%. N nova caused most bacteremia cases, whereas N farcinica caused most of the skin and brain infections. Infections with a few recent species likely represented first confirmation or report of human infections. Antimicrobial susceptibility tests of 117 strains showed that they were all susceptible to trimethoprim-sulfamethoxazole and linezolid but variably susceptible to other drugs depending on species. Most patients who were treated for the infection showed improvement or resolution.
  
  
  CONCLUSIONS
  Diverse Nocardia species can cause secondary infections in patients with cancer. Timely species identification and antimicrobial susceptibility tests may guide treatment.
authors.affiliation: From the Department of Laboratory Medicine, the University of Texas M. D. Anderson Cancer Center, Houston.
authors.forename: Huan-Ling
authors.initials: HL
authors.lastname: Wang
authors.affiliation: From the Department of Laboratory Medicine, the University of Texas M. D. Anderson Cancer Center, Houston.
authors.forename: Yiel-Hea
authors.initials: YH
authors.lastname: Seo
authors.affiliation: From the Department of Laboratory Medicine, the University of Texas M. D. Anderson Cancer Center, Houston.
authors.forename: P Rocco
authors.initials: PR
authors.lastname: LaSala
authors.affiliation: From the Department of Laboratory Medicine, the University of Texas M. D. Anderson Cancer Center, Houston.
authors.forename: Jeffery J
authors.initials: JJ
authors.lastname: Tarrand
authors.affiliation: From the Department of Laboratory Medicine, the University of Texas M. D. Anderson Cancer Center, Houston. xhan@mdanderson.org.
authors.forename: Xiang Y
authors.initials: XY
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001483:Base Sequence; D001921:Brain / Q000382:microbiology; D002648:Child; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008969:Molecular Sequence Data; D009369:Neoplasms / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D009615:Nocardia / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D012867:Skin / Q000382:microbiology; D013781:Texas; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S
keywords: 16S rRNA gene sequencing; Antimicrobial susceptibility; Cancer; Immunocompromised hosts; Nocardia