CLINICAL AND BACTERIOLOGICAL ASPECTS OF N OCARDIAL INFECTIONS - A SERIES OF 9 CASES

Objectives: Nocardial infection is usually localized in the immunocomp etent patient and occurs as an opportunistic disseminated infection in about half of the cases in immunoincompetents patients. Methods: We r eport a retrospective assessment of 9 cases of nocardial infection dia gnosed between January 1991 and February 1994. Results: Six of the pat ients were immunodepressed: 3 had a disseminated infection with pulmon ary (n=2), brain (n=2), skin (n=3) and/or ocular (n=1) localizations. There were 3 immunocompetent patients with an isolated local infection : skin and bone mycetoma, knee joint and lung. Diagnosis was made on s amples obtained invasively in 7 patients. Nocardia asteroides was isol ated in 5 patients, N. farcinica in 3 and N. caviae in 1. These organi sms showed in vitro sensitivity to amoxicillin-clavulanic acid 5/9, ce fotaxime 5/9 (0/3 for N. farcinica), imipeneme 7/9, amikacin 8/8, mino cyclin 5/8, pefloxacin 0/8 and trimethoprime-sulfamethoxazol (TMP-SMX) 3/9. Clinical outcome was favourable in all cases and was not always correlated with laboratory sensitivity. Conclusion: TMP-SMX remains th e reference antibiotic For one patient, only TMP-SMX (resistant in vit ro) was effective; with all the other antibiotic tried (sensitive in v ivo) treatment failed.