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Two cases of multidrug-resistant Nocardia farcinica infection in immunosuppressed patients and implications for empiric therapy

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Presented here are two cases of multidrug-resistant Nocardia farcinica infection that occurred in immunocompromised patients. One of the patients developed the infection despite being on trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis jiroveci. These cases demonstrate the propensity of Nocardia spp. to cause disseminated disease and to develop resistance to multiple antimicrobial agents used in the initial treatment of serious Nocardia infection. These factors lead to the conclusion that empiric monotherapy with trimethoprim/sulfamethoxazole may not be sufficient. Treatment with a combination regimen of imipenem and amikacin may be a more promising initial therapy.

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  1. Kontoyiannis DP, Ruoff K, Hooper DC (1998) Nocardia bacteremia. Report of 4 cases and review of the literature. Medicine 77:255–267

    Google Scholar 

  2. Schaal KP, Lee HJ (1992) Actinomycete infection in humans—a review. Gene 115:201–211

    Google Scholar 

  3. Torres OH, Domingo P, Pericas R, et al (2000) Infection caused by Nocardia farcinica: case report and review. Eur J Clin Microbiol Dis 19:205–212

    Google Scholar 

  4. National Committee for Clinical Laboratory Standards (1997) Performance standards for antimicrobial disk susceptibility tests. Approved standards M2-A6, 6th edn. NCCLS, Villanova, PA

  5. Lerner PI (1996) Nocardiosis. Clin Infect Dis 22:891–903

    CAS  PubMed  Google Scholar 

  6. Peters BR, Sambolle MA, Costantino JM (1996) Disseminated and cerebral infection due to Nocardia farcinica: diagnosis by blood culture and cure with antibiotics alone. Clin Infect Dis 23:1165–1167

    Google Scholar 

  7. Uttamchandani RB, Daikos GL, Reyes RR, et al (1994) Nocardiosis in 30 patients with advanced human immunodeficiency virus infection. Clinical features and outcome. Clin Infect Dis 18:348–353

    CAS  PubMed  Google Scholar 

  8. Threlkald SC, Hooper DC (1997) Update on management of patients with Nocardia infection. Curr Clin Top Infect Dis 17:1–23

    Google Scholar 

  9. Adams HG, Beeler BA, Wann LS, et al (1984) Synergistic action of trimethoprim and sulfamethoxazole for Nocardia asteroides: efficacious therapy in 5 patients. Am J Med Sci 287:8–12

    Google Scholar 

  10. Walensky RP, Moore RD (2001) A case series of 59 patients with nocardiosis. Infect Dis Clin Pract 10:249–254

    Google Scholar 

  11. McNeil MM, Brown JM, Hutwagner LC, et al (1995) Evaluation of therapy for Nocardia asteroides complex infections. Infect Dis Clin Pract 4:287–292

    Google Scholar 

  12. Schaal KP, Schutt-Gerowitt H, Goldman A (1986) In vivo and in vitro studies on the efficacy of various antimicrobial agents in the treatment of human nocardiosis. In: Szabo G, Miro S, Goodfellow M (eds) Biological, biochemical, and biomedical aspects of Actinomycetes. Part B. Academia Kiado, Budapest pp 619–633

    Google Scholar 

  13. Gombert ME, du Bouchet L, Aulicino TM, et al (1989) Antimicrobial synergism in the therapy of experimental cerebral nocardiosis. J Antimicrob Chemother 23:39–43

    Google Scholar 

  14. Gombert ME, Aulicino TM (1983) Synergism of imipenem and amikacin in combination with other antibiotics against Nocardia asteroides. Antimicrob Agents Chemother 24:810–811

    Google Scholar 

  15. Krone A, Schaal KP, Brawanski A, Schuknecht B (1989) Nocardial cerebral abscess cured with imipenem/amikacin and enucleation. Neurosurg Rev 12:333–340

    Google Scholar 

  16. Yazawa K, Mikama Y, Ohashi S, et al (1992) In-vitro activity of new carbapenem antibiotics: comparative studies with meropenem, L-627 and imipenem against pathogenic Nocardia spp. J Antimicrob Chemother 29:169–172

    CAS  PubMed  Google Scholar 

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We thank Dr. J. McCue and Dr. D. Zolet for their critique of the article.

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Correspondence to W. Hitti.

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Hitti, W., Wolff, M. Two cases of multidrug-resistant Nocardia farcinica infection in immunosuppressed patients and implications for empiric therapy. Eur J Clin Microbiol Infect Dis 24, 142–144 (2005).

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