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Recent advancements in DNA-based approaches have led to the identification of uncommon and rare bacterial pathogens. In this study, by utilizing a DNA-based approach, a total of 1043 clinical specimens were processed for the identification of actinobacteria targeting the 16S rRNA and  gyrB  genes. Drug susceptibility testing was also conducted using micro-broth dilution and PCR. Two isolates of  Nocardia flavorosea  and  Rhodococcus erythropolis  were reported for the first time in Iran. Also,  Nocardiopsis dassonvillei ,  Streptomyces olivaceus , and  Streptomyces griseus  were reported for the first time in Asia. Infections caused by  Nocardia caishijiensis  and  Prauserella muralis  have also been reported in this study. The first Asian case of pulmonary infection caused by  Nocardia ignorata  and the first global case of brain abscess caused by  Nocardia ninae  and  Nocardia neocaledoniensis  have been reported in this study. Overall 30 isolates belonging to 6 genera ( Nocardia ,  Streptomyces ,  Rodoccoccus ,  Nocardiopsis ,  Rothia , and  Prauserella ) were detected in 30 patients. All 30 isolates were susceptible to amikacin and linezolid. Three isolates including  Nocardia otitidiscaviarum  (n = 2) and  Nocardia flavorosea  (n = 1) were resistant to trimethoprim-sulfamethoxazole which were the first trimethoprim-sulfamethoxazole resistant clinical actinomycetes in Iran. Isolation of rare species of actinomycetes particularly  Nocardia  spp. requires urgent action before they spread clinically particularly among immunocompromised patients.

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Molecular identification and antibiotic resistance pattern of actinomycetes isolates among immunocompromised patients in Iran, emerging of new infections