Nocardiosis in the Tropical Northern Territory of Australia, 1997–2014 | Zendy

Sarah L. McGuinness | Zendy; Sarah Whiting | Zendy; Rob Baird | Zendy; Bart J. Currie | Zendy; Anna P. Ralph | Zendy; Nicholas M. Anstey | Zendy; Ric N. Price | Zendy; Joshua S. Davis | Zendy; Steven Y. C. Tong | Zendy

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Nocardiosis in the Tropical Northern Territory of Australia, 1997–2014

Author(s) -

Sarah L. McGuinness,

Sarah Whiting,

Rob Baird,

Bart J. Currie,

Anna P. Ralph,

Nicholas M. Anstey,

Ric N. Price,

Joshua S. Davis,

Steven Y. C. Tong

Publication year - 2016

Publication title -

open forum infectious diseases

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 1.546

H-Index - 35

ISSN - 2328-8957

DOI - 10.1093/ofid/ofw208

Subject(s) - nocardiosis , medicine , nocardia , population , incidence (geometry) , epidemiology , intensive care unit , surgery , biology , environmental health , bacteria , genetics , physics , optics

Background

Nocardia is an opportunistic pathogen that can cause life-threatening disease. We aimed to characterise the epidemiological, microbiological and clinical features of nocardiosis in the tropical north of Australia.

Methods

We conducted a retrospective cohort study of nocardiosis diagnosed between 1997 and 2014. Population-based incidences were calculated using district population data.

Results

Clinically significant nocardiosis was identified in sixty-one patients. The unadjusted population-based annual incidence of nocardiosis was 2.02 (95% confidence interval [CI] 1.55-2.60) per 100,000 people and was 1.7 (95% CI 0.96-2.90) fold higher in Indigenous compared with non-Indigenous persons (p=0.027). Of 61 patients, 47 (77%) had chronic lung disease, diabetes and/or hazardous alcohol consumption; 22 (36%) were immunocompromised; and 8 (13%) had no identified comorbidities. Disease presentations included pulmonary (69%; 42/61), cutaneous (13%, 8/61) and disseminated nocardiosis (15%, 9/61). The most commonly identified species were N. asteroides and N. cyriacigeorgica (each 11%). Linezolid was the only antimicrobial to which isolates were universally susceptible; 89% (48/54), 60% (32/53) and 48% (26/54) of isolates were susceptible to trimethoprim-sulfamethoxazole, ceftriaxone and imipenem, respectively. 18 patients (30%) required intensive care unit (ICU) admission and one-year mortality was 31%.

Conclusions

he incidence of nocardiosis in tropical Australia is amongst the highest reported globally. Nocardiosis occurs in both immunocompromised and immunocompetent hosts, and is associated with high rates of ICU-admission, 1-year mortality and resistance to commonly-recommended antimicrobials. Diagnosis should be considered in patients with consistent clinical features, particularly if they are Indigenous or have chronic lung disease.

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