Pulmonary nocardiosis in Western Europe-Clinical evaluation of 43 patients and population-based estimates of hospitalization rates.

Ott SR; Meier N; Kolditz M; Bauer TT; Rohde G; Presterl E; Schürmann D; Lepper PM; Ringshausen FC; Flick H; Leib SL; Pletz MW

doi:10.1016/j.ijid.2018.12.010

Back

Journal article

Pulmonary nocardiosis in Western Europe-Clinical evaluation of 43 patients and population-based estimates of hospitalization rates.

Ott SR Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Bern, Switzerland; Department of Pulmonary Medicine and Thoracic Surgery, St. Claraspital, Basel, Switzerland.
Meier N Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Bern, Switzerland; Department of Pulmonary Medicine and Thoracic Surgery, St. Claraspital, Basel, Switzerland.
Kolditz M Division of Pulmonology, Medical Department 1, University Hospital of TU Dresden, Dresden, Germany.
Bauer TT Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany. Electronic address: torsten.bauer@helios-gesundheit.de.
Rohde G Department of Pneumology and Allergology, Goethe University, Frankfurt, Germany.
Presterl E Klinisches Institut für Krankenhaushygiene, University of Vienna, Vienna, Austria.
Schürmann D Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Lepper PM Department of Internal Medicine V, University Hospital of Saarland, Homburg, Germany.
Ringshausen FC Department of Respiratory Medicine, Hannover Medical School, Hannover, and German Centre for Lung Research (DZL), Hannover, Germany.
Flick H Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Leib SL Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Pletz MW Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.

2019-01-19

Published in:

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. - 2019

English BACKGROUND
Pulmonary nocardiosis (PN) is an uncommon but potentially life-threatening infection. Most of our knowledge on PN is derived from case reports and small case series. Increasing incidence rates of PN have been reported recently. The aim of this study was to describe the clinical course of and risk factors for PN in four Western European countries and to estimate population-based annual hospitalization rates.

METHODS
This was a retrospective evaluation (1995-2011) of the clinical course of and risk factors for PN in patients at 11 hospitals in four European countries (Germany, Austria, Switzerland, and the Netherlands). Population-based estimates of hospitalization rates for PN in Germany (2005 to 2011) were calculated using official German nationwide diagnosis-related groups (DRG) hospital statistics.

RESULTS
Forty-three patients fulfilled stringent criteria for proven (n=8) and probable (n=35) PN; seven had extrapulmonary dissemination. For these 43 patients, the major risk factors for PN were immunocompromising (83.7%) and/or pulmonary (58.1%; as only comorbidity in 27.9%) comorbidities. The median duration of PN targeted therapy was 12 weeks. Distinctive patterns of resistance were observed (imipenem susceptibility: Nocardia farcinica 33.3%; Nocardia asteroides 66.7%). The overall mortality rate was 18.9% (50% in disseminated PN). Over time, annual PN hospitalization rates remained unchanged at around 0.04/100000, with the highest rate among men aged 75-84 years (0.24/100000).

CONCLUSIONS
PN is a rare, but potentially life-threatening disease, and mainly affects immunocompromised elderly males. Overall, annual hospitalization rates remained stable between 2005 and 2011.

Language