Attias Nofar Hezkelo, Schlaeffer-Yosef Tal, Zahavi Itay, Hasson Noga, Ari Yaara Ben, Darawsha Basel, Levitan Idan, Goldberg Elad, Landes Michal, Litchevsky Vladislav, Ben-Zvi Haim, Amit Sharon, Nesher Lior, Bishara Jihad, Paul Mical, Yahav Dafna, Margalit Ili
Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
Infectious Diseases Institute, Soroka Medical Center, Beer Sheba, Israel.
Infection. 2025 Jun;53(3):1115-1127. doi: 10.1007/s15010-024-02445-0. Epub 2024 Nov 26.
The prolonged treatment recommended for nocardiosis does not rely on strong evidence. Consequently, some clinicians opt shorter therapy in certain circumstances. We assessed the effectiveness of shorter therapy.
A multi-center retrospective cohort study comprising individuals diagnosed with nocardiosis between 2007 and 2022. We classified all patients who survived 90 days into three groups according to treatment duration: short (≤ 90 days), intermediate (91-180 days), and prolonged (> 180 days). We compared baseline characteristics (comorbidities, immune status) and nocardiosis manifestations across the unadjusted treatment groups, one-year all-cause mortality, disease relapse, and antibiotic-related adverse events to identify patients who may safely receive the short course.
We detected 176 patients with nocardiosis, their median age was 65 years; 74 (42%) were women. Forty-three (24%) patients died within 90 days. Of the remaining 133, 37 (28%) patients received short therapy, 40 (30%) intermediate, and 56 (42%) prolonged treatment duration. Longer courses were more likely to be administered to patients with immunosuppression, disseminated nocardiosis, and N. farcinica infection. Within a year, 20 (15%) individuals died and 2 (2%) relapsed. Treatment duration was not associated with either mortality (p = 0.945) or relapse (p = 0.509). Nocardiosis was the cause of death in only one patient, receiving a prolonged course. Of 73 patients with solitary pulmonary nocardiosis, 20 (27%) received short duration. None relapsed and 2 (10%) died, both immunocompromised. The rate of AE was similar across the groups.
With clinically guided case-by-case patient selection nocardiosis can be safely treated for durations significantly shorter than traditionally recommended.
针对诺卡菌病推荐的延长治疗方案缺乏有力证据。因此，一些临床医生在某些情况下会选择较短疗程的治疗。我们评估了较短疗程治疗的有效性。
一项多中心回顾性队列研究，纳入2007年至2022年间被诊断为诺卡菌病的患者。我们将存活90天的所有患者根据治疗时长分为三组：短疗程（≤90天）、中疗程（91 - 180天）和长疗程（>180天）。我们比较了未调整治疗组之间的基线特征（合并症、免疫状态）和诺卡菌病表现、一年全因死亡率、疾病复发情况以及抗生素相关不良事件，以确定可能安全接受短疗程治疗的患者。
我们检测到176例诺卡菌病患者，他们的中位年龄为65岁；74例（42%）为女性。43例（24%）患者在90天内死亡。在其余133例患者中，37例（28%）接受了短疗程治疗，40例（30%）接受了中疗程治疗，56例（42%）接受了长疗程治疗。长疗程治疗更有可能用于免疫抑制患者、播散性诺卡菌病患者和豚鼠耳炎诺卡菌感染患者。在一年内，20例（15%）患者死亡，2例（2%）复发。治疗时长与死亡率（p = 0.945）或复发率（p = 0.509）均无关。只有1例接受长疗程治疗的患者死于诺卡菌病。在73例孤立性肺诺卡菌病患者中，20例（27%）接受了短疗程治疗。无一例复发，2例（10%）死亡，均为免疫功能低下患者。各组不良事件发生率相似。
通过临床指导下的逐例患者选择，诺卡菌病可以安全地采用明显短于传统推荐时长的疗程进行治疗。
