Shorter vs. standard-duration antibiotic therapy for nocardiosis: a multi-center retrospective cohort study.

Autor: Attias NH; Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel., Schlaeffer-Yosef T; Infectious Diseases Institute, Soroka Medical Center, Beer Sheba, Israel.; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel., Zahavi I; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel., Hasson N; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel., Ari YB; Lev Hasharon Mental Health Center, Tzur Moshe, Israel., Darawsha B; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel., Levitan I; Department of Neurosurgery, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel., Goldberg E; Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel., Landes M; Internal Medicine D, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel., Litchevsky V; Infectious Diseases Unit, Sheba Medical Center, Sheba Road 2, Ramat-Gan, Israel., Ben-Zvi H; Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel., Amit S; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.; Microbiology Laboratory, Sheba Medical Center, Ramat-Gan, Israel., Nesher L; Infectious Diseases Institute, Soroka Medical Center, Beer Sheba, Israel.; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel., Bishara J; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel., Paul M; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.; Infectious Diseases Institute, Rambam Healthcare Campus, Haifa, Israel., Yahav D; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.; Infectious Diseases Unit, Sheba Medical Center, Sheba Road 2, Ramat-Gan, Israel., Margalit I; School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. ilimargalit@gmail.com.; Infectious Diseases Unit, Sheba Medical Center, Sheba Road 2, Ramat-Gan, Israel. ilimargalit@gmail.com.
Jazyk: angličtina
Zdroj: Infection [Infection] 2024 Nov 26. Date of Electronic Publication: 2024 Nov 26.
DOI: 10.1007/s15010-024-02445-0
Abstrakt: Purpose: 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.
Methods: 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.
Results: 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.
Conclusions: With clinically guided case-by-case patient selection nocardiosis can be safely treated for durations significantly shorter than traditionally recommended.
Competing Interests: Declarations. Generative AI in scientific writing: We did not use artificial intelligence tools during the preparation of this work. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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