1556. Risk Factors and Outcomes of Patients with Bloodstream Infection due to Nocardia Species
Session: Poster Abstract Session: Infections in the Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Garg IDSA Nocardia poster(6).pdf (101.0 kB)
  • Background:  
    Nocardiosis is an uncommon infection caused by the aerobic, gram positive filamentous organism Nocardia.  Although the rate of Nocardia-related infections appears to be increasing with the increased longevity and numbers of immunosupressed patients, Nocardia bacteremia is still rare.  The objective of our study is to identify the risk factors and prognosis of patients with Nocardia bacteremia.


    We performed a retrospective chart review study in two large tertiary care centers in Detroit, Michigan.  All patients with positive clinical samples for Nocarida,over an 11-year period, were identified.  Patients with no blood cultures performed within 48 hours of the nocardiosis diagnosis were excluded. We compared demographics, clinical, laboratory and radiological data of patients with nocardiosis associated with bacteremia to patients without bacteremia. 


    During the study period we identified 23 patients with nocardiosis.  Seven (30%) were bacteremic and 16 (70%) were not.  Fourteen (61%) were immunocompromised and nine (39.1%) had indwelling endovascular devices.  The groups were similar in terms of age, gender, underlying immunocompromised conditions and frequency of underlying endovascular devices.     Patients who were bacteremic were more likely to be receiving TMP/SMX prophylaxis at the time of diagnosis (43% vs. 6%, p=0.03).  None of the other clinical and laboratory factors reached statistical significance.  The overall mortality rate was 38% with higher mortality rates among those with bacteremia (71% vs. 21%, p<0.03).


    Patients with Nocardia bacteremia were similar to non-bacteremic cases except for higher rates of TMP/SMX prophylaxis at time of infection and higher mortality rates.  Presence of an endovascular device was not higher among those with Nocardia bacteremia and attempts should be made to find other potential primary sites before considering the device as the source of infection.
    Deepak Garg, MD, St John Hospital and Medical Center, Grosse Pointe Woods, MI, Pauline Jacinto, Wayne State University, Detroit, MI, Karam Obeid, MD, Medicine, St. John Hospital and Medical Center, Grosse Pointe Woods, MI, Pranatharthi Chandrasekar, M.D., Infectious Diseases, Wayne State University, Detroit, MI and Leonard Johnson, MD, St. John Hospital and Medical Center, Grosse Pointe Woods, MI


    D. Garg, None

    P. Jacinto, None

    K. Obeid, None

    P. Chandrasekar, None

    L. Johnson, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.