Risk factors and outcomes associated with Nocardia bacteremia

Backgournd: Nocardia bacteremia is rare, and the risk factors and outcomes for episodes of bacteremia compared with nonbacteremic cases are unknown. Methods: We performed a retrospective, multicenter study comparing patients with Nocardia infection with and without bacteremia from an 11-year period. Patients without blood cultures performed within 48 hours of the diagnosis of Nocardia infection were excluded. Results: We identified 23 patients including seven (30%) with bacteremia. The patients with and without bacteremia were similar in terms of underlying conditions except that those with bacteremia were more frequently receiving trimethoprim/sulfamethoxazole prophylaxis (42.9% vs. 6.3%, P = 0.03). The patients with bacteremia had a higher mortality rate at 6 months (71% vs. 21%, P = 0.02). The presence of an intravascular device was not higher among those with Nocardia bacteremia (57.1% vs. 31.3%, P = 0.24). Conclusions: Nocardiosis with Nocardia bacteremia carries the risk of higher mortality and should still be considered even when patients are receiving trimethoprim/sulfamethoxazole prophylaxis. Larger studies are needed to confirm these findings.