हल्का अप्रसारित क्यूटेनियस नोकार्डियोसिस जब TMP-SMX मोनोथेरेपी से नैदानिक सुधार नहीं हुआ

References

DOI: 10.1093/cid/ciae643

• Importantly, nondisseminated cutaneous nocardiosis is commonly the result of direct inoculation, either through trauma or environmental skin disruption (eg, contact with a thorn).
• Accordingly, patients with nondisseminated cutaneous nocardiosis are commonly immunocompetent without apparent predisposing condition.
• Although no validated grading system for Nocardia severity exists, patients with mild nocardiosis are often managed in the outpatient setting, have a chronic course leading to diagnosis, and have nondisseminated infection.
• These may be clinically indistinguishable from "typical" bacterial cellulitis or abscess and should be considered among patients who do not respond to first-line therapy.
• Patients with TMP-SMX toxicity and yet-to-improve severe infection may be better served transitioning to alternative therapy, as patients with severe nocardiosis are underrepresented in the available data.
• Antibiotics that most Nocardia isolates demonstrate susceptibility to include amikacin, imipenem, linezolid, and trimethoprim-sulfamethoxazole (TMP-SMX).
• If combination therapy is started empirically, treatment can be narrowed to monotherapy, particularly if there are signs of clinical improvement.