Real-World Application of Recommended Practices in Nocardiosis

To the Editor—We read with great interest the review by Yetmar et al [1] on diagnosis and management of nocardiosis, which offers a pragmatic framework for a complex and underrecognized infection. The authors’ emphasis on early suspicion, species-level identification, combined antimicrobial therapy in severe diseases, and prolonged follow-up prompted us to analyze 15 consecutive cases of nocardiosis (Table 1) that occurred at a tertiary-care center in Italy from 2015 to 2025. Moreover, we retrospectively review our cases to assess the application of the recommended clinical practices proposed in Yetmar and colleagues’ review [1]. Although appropriate samples were promptly sent to the laboratory, specific clinical suspicion of nocardiosis was never anticipated or communicated to the microbiologists. As a result, targeted antimicrobial therapy was initiated only after microbiological diagnosis was made. Therefore, a significant delay could have had a negative impact on patient survival, especially in the most severe immunocompromised individuals presenting bloodstream infections. Indeed, among the 5 cases with bacteremia without any identifiable focus, patient 1 suffered from septic shock and was transferred to hospice, while the remaining 4 patients died during hospitalization, in line with the poor outcomes described in disseminated diseases [2,3].