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Résumé Introduction Les nocardioses sont rares, de diagnostic clinique et microbiologique difficile, avec une morbi-mortalité importante, et surviennent souvent sur terrain débilité. Peu de données existent en France. Méthodes Étude rétrospective monocentrique de 2002 à 2014 incluant tous les patients avec au moins un prélèvement microbiologique positif à Nocardia . Résultats Dix-neuf patients, dont 15 hommes, ont été inclus, d’âge moyen 58 ans (25–85). Dix-sept présentaient un terrain à risque (pathologies pulmonaires 13, corticothérapie 12, tumeurs 2, infection par le VIH 2, diabète 3, greffe rénale 2, lymphopénie 1). On dénombre 12 infections pulmonaires, 3 infections cérébrales, 2 infections cutanées, 1 infection ganglionnaire, et 1 infection cornéenne. La croissance souvent lente du germe conduit à un délai médian de résultat de 35 jours (3–95). Neuf espèces ont été retrouvées. Quinze patients (79 %) ont reçu une ou plusieurs lignes antibiotiques comprenant entre autres : cotrimoxazole ( n = 9), amoxicilline ( n = 7) céfotaxime/ceftriaxone ( n = 7), imipénème ( n = 3) ou amikacine ( n = 3). La durée moyenne de l’antibiothérapie était de 207 jours. Quatre patients n’ont pas reçu d’antibiotiques à cause d’un résultat tardif ou d’une co-infection bactérienne masquant la nocardiose. On déplore 5 décès (26 %) dont 2 imputables à une atteinte cérébrale. Six patients ont guéri, 4 ont rechuté, l’évolution est inconnue pour 4, et 1 est encore en cours de traitement. Conclusion La prise en charge des nocardioses est compliquée. Une meilleure connaissance de celles-ci par une étude clinico-microbiologique nationale semble nécessaire. Introduction Nocardiosis are uncommon. The diagnosis may be difficult, with significant morbidity and mortality, often occurring on frail patients. Few data are available in France. Methods A retrospective single center study was conducted from 2002 to 2014 and included all patients with at least one positive microbiological sample for Nocardia with a follow-up in our hospital. Results Nineteen patients, including 15 men, were included with a mean age of 58 years (25–85). Seventeen had a risk factor (lung diseases [13], corticosteroids [12], solid neoplasia [2], HIV infection [2], diabetes mellitus [3], kidney transplant [2], lymphopenia [1]). Infections’ locations were: pulmonary (12), brain (3), skin (2), lymph node (1) and corneal (1). The slow growth leads to a median of 35 days for a positive result (3–95). Nine species were identified. Fifteen patients (79%) received one or more lines of antibiotics including: cotrimoxazole (9), amoxicillin (7) cefotaxime/ceftriaxone (7) imipenem (3), or amikacin (3). The average duration of antibiotic therapy was 207 days. Four patients did not receive antibiotics due to a late result or a bacterial co-infection masking nocardiosis. Five patients died (26%) including 2 with cerebral nocardiosis. Six patients were cured, 4 suffered a relapse, 4 had an unknown evolution, and 1 was still treated. Conclusion Our study shows that nocardiosis is a disease difficult to treat. A better understanding of this type of infection is necessary. [ABSTRACT FROM AUTHOR]

Abstract: Objectives. – To study the efficacy of selective digestive decontamination (SDD) for the prevention of nosocomial infections, particularly pneumonia, as well as its impact on the emergence of multiresistant bacteria. Data sources. – Data collected from the Pubmed: original articles, review articles and editorial published on SDD. The keywords were: selective digestive decontamination, pneumonia, intensive care unit, infection. Data selection. – Ten randomized clinical trials performed since 1995 in mechanically ventilated adult patients hospitalized in intensive care unit. Results. – The rationale for the use of SDD consists on the parenteral administration of a short course of antibiotic associated with the topical use of non-absorbable antibiotics directed against Gram negative bacteria. Five randomized studies described a reduction in the incidence of pneumonia associated with SDD. Only one study has showed a decrease in mortality rate. The other five studies, which present some methodological limitations, concluded the lack of efficacy of SDD. Regarding the emergence of multiresistant bacteria, the literature underlines the role of environment. The use of SDD seems to trigger the resistance in endemic areas, while these are softened in the units with a good control of their ecology. Conclusion. – The data from the literature provide arguments to use SDD in targeted patient populations like multiple traumas in intensive care units, which have a low rate of multiresistant bacteria. [Copyright &y& Elsevier]