trimethoprim--sulfamethoxazole-drug-combination and Facial-Injuries

Nocardia farcinica, the etiologic agent of bovine farcy, is microbiologically related to but distinct from Nocardia asteroides. N. farcinica is noted for its propensity to cause serious systemic infection in both normal and immunocompromised hosts and its marked degree of resistance to multiple antimicrobial agents. We present a case in which a nonimmunocompromised patient who sustained a contaminated facial laceration developed an abscess due to N. farcinica with underlying osteomyelitis. The severity of the infection necessitated surgical debridement followed by administration of intravenous amikacin therapy. The isolate was susceptible to amikacin and trimethoprim-sulfamethoxazole but resistant to erythromycin in vitro. Therapy with trimethoprim-sulfamethoxazole was started but was discontinued because of the patient's intolerance to the drug. Intramuscular amikacin was substituted, resulting in complete resolution of the infection. The history, epidemiology, and microbiological characteristics of this interesting and unusual microorganism are reviewed.

Topics: Abscess; Amikacin; Debridement; Drug Hypersensitivity; Drug Resistance, Microbial; Facial Injuries; Humans; Male; Middle Aged; Nocardia; Nocardia Infections; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection