Multicenter systematic review of clinical characteristics, diagnostic optimization, and personalized treatment for brain Nocardia infections

This study provides a systematic review of 512 reported cases of Nocardia brain infections from 2000 to mid-2024. It focuses on analyzing clinical manifestations, radiological findings, bacterial identification methods, and antibiotic resistance patterns. Special attention is given to the differences in outcomes between immunocompromised and non-immunocompromised patients. We also explored personalized treatment approaches by analyzing outcome-related factors through correlation analysis and linear discriminant analysis. Imaging findings commonly showed brain abscesses, lesions, and mass effects, with a high prevalence of antibiotic resistance. Diagnostic methods using conventional microbiological cultures were less effective compared to advanced molecular diagnostics, which enhanced detection accuracy and reduced time to diagnosis. This review also identifies key factors influencing treatment outcomes, including the timely initiation of appropriate antibiotics, particularly the combination of sulfonamides and β-lactams, as well as the importance of surgical intervention. These findings underscore the necessity of improving diagnostic and therapeutic strategies to achieve early diagnosis and personalized treatment.