Susceptibility profiles of Nocardia spp. to antimicrobial and antituberculotic agents detected by a microplate Alamar Blue assay

Nocardia species are ubiquitous in natural environments and can cause nocardiosis. Trimethoprim-sulfamethoxazole has long been the monotherapy treatment of choice, but resistance to this treatment has recently emerged. In this study, we used microplate Alamar Blue assays to determine the antimicrobial susceptibility patterns of 65 standard Nocardia isolates, including 28 type strains and 20 clinical Nocardia isolates, to 32 antimicrobial agents, including 13 little studied drugs. Susceptibility to the most commonly used drug, trimethoprim-sulfamethoxazole, was observed in 98% of the isolates. Linezolid, meropenem, and amikacin were also highly effective, with 98%, 95%, and 90% susceptibility, respectively, among the isolates. The isolates showed a high percentage of resistance or nonsusceptibility to isoniazid, rifampicin, and ethambutol. For the remaining antimicrobials, resistance was species-specific among isolates and was observed in traditional drug pattern types. In addition, the antimicrobial susceptibility profiles of a variety of rarely encountered standard Nocardia species are reported, as are the results for rarely reported clinical antibiotics. We also provide a timely update of antimicrobial susceptibility patterns that includes three new drug pattern types. The data from this study provide information on antimicrobial activity against specific Nocardia species and yield important clues for the optimization of species-specific Nocardia therapies.