Research progress on clinical challenges and prevention strategies of drug-resistant Nocardia infections

Drug-resistant Nocardia infections have become an increasingly intractable clinical challenge globally, with the incidence rising steadily among both immunocompromised and immunocompetent populations in recent decades. The clinical management of drug-resistant Nocardia infections is hindered by distinct regional variations in species distribution, complex molecular resistance mechanisms, and sophisticated species-specific immune escape strategies, all of which contribute to frequent treatment failure and poor patient outcomes. In this review, we synthesize the latest research progress on drug-resistant Nocardia from a clinical and translational perspective, focusing on its epidemiological characteristics (global epidemic trends, regional heterogeneity, and high-risk population stratification), pathological mechanisms (genomic features, drug resistance molecular basis, and species-specific immune escape pathways), and clinical diagnostic and therapeutic advances. We systematically compare the performance of conventional and novel diagnostic technologies for Nocardia identification and resistance detection, and summarize evidence-based antibiotic selection strategies, individualized treatment regimens for special populations (e.g., patients with hepatic/renal impairment, pregnant women, and pediatric patients), and rational combined antimicrobial therapies for different infection sites. Additionally, we critically analyze and characterize the interdependent relationships among the unresolved clinical bottlenecks—including regional resistance heterogeneity, diagnostic delays in resource-limited settings, and insufficient clinical evidence for special populations—and further translate these identified research gaps into prioritized and actionable research directions for the field. We further analyze how novel anti- Nocardia agents, innovative diagnostic/therapeutic technologies, and multidisciplinary collaboration can synergistically address these challenges, providing a forward-looking framework for advancing clinical management and translational research. This review aims to provide a comprehensive and up-to-date reference for clinical practitioners, microbiologists, and translational researchers, and to offer insights for optimizing the clinical diagnosis and treatment strategies of drug-resistant Nocardia infections

Antibiotic resistance · Clinical trial · Disease · Drug resistance · Multidisciplinary approach · Population · Translational research · Actinomycetales infections and treatment · Diverticular Disease and Complications · Infectious Disease Case Reports and Treatments · Epidemiology

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