Chronic renal insufficiency and Nocardia brasiliensis infection: A call for heightened vigilance and multidisciplinary management

Table 2 Diagnostic and therapeutic innovations in Nocardia brasiliensis infection

Aspect	Key innovations	Impact
Diagnostic modalities	MALDI-TOF MS: Rapid species identification (< 1 hour)	Reduced time-to-treatment compared to culture-based methods
	mNGS: Detection of polymicrobial infections and co-pathogens (e.g.,Pneumocystis jirovecii)	Enhanced diagnostic yield in immunocompromised hosts
	E-test: Guided antibiotic susceptibility testing	Optimized SMZ-TMP dosing based on local resistance patterns
Therapeutic strategies	Low-dose SMZ-TMP: Reduced nephrotoxicity risk in CRI patients	Improved tolerability and adherence in elderly populations
	Surgical drainage: Adjunctive management of cutaneous abscesses	Hastened resolution of localized infections
	Pharmacokinetic monitoring: Targeted SMZ trough levels (50-100 μg/mL)	Minimized toxicity while

MALDI-TOF MS: Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; mNGS: Metagenomic next-generation sequencing; SMZ-TMP: Sulfamethoxazole-trimethoprim; CRI: Chronic renal insufficiency; SMZ: Sulfamethoxazole.