{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:38:24Z","timestamp":1773920304240,"version":"3.50.1"},"reference-count":197,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    Drug-resistant\n                    <jats:italic>Nocardia<\/jats:italic>\n                    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\n                    <jats:italic>Nocardia<\/jats:italic>\n                    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\n                    <jats:italic>Nocardia<\/jats:italic>\n                    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\u2014including regional resistance heterogeneity, diagnostic delays in resource-limited settings, and insufficient clinical evidence for special populations\u2014and further translate these identified research gaps into prioritized and actionable research directions for the field. We further analyze how novel anti-\n                    <jats:italic>Nocardia<\/jats:italic>\n                    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\n                    <jats:italic>Nocardia<\/jats:italic>\n                    infections.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2026.1755629","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T06:50:52Z","timestamp":1773903052000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Research progress on clinical challenges and prevention strategies of drug-resistant Nocardia infections"],"prefix":"10.3389","volume":"14","author":[{"given":"Houjun","family":"Pang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Sichuan Provincial People\u2019s Hospital East Sichuan Hospital & Dazhou First People\u2019s Hospital (Dazhou Maternal and Child Health Hospital)","place":["Dazhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e53","DOI":"10.1093\/cid\/ciae643","article-title":"State-of-the-art review: modern approach to nocardiosis-diagnosis, management, and uncertainties","volume":"80","author":"Yetmar","year":"2025","journal-title":"Clin Infect Dis"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0002721","DOI":"10.1128\/cmr.00027-21","article-title":"Updated review on Nocardia species: 2006-2021","volume":"35","author":"Traxler","year":"2022","journal-title":"Clin Microbiol Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4601","DOI":"10.2147\/IDR.S249761","article-title":"Invasive nocardiosis: disease presentation, diagnosis and treatment - old questions, new 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