骨科患者诺卡菌属感染临床分布与耐药性分析  

Clinical distribution and drug resistance of Nocardiacausing infections in patients of orthopedics department

作　　者：王燕[1] 殷红秋[2] 隋秀丽[1] 王基萍[3] 丛芃[1] 

机构地区：[1]山东省文登整骨医院检验科,山东文登264400 [2]山东省文登整骨医院感染管理科,山东文登264400 [3]山东省文登整骨医院筋伤科,山东文登264400

出　　处：《中华医院感染学杂志》2015年第22期5119-5121,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(ZR2011HL058)

摘　　要：目的分析骨科医院诺卡菌属感染的临床资料,为临床医师早诊断、早治疗提供参考依据。方法回顾性统计分析2007年1月-2014年12月骨科医院住院患者诺卡菌属感染的标本来源、菌种分布、科室分布、临床表现及耐药性。结果在临床各类标本中共分离出8株诺卡菌属,其中星形诺卡菌6株、巴西诺卡菌及鼻疽诺卡菌各1株,分别占75.0%、12.5%、12.5%;诺卡菌属感染男性多于女性,伤口分泌物、关节穿刺液和痰液是诺卡菌属的主要标本来源,分别占37.5%、25.0%、25.0%;诺卡菌属感染患者主要分布在足踝一科、重症医学科;临床指标分布率,发热为75.0%、皮肤外伤史为62.5%、C-反应蛋白增高为87.5%、外周血白细胞增高为62.5%、肝功能异常为50.0%,颅内感染和并存恶性肿瘤者预后差;诺卡菌属对磺胺甲噁唑/甲氧苄啶、利奈唑胺和亚胺培南耐药率较低为12.5%,对青霉素、氨苄西林和红霉素耐药率>75.0%。结论诺卡菌属临床少见,及时、准确地鉴定对临床医师早期确诊、治疗及预后至关重要。OBJECTIVE To investigate the clinical data of Nocardia isolated from the patients of orthopedics depart‐ment so as to provide guidance for early clinical diagnosis and treatment .METHODS The patients with Nocardia infections who were hospitalized the orthopedic hospital from Jan 2007 to Dec 2014 were enrolled in the study .The specimen sources ,distribution of pathogens ,distribution of departments ,clinical manifestations ,and drug resist‐ance were retrospectively analyzed .RESULTS A total of 8 strains of Nocardia were isolated from the clinical speci‐mens ,including 6 （75 .0% ） strains of Nocardia asteroids ,1 （12 .5% ） strain of Nocardia brasiliensis ,and 1 （12 .5% ） strain of Nocardia f arcinia .The male patients with Nocardia infections were more than the female pa‐tients .The wound secretions ,joint puncture fluid ,and sputum were the major specimen sources ,accounting for 37 .5% ,25 .0% ,and 25 .0% ,respectively .The patients with Nocardia infections mainly distributed in the foot and ankle department one and the critical care medicine department .The analysis of the clinical indicators showed that 75 .0% had fever ,62 .5% had history of skin trauma ,87 .5% had elevated level of CRP ,62 .5% had elevated level of white blood cell in peripheral blood ,and 50 .0% had abnormal liver function .The prognosis of the patients with intracranial infection or complication of malignant tumor was poor .The drug resistance rates of the Nocardia to sulfamethoxazole‐trimethoprim ,linezolid ,and imipenem were 12 .5% ,while the drug resistance rates to peni‐cillin ,ampicillin ,and erythromycin were more than 75 .0% .CONCLUSION Nocardia is clinically rare ,and it is crucial for the early diagnosis and treatment as well as the prognosis to carry out the timely and accurate identification .

关 键 词：诺卡菌属 分布 细菌鉴定 药敏试验 

分 类 号：R378[医药卫生—病原生物学]