HIV患者合并诺卡菌肺炎的实验室检查特点及药敏结果分析  

Analysis of laboratory test characteristics and drug sensitivity results of HIV patients complicated with Nocardia pneumonia

作　　者：李虎金 马小艳[2] 孙继云[2] 李瑞红[2] 徐新民[2] 张燕[2] 王慧珠[2] Li Hujin;Ma Xiaoyan;Sun Jiyun;Li Ruihong;Xu Xinmin;Zhang Yan;Wang Huizhu(Department of Blood Transfusion,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院输血科,100015 [2]首都医科大学附属北京地坛医院检验科,100015

出　　处：《北京医学》2021年第3期235-237,共3页Beijing Medical Journal

摘　　要：目的总结HIV患者合并诺卡菌肺炎的实验室检查特点及药敏结果。方法采集2013年8月至2019年7月首都医科大学附属北京地坛医院2498例HIV患者痰液及肺泡灌洗液标本,进行涂片镜检及细菌培养,对培养生长的可疑菌落进行质谱鉴定及药敏试验。结果分离出7株诺卡菌,5株来源于肺泡灌洗液标本,2株来源于痰液标本。经质谱鉴定,皮疽诺卡菌3株,新星诺卡菌1株,北京诺卡菌2株,盖尔森基兴诺卡菌1株。药敏结果显示,全部菌株对磺胺甲噁唑/甲氧苄啶(sulfamethoxazole trimethoprim,SMZTMP)、阿米卡星、亚胺培南、利奈唑胺敏感,4株对头孢曲松、妥布霉素、米诺环素、莫西沙星、阿莫西林/克拉维酸钾敏感,仅1株对环丙沙星、克拉霉素敏感。单独应用SMZTMP治疗5例,以SMZ-TMP为基础联合美罗培南治疗1例,联合阿莫西林/克拉维酸钾治疗1例,7例患者病情均好转出院。结论诺卡菌肺炎是诺卡菌引起的严重呼吸道感染,免疫功能低下是诺卡菌肺炎的基础。诺卡菌培养阳性是确诊的唯一方法。药物治疗以SMZTMP为主,可根据患者病情和药敏结果联合用药。Objective To summarize the laboratory test characteristics and drug sensitivity of the HIV patients complicated with Nocardia pneumonia.Methods The samples of Sputum and bronchoalveolar lavage specimens of 2498 HIV patients in Beijing Ditan Hospital,Capital Medical University From August 2013 to July 2019,were collected and examined by smear microscopy and bacterial culture,the bacterial colony was identified by mass spectrometry and the drug sensitivity test was carried out.Results Seven strains of Nocardia were detected,among which five were from alveolar lavage fluid samples and two were from sputum samples.The mass spectrometry showed that three strains were Nocardia farcinica,one strain was Nocardia nova,two strains were Nocardia Beijingonsis and one strain was Nocardia cyriacigeorgica.The drug sensitivity test showed that all of the Nocardia were sensitive to sulfamethoxazole trimethoprim(SMZTMP),amikacin,imipenem and linezolid.Four strains were sensitive to ceftriaxone,tobramycin,minocycline,moxifloxacin,amoxicillin/potassium clavulanate.Only one strain was sensitive to ciprofloxacin and clarithromycin.Among the patients,five were treated with SMZTMP alone,one was treated with SMZTMP combined with meropenem,and one was treated with amoxicillin/potassium clavulanate.Seven patients were discharged after their conditions improved.Conclusions Nocardia pneumonia is a serious infection caused by Nocardia,immunodeficiency is the basis of Nocardia pneumonia.Pathogen culture positive is the only diagnosis of Nocardia.SMZTMP is the main drug therapy,and combined drug therapy should be used according to the patient's condition and drug sensitivity results.

关 键 词：诺卡菌 人类免疫缺陷病毒 实验室诊断 药敏结果 

分 类 号：R446.5[医药卫生—诊断学] R512.91[医药卫生—临床医学] R563.1