10例诺卡菌感染的病原学鉴定和临床特征  

Identification,clinical characteristics and antimicrobial susceptibility of 10 clinical Nocardia infection cases

作　　者：程琰[1] 高杰英[2] 顾江 袁宏丽[2] 高鹏[2] 宋阳 CHENG Yan;GAO Jie-ying;GU Jiang;YUAN Hong-li;GAO Peng;SONG Yang(Department of Basic Medical Laboratory,The 980th Hospital of the PLA Joint Logistics Support Force(Bethune International Peace Hospital),Shijiazhuang,Hebei 050081,China;不详)

机构地区：[1]联勤保障部队第980(白求恩国际和平)医院基础医学实验室,河北石家庄050081 [2]联勤保障部队第980(白求恩国际和平)医院 [3]陆军军医大学药学与检验医学系 [4]中国人民解放军总医院第一医学中心检验科,北京100853

出　　处：《中国微生态学杂志》2022年第6期690-696,共7页Chinese Journal of Microecology

基　　金：国家自然科学基金青年科学基金(31200142);海南省卫生计生行业科研项目(14A210195)。

摘　　要：目的分析诺卡菌感染的病原学特点、耐药性、临床特征、危险因素、影像学表现以及诊治方法,以提高临床对诺卡菌病的认识和诊治水平,并为临床合理应用抗菌药物提供依据。方法回顾性分析2016年4月-2018年12月医院住院患者诺卡菌感染的临床资料;提取细菌DNA,扩增16S rRNA基因序列并测序,与NCBI数据库进行BLAST比对,鉴定菌种。微量肉汤稀释法进行药敏试验。结果10例诺卡菌感染病例中,男性7例,女性3例,年龄34~81岁,均为免疫功能受损或者有基础疾病患者。主要感染部位为肺部,临床表现有咳嗽、咳痰、发热、喘息、乏力、呼吸困难等。多数病例中性粒细胞数升高、血沉增快、C-反应蛋白升高。影像学特征不具有特异性,多表现为肺实变、结节灶、空洞等。10株诺卡菌对复方新诺明、阿米卡星、利奈唑胺的敏感率为100%,对亚胺培南、头孢曲松、米诺环素保持较高的敏感性,但对环丙沙星、阿莫西林/克拉维酸的敏感性较低;治疗以复方新诺明联合其他抗菌药物为主的联合用药方案,8例患者好转出院。结论诺卡菌感染多发生于合并有基础疾病以及免疫功能受损的患者,诺卡菌病仅根据临床表现极易误诊,病原学鉴定、影像学检查,联合诺卡菌感染的高危因素进行综合判断,可尽早明确诊断并及时合理治疗。Objective To analyze the pathogenic characteristics,antimicrobial susceptibility,clinical characteristics,risk factors,imageological characteristics,and treatment of Nocardia infection,so as to improve the awareness,clinical diagnosis and treatment of this disease,and provide guidance for reasonable clinical use of antibiotics.Methods Clinical data of patients suffering from nocardiosis from April 2016 to December 2018 were analyzed retrospectively.DNA was extracted for sequencing of 16 S rRNA;the tested sequence was compared with that in NCBI database through BLAST and the bacterial species was identified.Antimicrobial susceptibility test was carried out by using micro broth dilution method.Results A total of 10 cases of Nocardia infection were included,involving 7 males and 3 females with age ranging from 34 to 81.All the patients were immunocompromised or with underlying diseases.Pulmonary infection was the major clinical manifestation and was characterized by cough,expectoration,fever,respite,fatigue,dyspnea,etc.In most cases,the number of neutrophils,erythrocyte sedimentation,and C-reactive protein increased.The imaging features were similar to those of most of pulmonary diseases,such as nodules,consolidation and cavity.Nocardia strains were 100% sensitive to Trimethoprim-sulfamethoxazole(SMZco),linezolid and amikacin,and highly susceptible to imipenem,cefatriaxone and minocycline,but less susceptible to ciprofloxacin and amoxicillin/clavulanate.SMZco combined with other antibiotics was the first choice for treatment of the infection.Eight patients recovered and discharged.Conclusion Nocardia cause opportunistic infection in immunocompromised patients or those with underlying diseases.Nocardiosis is often misdiagnosed according only to clinical manifestations.Pathological examination and imaging combined with comprehensive evaluation based on the risk factors of Nocardia infection can help to achieve timely and rational treatment.

关 键 词：诺卡菌 感染 病原学 耐药性 

分 类 号：R446[医药卫生—诊断学]