9例外科感染诺卡菌患者的临床特点及耐药性分析  

An Analysis of Clinical Characteristics and Drug Resistancesof 9 Patients with Surgical Infection of Nocardia

作　　者：李少增[1] 张菲娅 时宇 熊瑜琳 LI Shaozeng;ZHANG Feiya;SHI Yu;XIONG Yulin(Laboratory Department,the Fourth Medical Center of General Hospital of PLA,Beijing 100037,China)

机构地区：[1]解放军总医院第四医学中心检验科,北京100037

出　　处：《标记免疫分析与临床》2022年第8期1293-1296,共4页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探讨外科感染诺卡菌患者的临床特点及耐药性,提高对诺卡菌感染的认识以制定抗菌方案。方法采用VITEK-MS(基质辅助离子解析时间飞行质谱仪)对2011年9月至2021年11月分离自解放军总医院第四医学中心,9例诺卡菌感染患者不同种类标本的细菌培养结果进行鉴定,采用E-test方法测量不同种诺卡菌对8种抗生素的MIC值(最小抑菌浓度),根据CLSI(美国临床和实验室标准化协会)M24-2A药敏折点判断敏感性。结果9株诺卡菌非重复菌种分别来自于骨科5株、普外科1株、整形外科2株、急救部1株。菌种分布为:皮疽诺卡菌4株、盖尔森基兴诺卡菌2株、巴西诺卡菌1株、豚鼠耳炎诺卡菌1株、脓肿诺卡菌1株。9株诺卡菌药物敏感性最高的是复方新诺明、阿米卡星和利奈唑胺,敏感率均为100%。结论诺卡菌感染较为罕见,我院诺卡菌分布以骨科及整形外科感染为主,不同诺卡菌耐药性差异较大,复方新诺明、阿米卡星及利奈唑胺较敏感,临床治疗多采用甲氧苄啶-磺胺甲悪唑联合其他敏感药物同时进行局部手术清创为主。Objective To explore clinical characteristics and drug resistances of patients with Nocardia infection in surgery,so as to improve the understanding of Nocardia infection,and to formulate antibacterial programs.Methods VITEK-MS(Matrix-assisted laser desorption/ionization analysis time-of-flight mass spectrometer)was isolated from the Fourth Medical Center of the PLA General Hospital during September,2011 to December,2021,The bacterial culture results of different specimens of 9 patients with Nocardia infection were identified,and E-test method was used to measure MIC values(minimum inhibitory concentration)of different species of Nocardia against 8 used antibiotics.The breakpoints for susceptible intermediate and resistant were followed by CLSI(clinical and laboratory standards institute)M24-2A.Results 9 non-repetitive strains of Nocardia included:5 from Orthopedics,2 from Plastic Surgery,1 from General Surgery,and 1 from Emergency Department.The strain distribution was:4 strains of Nocardia farcinica,2 strains of Nocardia cyriacigeorgica,1 strain of Nocardia otitidiscaviarum,1 strain of Nocardia brasiliensis,and 1 strain of Nocardia abscessus.9 Nocardia strains with the highest sensitivity were SXT,amikacin,and linezolid.The sensitivity rates were all 100%.Conclusion Nocardia infection is relatively rare,and the distribution of Nocardia in our hospital is mainly from Orthopedic and Plastic Surgery Departments.The drug resistance of different Nocardia bacteria is quite different,and SXT,amikacin and linezolid are more sensitivity.Clinical treatments mostly use trimethoprim-sulfamethoxazole combined with other sensitive drugs or simultaneous local surgical debridement.

关 键 词：诺卡菌 临床特点 药敏试验 

分 类 号：R378[医药卫生—病原生物学]