1例巴西诺卡菌导致膜性肾病患者多发感染的治疗分析  

Analysis of the Treatment of Multiple Infections in a Patient with Membranous Nephropathy Caused by Nocardia brasiliensis

作　　者：杨萍[1] 沈艳琳[1] 周佳[1] 张金莲[1] YANG Ping;SHEN Yanlin;ZHOU Jia;ZHANG Jinlian(Department of Clinical Pharmacology,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院临床药学部,上海200092

出　　处：《医药导报》2025年第5期787-790,共4页Herald of Medicine

摘　　要：目的探讨巴西诺卡菌感染的临床特征及诊治方案。方法1例膜性肾病患者感染巴西诺卡菌致肺部、眼部、神经系统多发感染,临床药师查阅资料,评估患者的感染症状、严重程度并参与制订用药方案。结果治疗3~6个月后,患者明显好转。门诊随访,患者肺部、眼部、下肢神经系统恢复正常。结论巴西诺卡菌可在多种环境中定植,免疫系统受损人群可能感染。临床诊断需要依赖宏基因组测序方法进行鉴定。轻中度巴西诺卡菌感染可单独使用复方磺胺甲GFEB4唑,重度感染常选用2或3种抗菌药物(如复方磺胺甲GFEB4唑、亚胺培南西司他丁、阿米卡星)静脉联合治疗3~6周,后转为口服治疗。整个疗程3~6个月。及时实施有效治疗的患者预后通常较好。Objective To analyze the clinical characteristics and treatment strategies for Nocardia brasiliensis infection.Methods A clinical pharmacist participated in the clinical diagnosis and treatment plan for a case of a membranous nephropathy patient infected with Nocardia brasiliensis,resulting in multiple infections in the lungs,eyes,and nervous system.They were involved in assessing the patient's infection symptoms and severity,as well as reviewing the literature to participate in developing and optimizing the clinical drug therapy regimen.Results Following infection with Nocardia brasiliensis,the patient developed lung,eye,and nervous system infections.The patient showed significant improvement after targeted treatment by clinical doctors and clinical pharmacists.At the 3-month outpatient follow-up,the patient's lung,eye,and lower limb nervous system had returned to normal.Conclusions Nocardia brasiliensis can colonize in various environments,and immunocompromised individuals are at risk of infection.Clinical diagnosis relies on metagenomic sequencing methods for identification.For mild to moderate infections,a combination of sulfamethoxazole/trimethoprim(TMP-SMX)can be used as monotherapy.Severe infections often require a combination of two or three antibiotic drugs(such as TMP-SMX,imipenem cilastatin,amikacin)for intravenous treatment for 3-6 weeks,and followed by oral therapy.The entire course of treatment typically lasts 3-6 months.Patients with timely and effective treatment usually have a better prognosis.

关 键 词：诺卡菌感染 膜性肾病 复方磺胺甲GFEB4唑 神经损伤 

分 类 号：R978[医药卫生—药品] R969.3[医药卫生—药学]