Roberts S A, Franklin J C, Mijch A, Spelman D
Microbiology and Infectious Diseases Department, Alfred Hospital, Melbourne, Australia.
Clin Infect Dis. 2000 Oct;31(4):968-72. doi: 10.1086/318150. Epub 2000 Oct 25.
Nocardia infections are uncommon in recipients of heart, lung, or heart-lung transplants, but such infections are well described. Frequent episodes of rejection, high-dose prednisolone treatment, renal impairment, and prolonged respiratory support have all been shown to increase the risk of Nocardia infection in this group. In this retrospective review of 540 recipients of heart, lung, or heart-lung transplants, 10 patients developed Nocardia infection (frequency, 1.85%). Infection occurred at a mean +/- standard deviation of 13+/-14.5 months after transplantation. All patients had pulmonary disease with no evidence of extrapulmonary disease. The Nocardia infection did not contribute directly to patient deaths. Coinfection with other pathogens was present in 6 patients, and 2 patients had sequential infections. Radiological findings varied. All isolates were susceptible to trimethoprim-sulfamethoxazole, amikacin, and imipenem. Treatment regimens varied. Two (30%) of 6 patients treated with trimethoprim-sulfamethoxazole developed adverse reactions, which necessitated a change in antibiotic therapy. The optimal treatment regimen, which comprises both the antimicrobial agent and the length of treatment, is unclear.
诺卡菌感染在心脏、肺或心肺移植受者中并不常见，但此类感染已有详尽描述。频繁的排斥反应、高剂量泼尼松龙治疗、肾功能损害及长时间呼吸支持均已显示会增加该组患者诺卡菌感染的风险。在这项对540例心脏、肺或心肺移植受者的回顾性研究中，有10例患者发生诺卡菌感染（发生率为1.85%）。感染发生在移植后平均±标准差13±14.5个月。所有患者均有肺部疾病，无肺外疾病证据。诺卡菌感染并非直接导致患者死亡。6例患者合并有其他病原体感染，2例患者先后发生感染。影像学表现各异。所有分离菌株对甲氧苄啶 - 磺胺甲恶唑、阿米卡星和亚胺培南均敏感。治疗方案各不相同。6例接受甲氧苄啶 - 磺胺甲恶唑治疗的患者中有2例（30%）出现不良反应，这使得必须更换抗生素治疗。包括抗菌药物及治疗时长在内的最佳治疗方案尚不清楚。
