Naik S, Mateo-Bibeau R, Shinnar M, Mahal M, Freudenberger R
Division of Heart Failure and Transplant Cardiology, Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, 125 Patterson Street, New Brunswick, NJ 08903, USA.
Transplant Proc. 2007 Jun;39(5):1720-2. doi: 10.1016/j.transproceed.2006.11.029.
Nocardia is an opportunistic pathogen in solid organ transplantation for which long-term sulfonamide therapy is considered the treatment of choice. We report a patient 7 months status post-orthotopic heart transplantation with Nocardia nova bacteremia and pneumonia. Initial treatment consisted of intravenous trimethoprim-sulfamethoxazole, which cleared blood cultures, but the patient subsequently went into renal failure and required alternative therapy. This report describes the first case of N nova bacteremia after orthotopic heart transplantation successfully treated with clarithromycin. All therapy should be guided by antibiotic sensitivity, and combination therapy should be considered in acutely ill patients and cases where in vitro synergy has been documented. This case suggests that clarithromycin can be an alternative treatment in cases of sulfonamide resistance, intolerance, or allergy.
诺卡菌是实体器官移植中的一种机会致病菌，长期磺胺类药物治疗被认为是其首选治疗方法。我们报告了1例原位心脏移植术后7个月发生新星诺卡菌血症和肺炎的患者。初始治疗采用静脉注射甲氧苄啶-磺胺甲恶唑，血培养转阴，但患者随后出现肾衰竭，需要更换治疗方案。本报告描述了首例原位心脏移植术后新星诺卡菌血症患者成功接受克拉霉素治疗的病例。所有治疗均应以抗生素敏感性为指导，对于急性病患者和已证明有体外协同作用的病例，应考虑联合治疗。该病例表明，在磺胺类药物耐药、不耐受或过敏的情况下，克拉霉素可作为替代治疗药物。
