Aydoslu Bayram, Tuğrul H Murat
Devlet Hastanesi, Klinik Mikrobiyoloji ve Infeksiyon Hastaliklan Klinigi, Karabük.
Mikrobiyol Bul. 2007 Oct;41(4):529-35.
The aims of this study were the isolation and identification of Nocardia spp. from clinical samples of immunocompromised patients and patients with underlying diseases, and determination of antibiotic susceptibilities of the isolates. A total of 234 patients (172 male, 62 female; mean age: 58.6 +/- 15.9 years) of whom 126 (53.8%) with malignancy and 108 (46.2%) with other underlying diseases (pulmonary diseases, rheumatologic disorders, diabetes mellitus, chronic renal disfunction, cerebrovascular disorders and malnutrition) were included to the study. Biochemical characteristics, growth properties and antibiotic susceptibility patterns were used for the identification of the isolates. The distribution of specimens were as follows; sputum (124), tracheal aspirate (54), pleural fluid (27), bronchoalveolar lavage (23), abscess material (7) and lung biopsy (1) material. Nocardia spp were isolated from four out of 234 patients (1.7%), and two of them were identified as N. farcinica, one as N. asteroides and one as N. otitidiscaviarum. All of the four patients have had predisposing factors (hepatocellular carcinoma/diabetes mellitus; antiphospholipid syndrome/steroid use; nephrotic syndrome/ steroid use; chronic obstructive lung disease/lung cancer?), with a mean age of 52.5 years, and of them two were male. Nocardiosis has been presented as pulmonary infection in two of the cases, and brain and soft tissue abscesses in one of each patient. Kirby-Bauer disk diffusion, E-test and broth microdilution methods were used in order to detect the antibiotic susceptibilities of the strains. All isolates were found susceptible to imipenem and amikacin and resistant to erythromycin and ampicillin. One N. asteroides isolate was found susceptible to trimetoprim-sulphamethoxazole (TMP-SMX), whereas two N. farcinica and one N. otitidiscaviarum strains were resistant. The antibiotics to which N. farcinica isolates were susceptible were ceftriaxone and cefotaxime. As a result, since there is an increase in the number of immunocompromised patients recently, Nocardia spp. should be considered in such patients, and TMP-SMX should be used with care for empirical therapy.
本研究的目的是从免疫功能低下患者和患有基础疾病患者的临床样本中分离和鉴定诺卡菌属，并测定分离株的抗生素敏感性。共有234例患者（男性172例，女性62例；平均年龄：58.6±15.9岁）纳入本研究，其中126例（53.8%）患有恶性肿瘤，108例（46.2%）患有其他基础疾病（肺部疾病、风湿性疾病、糖尿病、慢性肾功能不全、脑血管疾病和营养不良）。利用生化特性、生长特性和抗生素敏感性模式对分离株进行鉴定。标本分布如下：痰液（124份）、气管吸出物（54份）、胸腔积液（27份）、支气管肺泡灌洗（23份）、脓肿材料（7份）和肺活检（1份）材料。234例患者中有4例（1.7%）分离出诺卡菌属，其中2例鉴定为豚鼠耳炎诺卡菌，1例为星状诺卡菌，1例为鱼孢诺卡菌。所有4例患者均有易感因素（肝细胞癌/糖尿病；抗磷脂综合征/使用类固醇；肾病综合征/使用类固醇；慢性阻塞性肺疾病/肺癌？），平均年龄52.5岁，其中2例为男性。两例患者的诺卡菌病表现为肺部感染，另外两名患者分别表现为脑部和软组织脓肿。采用纸片扩散法、E试验和肉汤微量稀释法检测菌株的抗生素敏感性。所有分离株对亚胺培南和阿米卡星敏感，对红霉素和氨苄西林耐药。1株星状诺卡菌对复方磺胺甲恶唑（TMP-SMX）敏感，而2株豚鼠耳炎诺卡菌和1株鱼孢诺卡菌耐药。豚鼠耳炎诺卡菌分离株敏感的抗生素为头孢曲松和头孢噻肟。因此，由于最近免疫功能低下患者的数量有所增加，对此类患者应考虑诺卡菌属感染，经验性治疗时应谨慎使用TMP-SMX。
