Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
BMC Infect Dis. 2014 Jan 9;14:10. doi: 10.1186/1471-2334-14-10.
There have been few studies of pulmonary actinomycosis, which is an uncommon anaerobic infection. Consequently, the optimal therapeutic regimen, appropriate duration of treatment, long-term prognosis, and factors predicting prognosis are not well established.
We retrospectively reviewed the medical records of histopathologically confirmed cases of pulmonary actinomycosis seen between November 2003 and December 2012.
The study included 68 patients with a mean age of 58.4 ± 11.6 years. Of the 68, initial surgery was performed in 15 patients (22.1%), while the remaining 53 (77.9%) received antibiotic therapy initially. In the initial antibiotic group, 45/53 (84.9%) were cured without relapse (median antibiotic duration 5.3 months). 5/53 (9.4%) patients were refractory medically (median antibiotic duration 9.7 months), and 3/53 (5.7%) experienced a recurrence (median time to relapse 35.3 months). In the initial surgery group, 14/15 (93.3%) were cured and treatment failure occurred in one (6.7%). In the multivariate analysis, the absence of an antibiotic response at 1 month was the only independent factor associated with a poor treatment outcome, with an adjusted odds ratio of 49.2 (95% CI, 3.34-724.30). There was no significant difference in treatment outcome based on the size of the parenchymal lesion, comorbidities, whether intravenous antibiotics were used, antibiotic therapy duration, or whether the initial treatment was surgical.
Antibiotic treatment with or without surgery was effective for treatment of pulmonary actinomycosis. Nevertheless, treatment failure or recurrence occurred in a considerable proportion of patients, especially those resistant to the initial antibiotic treatment.
肺部放线菌病是一种罕见的厌氧菌感染，相关研究较少，因此，其最佳治疗方案、治疗持续时间、长期预后以及预测预后的因素尚未明确。
我们回顾性分析了 2003 年 11 月至 2012 年 12 月期间经组织病理学证实的肺部放线菌病患者的病历。
本研究共纳入 68 例患者，平均年龄为 58.4±11.6 岁。其中 15 例（22.1%）患者初始接受了手术治疗，53 例（77.9%）患者初始接受了抗生素治疗。在初始抗生素治疗组中，45/53（84.9%）例患者未复发而治愈（中位抗生素治疗时间为 5.3 个月）；5/53（9.4%）例患者对抗生素治疗无反应（中位抗生素治疗时间为 9.7 个月），3/53（5.7%）例患者复发（中位复发时间为 35.3 个月）。在初始手术组中，14/15（93.3%）例患者治愈，1 例（6.7%）患者治疗失败。多变量分析显示，1 个月时无抗生素反应是治疗结局不良的唯一独立因素，调整后的优势比为 49.2（95%可信区间，3.34-724.30）。根据实质病变的大小、合并症、是否使用静脉抗生素、抗生素治疗持续时间或初始治疗是否为手术，治疗结局无显著差异。
无论是否手术，抗生素治疗对肺部放线菌病均有效，但相当一部分患者（尤其是对初始抗生素治疗耐药的患者）治疗失败或复发。
