Division of Infectious Disease, Hospital of University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts.
Clin Transplant. 2019 Sep;33(9):e13588. doi: 10.1111/ctr.13588. Epub 2019 Jun 25.
These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the epidemiology, diagnosis, prevention, and management of nontuberculous mycobacterial infections in the pre- and post-transplant period. NTM commonly cause one of five different clinical syndromes: pleuropulmonary disease, skin and soft tissue infection, osteoarticular infection, disseminated disease, including that caused by catheter-associated infection, and lymphadenitis. Diagnosis of these infections can be challenging, particularly when they are isolated from nonsterile spaces, owing to their ubiquity in nature. Consequently, diagnosis of pulmonary infections with these pathogens requires fulfillment of microbiologic, radiographic, and clinical criteria to address this concern. A combination of culture and molecular diagnostic techniques is often required to make a species-level identification. Treatment varies depending on the species isolated and is complex, owing to drug toxicities, need for long-term multidrug regimens, and consideration of complex drug-drug interactions between antimicrobials and immunosuppressive agents. Given these treatment challenges, efforts should be made in both the hospital and community settings to limit exposure to these pathogens to the extent feasible.
这些由美国移植传染病学会实践社区更新的指南，回顾了移植前和移植后时期非结核分枝杆菌感染的流行病学、诊断、预防和管理。非结核分枝杆菌通常引起五种不同临床综合征之一：肺疾病、皮肤和软组织感染、骨关节感染、播散性疾病，包括导管相关感染引起的疾病，以及淋巴结炎。这些感染的诊断具有挑战性，特别是当它们从非无菌部位分离出来时，因为它们在自然界中无处不在。因此，为了解决这个问题，需要满足微生物学、影像学和临床标准来诊断这些病原体引起的肺部感染。通常需要结合培养和分子诊断技术来进行种水平的鉴定。治疗因药物毒性、需要长期多药物治疗方案以及考虑抗微生物药物和免疫抑制剂之间复杂的药物相互作用而有所不同。鉴于这些治疗挑战，应在医院和社区环境中努力在可行的范围内限制接触这些病原体。
