Huang Lei, Sun Liying, Yan Yan
Department of Clinical Laboratory, Peking University First Hospital, Beijing, China.
Medicine (Baltimore). 2019 Nov;98(45):e17913. doi: 10.1097/MD.0000000000017913.
Nocardia is an opportunistic pathogen from environment, which is generally thought to infect immunosuppressed patients (ISPs), but recent studies showed it could also cause infections in immunocompetent patients (ICPs).The aim of this study was to compare the clinical characteristics, patients' outcome, Nocardia species' identification, and antibiotic susceptibility profiles of nocardiosis between ICPs and ISPs.The detailed clinical data were collected from all the nonrepetitive nocardiosis patients during 2011 and 2018, from a tertiary general hospital in Beijing, China. Then each Nocardia isolate was identified to species level by DNA sequencing. The antibiotic susceptibility testing was performed by E test method, and interpreted following CLSI M24 document. The clinical and microbiological characteristics between ICPs and ISPs were compared statistically.A total of 23 nonrepetitive nocardiosis patients with detailed clinical data were enrolled in this study. Among them, 9 were ICPs and 14 were ISPs. All the skin and soft tissue infections occurred in ICPs (33.3% vs 0%, P < .05). Bronchiectasis occurred more frequently in ICPs (44.4% vs 21.4%), whereas chronic kidney diseases and coinfection with aspergillosis occurred more frequently in ISPs (35.7% vs 0%, 35.7% vs 0%, respectively), although they did not reach the statistical significance. There were no significant differences in other clinical characteristics, Nocardia species' identification, and antibiotic susceptibility between ISPs and ICPs (P > .05).Nocardiosis could occur in both ISPs and ICPs. Skin and soft tissue infection and bronchiectasis occurred more frequently in ICPs. Chronic kidney diseases and co-infection with aspergillosis occurred more frequently in ISPs. These characteristics should be noticed by physicians in diagnosis of nocardiosis.
诺卡菌是一种来自环境的机会致病菌，通常认为它会感染免疫抑制患者（ISP），但最近的研究表明它也可能导致免疫功能正常患者（ICP）感染。本研究的目的是比较ICP和ISP之间诺卡菌病的临床特征、患者预后、诺卡菌菌种鉴定及抗生素敏感性谱。详细的临床数据收集自2011年至2018年期间中国北京一家三级综合医院的所有非重复性诺卡菌病患者。然后通过DNA测序将每个诺卡菌分离株鉴定到种水平。采用E试验法进行抗生素敏感性试验，并按照CLSI M24文件进行解读。对ICP和ISP之间的临床和微生物学特征进行统计学比较。本研究共纳入23例具有详细临床数据的非重复性诺卡菌病患者。其中，9例为ICP，14例为ISP。所有皮肤和软组织感染均发生在ICP中（33.3%对0%，P<0.05）。支气管扩张在ICP中更常见（44.4%对21.4%），而慢性肾脏病和曲霉合并感染在ISP中更常见（分别为35.7%对0%，35.7%对0%），尽管未达到统计学意义。ISP和ICP在其他临床特征、诺卡菌菌种鉴定及抗生素敏感性方面无显著差异（P>0.05）。诺卡菌病可发生在ISP和ICP中。皮肤和软组织感染及支气管扩张在ICP中更常见。慢性肾脏病和曲霉合并感染在ISP中更常见。医生在诊断诺卡菌病时应注意这些特征。
