Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CIBER de Enfermedades Respiratorias(CIBERES CB06/06/0058), Madrid, Spain.
Int J Infect Dis. 2021 Jan;102:446-454. doi: 10.1016/j.ijid.2020.10.087. Epub 2020 Nov 3.
To analyse relevant changes in incidence, clinical and microbiological characteristics of nocardiosis over the last 24 years at the current institution.
The clinical records of patients with nocardiosis (2006-2018) were reviewed and then compared with a previous cohort (1995-2006). Nocardia isolates were identified by 5'-end-16S-rRNA-gene-PCR targeting the first 500 bp of the gene and sequencing. Susceptibility tests were determined by broth microdilution (CLSI guidelines).
Forty-two patients (64.3% male) with nocardiosis were evaluated in the recent cohort: 51.2% had COPD, 43.9% were on corticosteroid therapy and 31.7% had cancer. The incidence of nocardiosis varied from 6.3 to 7.1/100,000 admissions (p = 0.62). There was a decrease in HIV patients (27% vs. 4.9%, p = 0.01) and solid organ transplantation (SOT) recipients (18.9% vs. 2 .4%, p = 0.01). Cases with pulmonary involvement had increased (70.3% vs. 90.5%, p = 0.04). Nocardia species were similar but the most common were N. cyriacigeorgica (32.4% vs. 40.5%, p = 0.49) and N. farcinica (24.3% vs. 14.3%, p = 0.39). Antibiotic resistance remained stable: cotrimoxazole (10.8% vs. 5.7%, p = 0.68), imipenem (5.4% vs. 5.6%, p = 1.0); amikacin and linezolid were 100% active. No differences were found in breakthrough nocardiosis (21.6% vs. 9.8%, p = 0.21) or related mortality (21.6% vs. 21.4%, p = 1.0). The multivariate analysis confirmed that nocardiosis caused by N. farcinica is a risk factor for poor outcome (p = 0.045).
Nocardiosis incidence has remained stable. It mainly affected elderly patients with chronic respiratory conditions and those on corticosteroid treatment. Infections in HIV and SOT patients have practically disappeared. Pulmonary involvement remains the most common area to be affected. Nocardiosis caused by N. farcinica is apparently a risk factor for poor clinical outcome.
分析本单位过去 24 年中诺卡氏菌病的发病率、临床和微生物学特征的相关变化。
回顾了 2006-2018 年间患有诺卡氏菌病的患者的临床记录，并与之前的队列（1995-2006 年）进行了比较。采用针对基因前 500 个碱基的 5'-端 16S-rRNA 基因-PCR 鉴定诺卡氏菌分离株，并进行测序。采用肉汤微量稀释法（CLSI 指南）测定药敏试验。
在最近的队列中评估了 42 例（64.3%为男性）患有诺卡氏菌病的患者：51.2%患有 COPD，43.9%正在接受皮质类固醇治疗，31.7%患有癌症。诺卡氏菌病的发病率为 6.3 至 7.1/100,000 人次（p = 0.62）。HIV 患者（27%比 4.9%，p = 0.01）和实体器官移植（SOT）受者（18.9%比 2.4%，p = 0.01）减少。肺受累病例增加（70.3%比 90.5%，p = 0.04）。诺卡氏菌的种类相似，但最常见的是 N. cyriacigeorgica（32.4%比 40.5%，p = 0.49）和 N. farcinica（24.3%比 14.3%，p = 0.39）。抗生素耐药性保持稳定：复方磺胺甲噁唑（10.8%比 5.7%，p = 0.68）、亚胺培南（5.4%比 5.6%，p = 1.0）；阿米卡星和利奈唑胺均 100%有效。突破性诺卡氏菌病（21.6%比 9.8%，p = 0.21）或相关死亡率（21.6%比 21.4%，p = 1.0）无差异。多变量分析证实，由 N. farcinica 引起的诺卡氏菌病是预后不良的危险因素（p = 0.045）。
诺卡氏菌病的发病率保持稳定。它主要影响患有慢性呼吸道疾病和接受皮质类固醇治疗的老年患者。HIV 和 SOT 患者的感染几乎已消失。肺受累仍然是最常见的受累部位。由 N. farcinica 引起的诺卡氏菌病显然是不良临床结局的危险因素。
