Kinsella Paul M, Smibert Olivia C, Whitlam John B, Steven Mark, Masia Ricard, Gandhi Ronak G, Kotton Camille N, Holmes Natasha E
Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
Eur J Clin Microbiol Infect Dis. 2021 Dec;40(12):2627-2631. doi: 10.1007/s10096-021-04270-x. Epub 2021 May 14.
Malakoplakia is a chronic granulomatous disease associated with incomplete clearance of bacterial pathogens. A multimodal approach to therapy includes antimicrobials with intracellular activity, reduction in immunosuppression, and debulking of lesions. Azithromycin has an intracellular mechanism of action and enhanced Gram-negative activity compared to other macrolides. Despite some in vitro data to support its use, there are no clinical breakpoints or epidemiological cut-off values for most Enterobacterales from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) or the Clinical and Laboratory Standards Institute (CLSI). We present two cases, previously unreported, of Escherichia coli associated renal allograft malakoplakia successfully treated with azithromycin.
软斑病是一种与细菌病原体清除不完全相关的慢性肉芽肿性疾病。多模式治疗方法包括使用具有细胞内活性的抗菌药物、降低免疫抑制以及减少病变体积。与其他大环内酯类药物相比，阿奇霉素具有细胞内作用机制且革兰氏阴性菌活性增强。尽管有一些体外数据支持其使用，但欧洲抗菌药物敏感性测试委员会（EUCAST）或临床和实验室标准协会（CLSI）针对大多数肠杆菌科细菌均未制定临床断点或流行病学截断值。我们报告两例此前未报道的病例，均为大肠杆菌相关的肾移植软斑病，经阿奇霉素成功治疗。
