Dumitrascu Adrian G, Rojas Carlos A, Stancampiano Fernando, Johnson Elizabeth M, Harris Dana M, Chirila Razvan M, Omer Mohamed, Hata D Jane, Meza-Villegas Diana M, Heckman Michael G, White Launia J, Alvarez Salvador
Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL.
Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ.
Mayo Clin Proc Innov Qual Outcomes. 2022 Dec 21;7(1):20-30. doi: 10.1016/j.mayocpiqo.2022.11.002. eCollection 2023 Feb.
To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for emphasizing the differences between invasive disease and colonization.
We conducted a single-center, retrospective cohort study of 133 patients with a positive isolate between August 1, 1998, and November 30, 2018, and a computed tomography (CT) of the chest within 30 days before or after the bacteria isolation date.
Patients with colonization were older (71 vs 65 years; =.004), frequently with chronic obstructive pulmonary disease (56.8% vs 16.9%; <.001) and coronary artery disease (47.7% vs 27%, =.021), and had isolated exclusively from lung specimens (100% vs 83.1%; =.003). On CT of the chest, they had frequent airway disease (84.1% vs 51.7%; <.001). Patients with invasive nocardiosis had significantly (<.05) more diabetes, chronic kidney disease, solid organ transplant, use of corticosteroids, antirejection drugs, and prophylactic sulfa. They had more fever (25.8% vs 2.3%; <.001), cutaneous lesions (14.6% vs 0%; =.005), fatigue (18% vs 0%; =.001), pulmonary nodules (52.8% vs 27.3%; =.006), and free-flowing pleural fluid (63.6% vs 29.4%; =.024). The patterns of nodule distribution were different-diffuse for invasive nocardiosis and peribronchiolar for colonization.
The isolation of in sputum from a patient with respiratory symptoms does not equal active infection. Only by combining clinical and chest CT findings, one could better differentiate between invasive nocardiosis and colonization.
描述大量培养结果呈阳性的患者的临床和影像学表现，强调侵袭性疾病与定植之间的差异。
我们对1998年8月1日至2018年11月30日期间133例分离株培养结果呈阳性的患者进行了单中心回顾性队列研究，并在细菌分离日期前后30天内进行了胸部计算机断层扫描（CT）。
定植患者年龄较大（71岁对65岁；P = 0.004），常患有慢性阻塞性肺疾病（56.8%对16.9%；P < 0.001）和冠状动脉疾病（47.7%对27%，P = 0.021），且分离株仅来自肺标本（100%对83.1%；P = 0.003）。在胸部CT上，他们常有气道疾病（84.1%对51.7%；P < 0.001）。侵袭性诺卡菌病患者患糖尿病、慢性肾脏病、实体器官移植、使用皮质类固醇、抗排斥药物和预防性磺胺类药物的比例显著更高（P < 0.05）。他们发热更多（25.8%对2.3%；P < 0.001）、有皮肤病变（14.6%对0%；P = 0.005）、疲劳（18%对0%；P = 0.001）、有肺结节（52.8%对27.3%；P = 0.006）和有自由流动的胸腔积液（63.6%对29.4%；P = 0.024）。结节分布模式不同——侵袭性诺卡菌病为弥漫性，而定植为细支气管周围性。
从有呼吸道症状的患者痰中分离出[细菌名称未给出]并不等同于活动性感染。只有结合临床和胸部CT表现，才能更好地区分侵袭性诺卡菌病和[细菌名称未给出]定植。
