Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia.
Eur J Clin Microbiol Infect Dis. 2023 Mar;42(3):339-345. doi: 10.1007/s10096-022-04542-0. Epub 2023 Feb 1.
The study aims to characterise the species identification and antimicrobial susceptibility testing (AST) results of Nocardial isolates from adult patients across major public hospitals in Queensland, Australia, over a 15-year period. A multi-centre retrospective observational study of Nocardia sp. isolates was conducted from 7 major public hospitals in Queensland, Australia, over a 15-year period. Clinical samples from patients aged ≥ 18 years that isolated Nocardia sp. were included. Demographic and clinical data were collected, along with species identification and AST results. Overall, 484 Nocardia sp. were isolated. Most patients were male (297, 61%) with a mean (IQR) age of 60 (51-75) and a median (IQR) Charlson Comorbidity Index of 4 (2-6). Of these, 239 (49%) patients were immunosuppressed. Organisms were most frequently isolated from sputum (174, 36%), and superficial swabs (102, 21%). Patients presented with pulmonary infections (165, 35%) and superficial skin and soft tissue infections (87, 18%) most commonly. One hundred (21%) isolates were deemed pulmonary colonisation and were not treated. Of the speciated organisms, N. nova complex was the most common (93, 19%), followed by N. farcinica complex (79, 16%). Organisms were reliably susceptible to linezolid (240/245, 98%), amikacin (455/470, 97%), and trimethoprim/sulfamethoxazole (459/476, 96%), but less so to imipenem (243/472, 51%) and ceftriaxone (261/448, 58%). This is the largest Australian description of Nocardia sp. to date. Given antimicrobials are often commenced prior to AST results and sometimes even speciation, characterisation of local species and antibiogram data is important to guide empiric choices and local guidelines.
这项研究旨在描述在澳大利亚昆士兰州的主要公立医院中，15 年来成年患者的诺卡氏菌物种鉴定和药敏试验（AST）结果。对来自澳大利亚昆士兰州 7 家主要公立医院的诺卡氏菌属分离株进行了一项为期 15 年的多中心回顾性观察研究。纳入了年龄≥18 岁的患者的临床样本，这些样本中分离出了诺卡氏菌属。收集了人口统计学和临床数据，以及物种鉴定和 AST 结果。共有 484 株诺卡氏菌属分离株。大多数患者为男性（297 例，61%），平均（IQR）年龄为 60（51-75）岁，中位（IQR）Charlson 合并症指数为 4（2-6）。其中，239 例（49%）患者存在免疫抑制。最常从痰（174 例，36%）和浅表拭子（102 例，21%）中分离出病原体。患者最常出现肺部感染（165 例，35%）和浅表皮肤和软组织感染（87 例，18%）。100 株（21%）分离株被认为是肺部定植，未进行治疗。在鉴定的病原体中，新型诺卡氏菌复合体是最常见的（93 例，19%），其次是远藤氏菌复合体（79 例，16%）。病原体对利奈唑胺（240/245，98%）、阿米卡星（455/470，97%）和甲氧苄啶/磺胺甲恶唑（459/476，96%）具有可靠的敏感性，但对亚胺培南（243/472，51%）和头孢曲松（261/448，58%）的敏感性较低。这是迄今为止澳大利亚对诺卡氏菌属的最大描述。鉴于抗生素通常在 AST 结果之前开始使用，甚至在鉴定物种之前就开始使用，因此，对当地物种和抗生素图谱数据进行特征描述对于指导经验性选择和当地指南非常重要。
