肺移植受者诺卡菌病的临床特征及治疗策略：单中心经验
Clinical characteristics and treatment strategy of nocardiosis in lung transplant recipients: A single-center experience.
作者信息
Xu Yu, Lian Qiao-Yan, Chen Ao, Zhang Jian-Heng, Xu Xin, Huang Dan-Xia, He Jian-Xing, Ju Chun-Rong
机构信息
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Department of Thoracic Surgery, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
出版信息
IDCases. 2023 Mar 31;32:e01758. doi: 10.1016/j.idcr.2023.e01758. eCollection 2023.
OBJECTIVE
are infrequent pathogens that disproportionately afflict organ transplant recipients. The present study aimed to summarize the clinical manifestations, diagnostic approaches, and treatment strategies of nocardiosis in lung transplant recipients.
METHODS
This retrospective study reviewed the clinical data of adult lung transplant recipients who were complicated with nocardiosis between January 2018 and December 2021 at the largest lung transplant center in South China.
RESULTS
The incidence of nocardiosis was 4.2% (13/316), including 9 cases of pulmonary nocardiosis and 4 disseminated nocardiosis (blood, pulmonary and intracranial). The accuracy in diagnosing nocardiosis was 77.8% by culture and 100% by metagenomic next-generation sequencing (mNGS). was the most common causative pathogen. Trimethoprim-sulfamethoxazole-based combination therapy was administered initially, followed by a single antibiotic as the maintained therapy, lasting for 4-8 months.
CONCLUSIONS
mNGS is more accurate than culture in diagnosing nocardiosis. Most patients responded well to the antibiotic therapy with combined antibiotics at the initial stage followed by a single antibiotic treatment.
目的
是罕见病原体，对器官移植受者造成的影响不成比例。本研究旨在总结肺移植受者诺卡菌病的临床表现、诊断方法和治疗策略。
方法
这项回顾性研究回顾了2018年1月至2021年12月在中国南方最大的肺移植中心发生诺卡菌病的成年肺移植受者的临床资料。
结果
诺卡菌病的发病率为4.2%（13/316），包括9例肺诺卡菌病和4例播散性诺卡菌病（血液、肺和颅内）。通过培养诊断诺卡菌病的准确率为77.8%，通过宏基因组下一代测序（mNGS）的准确率为100%。是最常见的致病病原体。最初给予基于甲氧苄啶-磺胺甲恶唑的联合治疗，随后用单一抗生素作为维持治疗，持续4-8个月。
结论
mNGS在诊断诺卡菌病方面比培养更准确。大多数患者在初始阶段接受联合抗生素治疗，随后接受单一抗生素治疗时对抗生素治疗反应良好。
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