Department of Clinical Laboratory, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing, China.
Tuberculosis Department, Beijing Chest Hospital, Capital Medical University, Beijing, China.
PLoS Negl Trop Dis. 2023 Jul 10;17(7):e0011432. doi: 10.1371/journal.pntd.0011432. eCollection 2023 Jul.
Nocardia species can cause local or disseminated infection. Prompt diagnosis and appropriate treatment of nocardiosis are required, because it can cause significant morbidity and mortality. Knowledge of local species distribution and susceptibility patterns is important to appropriate empiric therapy. However, knowledge on the epidemiology and antimicrobial susceptibility profiles of clinical Nocardia species remains limited in China.
The data of isolation of Nocardia species were collected from databases such as Pubmed, Web of Science, Embase as well as Chinese databases (CNKI, Wanfang and VIP). Meta-analysis was performed using RevMan 5.3 software. Random effect models were used and tested with Cochran's Q and I2 statistics taking into account the possibility of heterogeneity between studies.
In total, 791 Nocardia isolates were identified to 19 species levels among all the recruited studies. The most common species were N. farcinica (29.1%, 230/791), followed by N. cyriacigeorgica (25.3%, 200/791), N. brasiliensis (11.8%, 93/791) and N. otitidiscaviarum (7.8%, 62/791). N. farcinica and N. cyriacigeorgica were widely distributed, N. brasiliensis mainly prevalent in the south, N. otitidiscaviarum mainly distributed in the eastern coastal provinces of China. Totally, 70.4% (223/317) Nocardia were cultured from respiratory tract specimens, 16.4% (52/317) from extra-pulmonary specimens, and 13.3% (42/317) from disseminated infection. The proportion of susceptible isolates as follows: linezolid 99.5% (197/198), amikacin 96.0% (190/198), trimethoprim-sulfamethoxazole 92.9% (184/198), imipenem 64.7% (128/198). Susceptibility varied by species of Nocardia.
N. farcinica and N. cyriacigeorgica are the most frequently isolated species, which are widely distributed in China. Pulmonary nocardiosis is the most common type of infection. Trimethoprim-sulfamethoxazole can still be the preferred agent for initial Nocardia infection therapy due to the low resistance rate, linezolid and amikacin could be an alternative to treat nocardiosis or a choice in a combination regimen.
奴卡菌可引起局部或播散性感染。需要及时诊断和适当治疗奴卡菌病，因为它会导致严重的发病率和死亡率。了解当地物种分布和药敏模式对于经验性治疗至关重要。然而，中国对临床奴卡菌物种的流行病学和抗菌药物敏感性谱的了解仍然有限。
从 Pubmed、Web of Science、Embase 以及中国数据库（CNKI、万方和 VIP）等数据库中收集奴卡菌分离的数据。使用 RevMan 5.3 软件进行荟萃分析。采用随机效应模型，并结合 Cochran's Q 和 I2 统计量考虑研究间异质性的可能性进行检验。
在所有纳入的研究中，共鉴定出 791 株奴卡菌，分为 19 个种水平。最常见的菌种是星形奴卡菌（29.1%，230/791），其次是雪松奴卡菌（25.3%，200/791）、巴西奴卡菌（11.8%，93/791）和耳炎奴卡菌（7.8%，62/791）。星形奴卡菌和雪松奴卡菌分布广泛，巴西奴卡菌主要流行于南方，耳炎奴卡菌主要分布于中国东部沿海省份。共有 70.4%（223/317）的奴卡菌从呼吸道标本中培养出来，16.4%（52/317）从肺外标本中培养出来，13.3%（42/317）从播散性感染中培养出来。敏感分离株的比例如下：利奈唑胺 99.5%（197/198）、阿米卡星 96.0%（190/198）、复方磺胺甲噁唑 92.9%（184/198）、亚胺培南 64.7%（128/198）。奴卡菌的药敏性因菌种而异。
星形奴卡菌和雪松奴卡菌是最常分离的菌种，在中国广泛分布。肺部奴卡菌病是最常见的感染类型。由于耐药率低，复方磺胺甲噁唑仍然可以作为奴卡菌初始感染治疗的首选药物，利奈唑胺和阿米卡星可以作为治疗奴卡菌病的替代药物，也可以作为联合治疗方案的选择。
