1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece.
2University of Crete Medical School, Heraklion, Crete, Greece.
Acta Microbiol Immunol Hung. 2023 Jul 17;70(3):239-245. doi: 10.1556/030.2023.02071. Print 2023 Sep 21.
Nocardiosis is a rare disease affecting both immunocompromised and immunocompetent hosts, presented in various clinical forms ranging from localized to disseminated infection. Aim of the present study was to investigate the clinical and microbiological characteristics of nocardiosis, antimicrobial resistance profiles, treatment, and outcomes of Nocardia infection over the last 5 years at our institution. The medical records and microbiological data of patients affected by nocardiosis and treated at the university hospital of Heraklion, Crete, Greece, between 2018 and 2022, were retrospectively analyzed. The isolates were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and through sequencing of 16S rRNA. Antimicrobial susceptibility for 17 agents was determined by E-test and results were interpreted according to CLSI guidelines. Among the 28 Nocardia isolates, eight species were identified, with Nocardia brasiliensis being the most prevalent (32.1%), followed by Nocardia otitidiscaviarum (25%), and Nocardia farcinica (14.3%). Skin and soft tissue infections were the most common presentations, noted in 13 (50%) patients, followed by pulmonary infection presented in 10 (38.5%) patients. Fifteen patients (57.7%) had at least one underlying disease, and 11 (42.3%) were on immunosuppressive or long-term corticosteroid treatment. Susceptibility rates of linezolid, tigecycline, amikacin, trimethoprim-sulfamethoxazole, moxifloxacin, and imipenem were 100, 100, 96.4, 92.9, 82.1, and 42.9%, respectively. The 26 patients in this study were treated with various antibiotics. Mortality rate was 3.8%, and the patient who died had disseminated infection. Since epidemiology and antimicrobial susceptibility are evolving, continuous surveillance is mandatory in order to initiate appropriate treatment in a timely manner.
诺卡氏菌病是一种罕见的疾病，影响免疫功能低下和免疫功能正常的宿主，表现为从局部感染到播散性感染的各种临床形式。本研究旨在调查过去 5 年在我们机构中，诺卡氏菌感染的临床和微生物学特征、抗微生物药物耐药谱、治疗方法和结局。回顾性分析了 2018 年至 2022 年期间在希腊克里特岛伊拉克利翁大学医院治疗的诺卡氏菌感染患者的病历和微生物学数据。通过基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）和 16S rRNA 测序对分离株进行鉴定。采用 E 试验法测定 17 种药物的药敏性，根据 CLSI 指南解释结果。在 28 株诺卡氏菌分离株中，鉴定出 8 个种，其中巴西诺卡氏菌最为常见（32.1%），其次是耳炎诺卡氏菌（25%）和远藤诺卡氏菌（14.3%）。皮肤和软组织感染是最常见的表现，13 例（50%）患者存在此类感染，其次是肺部感染 10 例（38.5%）。15 例（57.7%）患者至少有一种基础疾病，11 例（42.3%）患者接受免疫抑制或长期皮质类固醇治疗。利奈唑胺、替加环素、阿米卡星、复方磺胺甲噁唑、莫西沙星和亚胺培南的敏感性率分别为 100%、100%、96.4%、92.9%、82.1%和 42.9%。本研究中的 26 例患者接受了各种抗生素治疗。死亡率为 3.8%，死亡患者为播散性感染。由于流行病学和抗微生物药物敏感性在不断变化，因此必须进行持续监测，以便及时启动适当的治疗。
