Yetmar Zachary A, Khodadadi Ryan B, Chesdachai Supavit, McHugh Jack W, Challener Douglas W, Wengenack Nancy L, Bosch Wendelyn, Seville Maria Teresa, Beam Elena
Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Open Forum Infect Dis. 2023 Aug 1;10(8):ofad409. doi: 10.1093/ofid/ofad409. eCollection 2023 Aug.
primarily infects patients who are immunocompromised or those with chronic lung disease. Although disseminated infection is widely recognized as an important prognostic factor, studies have been mixed on its impact on outcomes of nocardiosis.
We performed a retrospective cohort study of adults with culture-confirmed nocardiosis. Advanced infection was defined as disseminated infection, cavitary pulmonary infection, or pleural infection. The primary outcome was 1-year mortality, as analyzed by multivariable Cox regression.
Of 511 patients with culture growth of , 374 (73.2%) who had clinical infection were included. The most common infection sites were pulmonary (82.6%), skin (17.9%), and central nervous system (14.2%). In total, 117 (31.3%) patients had advanced infection, including 74 (19.8%) with disseminated infection, 50 (13.4%) with cavitary infection, and 18 (4.8%) with pleural infection. Fifty-nine (15.8%) patients died within 1 year. In multivariable models, disseminated infection was not associated with mortality (hazard ratio, 1.16; 95% CI, .62-2.16; = .650) while advanced infection was (hazard ratio, 2.48; 95% CI, 1.37-4.49; = .003). , higher Charlson Comorbidity Index, and culture-confirmed pleural infection were also associated with mortality. Immunocompromised status and combination therapy were not associated with mortality.
Advanced infection, rather than dissemination alone, predicted worse 1-year mortality after nocardiosis. was associated with mortality, even after adjusting for extent of infection. While patients who were immunocompromised had high rates of disseminated and advanced infection, immunocompromised status did not predict mortality after adjustment. Future studies should account for high-risk characteristics and specific infection sites rather than dissemination alone.
主要感染免疫功能低下的患者或患有慢性肺部疾病的患者。尽管播散性感染被广泛认为是一个重要的预后因素，但关于其对诺卡菌病结局的影响，研究结果不一。
我们对成年培养确诊的诺卡菌病患者进行了一项回顾性队列研究。进展期感染定义为播散性感染、空洞性肺部感染或胸膜感染。主要结局是1年死亡率，通过多变量Cox回归分析。
在511例有培养生长的患者中，纳入了374例（73.2%）有临床感染的患者。最常见的感染部位是肺部（82.6%）、皮肤（17.9%）和中枢神经系统（14.2%）。共有117例（31.3%）患者有进展期感染，包括74例（19.8%）播散性感染、50例（13.4%）空洞性感染和18例（4.8%）胸膜感染。59例（15.8%）患者在1年内死亡。在多变量模型中，播散性感染与死亡率无关（风险比，1.16；95%CI，0.62 - 2.16；P = 0.650），而进展期感染则有关（风险比，2.48；95%CI，1.37 - 4.49；P = 0.003）。此外，较高的Charlson合并症指数和培养确诊的胸膜感染也与死亡率相关。免疫功能低下状态和联合治疗与死亡率无关。
进展期感染而非单纯的播散，预示着诺卡菌病后1年死亡率更差。即使在调整感染程度后，[原文此处有缺失信息]仍与死亡率相关。虽然免疫功能低下的患者播散性和进展期感染发生率高，但调整后免疫功能低下状态并不能预测死亡率。未来的研究应考虑高危特征和特定感染部位，而不仅仅是播散情况。
