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首例报道的由格氏假诺卡菌引起的肺部奴卡菌病在一名免疫功能正常的患者中对复方磺胺甲噁唑(TMP-SMZ)耐药。

The first reported pulmonary nocardiosis caused by Nocardia gipuzkoensis resisted to trimethoprim/sulfamethoxazol (TMP-SMZ) in an immunocompetent patient.

机构信息

Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.

Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.

出版信息

J Glob Antimicrob Resist. 2024 Jun;37:214-218. doi: 10.1016/j.jgar.2024.02.008. Epub 2024 Mar 8.

Abstract

OBJECTIVES

Nocardia gipuzkoensis was first described as a novel and distinct species in 2020 by Imen Nouioui and pulmonary nocardiosis associated with N. gipuzkoensis was once reported in two bronchiectasis patients. Noteworthy, both reported N. gipuzkoensis cases showed sensitivity to trimethoprim/sulfamethoxazol (TMP-SMZ), which are usually recommended for empirical therapy.

METHODS

We reported the third case of N. gipuzkoensis infection in a 16-year-old girl with chief complaints of cough and persistent chest and back pain. No underlying immuno-suppressive conditions and glucocorticoid use was revealed. Patchy lesions next to the spine and located in the posterior basal segment of the lower lobes of the left lung were seen in thorax computed tomography (CT), but no pathogenic bacteria were detected according to routine laboratory testings.

RESULTS

Metagenomic next-generation sequencing (mNGS) combined with whole-genome sequencing (WGS) was used to classified our isolate from bronchoalveolar lavage fluid (BALF) as N. gipuzkoensis. It is worth mentioning that drug susceptibility testing of our isolate showed resistance to TMP-SMZ, which was never reported before. The patient improved remarkably both clinically and radiographically according to the treatment with imipenem-cilastatin infusion alone.

CONCLUSION

mNGS and WGS showed excellent performance in identifying the Nocardia genus to the species level and improving the detection rate of N. gipuzkoensis ignored by traditional culture. Different from previously reported cases, the N. gipuzkoensis infection case showed resistance to TMP-SMZ, which is an unprecedented finding and a crucial addition to our understanding of the antibacterial spectrum of N. gipuzkoensis. The successful treatment with imipenem-cilastatin infusion alone in this case is a testament to the importance of precise identification and tailored antibiotic therapy.

摘要

目的

2020 年,Imen Nouioui 首次将 Nocardia gipuzkoensis 描述为一个新的独特物种,并且曾有两例支气管扩张症患者与 Nocardia gipuzkoensis 相关的肺部诺卡氏菌病的报道。值得注意的是,这两例报道的 Nocardia gipuzkoensis 病例均对复方磺胺甲噁唑(TMP-SMZ)敏感,该药物通常被推荐用于经验性治疗。

方法

我们报道了第三例 Nocardia gipuzkoensis 感染病例,患者为一名 16 岁女孩,主要症状为咳嗽和持续性胸痛及背痛。患者无潜在免疫抑制状态和糖皮质激素使用史。胸部 CT 显示脊柱旁和左肺下叶后基底段有斑片状病变,但根据常规实验室检测未发现病原体。

结果

采用宏基因组下一代测序(mNGS)联合全基因组测序(WGS)对支气管肺泡灌洗液(BALF)分离株进行鉴定,结果为 Nocardia gipuzkoensis。值得注意的是,药敏试验显示我们的分离株对 TMP-SMZ 耐药,这是以前从未报道过的。该患者仅接受亚胺培南-西司他丁静脉滴注治疗,在临床和影像学上均有显著改善。

结论

mNGS 和 WGS 可出色地将诺卡氏菌属鉴定到种水平,并提高传统培养方法忽略的 Nocardia gipuzkoensis 的检出率。与以前报道的病例不同,该 Nocardia gipuzkoensis 感染病例对 TMP-SMZ 耐药,这是一个前所未有的发现,也是对我们对 Nocardia gipuzkoensis 抗菌谱理解的重要补充。该病例仅用亚胺培南-西司他丁静脉滴注成功治疗,证明了精确鉴定和针对性抗生素治疗的重要性。

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