诺卡菌感染的临床特点及耐药性分析
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摘要
目的了解诺卡菌感染的临床特点、标本类型及耐药性,为临床合理应用抗菌药物提供依据。方法回顾性分析医院2012年1月-2017年3月细菌培养分离的诺卡菌,分析其菌种分布、标本来源、临床特点及药敏结果,使用16SrRNA扩增测序鉴定菌种,体外药敏试验采用微量肉汤稀释法。结果共收集诺卡菌15株,包含三种诺卡菌,分别为盖尔森基兴诺卡菌、鼻疽诺卡菌、豚鼠耳炎诺卡菌,各占66.7%、20.0%、13.3%;标本来源以痰液为主,占46.5%,其次为静脉血,占20.0%;患者呼吸系统、皮肤、中枢神经系统均有受累,临床表现以肺部感染为主,主要表现为咳嗽、咳痰、发热;诺卡菌对环丙沙星耐药率最高,为80.0%,其次为庆大霉素,为26.7%;所有菌株对阿米卡星、克拉霉素、利奈唑胺、磺胺甲唑/甲氧苄啶100.0%敏感,对亚胺培南、米诺环素等均表现较高的敏感性。结论诺卡菌对利奈唑胺、大环内酯类及磺胺类药物均有较高的敏感性,但对喹诺酮类药物敏感性较低,应加强药物检测,为临床合理使用抗菌药物及医院感染的有效控制提供理论依据。
OBJECTIVE To investigate the clinical characteristics of Nocardia infection,specimens sources and drug resistance so as to provide guidance for reasonable clinical use of antibiotics.METHODS The Nocardiastrains that were isolated from Jan 2012 to Mar 2017 were retrospectively analyzed,the distribution of species,specimens sources,clinical characteristics and results of drug susceptibility testing were observed,the strains were amplified,sequenced and identified by using 16 SrRNA,and the in vitro drug susceptibility testing was performed with the use of micro broth dilution method.RESULTS Totally 15 strains of Nocardia were collected,including 3 species,66.7% of which were Nocardia cyriacigeorigica,20.0% were Nocardia farcinica,and 13.3% were Nocardia otitidiscaviarum.Of the specimens sources,46.5% were sputum specimens,and 20.0% were venous blood specimens.The respiratory system,skin and central nervous system were involved,the pulmonary infection was the major clinical manifestation and was characterized by cough,expectoration and fever.The drug resistance rate of the Nocardiastrains to ciprofloxacin was the highest(80.0%),followed by gentamicin(26.7%).The drug susceptibility rates of all the strains to amikacin,clarithromycin,linezolid and sulfamethoxazole-trimethoprim were 100.0%,and the strains were highly susceptible to imipenem and minocycline.CONCLUSION The Nocardia strains are highly susceptible to linezolid and macrolides as well as sulfonamides but are less susceptible to quinolones.It is necessary to strengthen the surveillance of drug resistance so as to provide theoretical bases for reasonable clinical use of antibiotics and control of nosocomial infection.
OBJECTIVE To investigate the clinical characteristics of Nocardia infection,specimens sources and drug resistance so as to provide guidance for reasonable clinical use of antibiotics.METHODS The Nocardiastrains that were isolated from Jan 2012 to Mar 2017 were retrospectively analyzed,the distribution of species,specimens sources,clinical characteristics and results of drug susceptibility testing were observed,the strains were amplified,sequenced and identified by using 16 SrRNA,and the in vitro drug susceptibility testing was performed with the use of micro broth dilution method.RESULTS Totally 15 strains of Nocardia were collected,including 3 species,66.7% of which were Nocardia cyriacigeorigica,20.0% were Nocardia farcinica,and 13.3% were Nocardia otitidiscaviarum.Of the specimens sources,46.5% were sputum specimens,and 20.0% were venous blood specimens.The respiratory system,skin and central nervous system were involved,the pulmonary infection was the major clinical manifestation and was characterized by cough,expectoration and fever.The drug resistance rate of the Nocardiastrains to ciprofloxacin was the highest(80.0%),followed by gentamicin(26.7%).The drug susceptibility rates of all the strains to amikacin,clarithromycin,linezolid and sulfamethoxazole-trimethoprim were 100.0%,and the strains were highly susceptible to imipenem and minocycline.CONCLUSION The Nocardia strains are highly susceptible to linezolid and macrolides as well as sulfonamides but are less susceptible to quinolones.It is necessary to strengthen the surveillance of drug resistance so as to provide theoretical bases for reasonable clinical use of antibiotics and control of nosocomial infection.
引文
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[14]王燕,殷红秋,隋秀丽.等.骨科患者诺卡菌属感染临床分布与耐药性分析[J].中华医院感染学杂志,2015,25(22):5119-5121.
[15]刘涛华,王颜颜,牟丽丽,等.11株临床诺卡菌16SrRNA及药敏分析[J].贵阳医学院学报,2016,41(3):268-271.
[16]Valdezate S,Garrido N,Carrasco G,et al.Resistance gene pool to co-trimoxazole in non-susceptible Nocardia strains[J].Front Microbiol,2015,6:376.
[17]Matin A,Sharma S,Mathur P,et al.Myelosuppression-sparing treatment of central nervous system nocardiosis in a multiple myeloma patient utilizing a tedizolid-based regimen:a case report[J].Int J Antimicrob Agents,2017,49(4):488-492.
[18]郭丽娜,孙军平,汪建新.利奈唑胺联合SMZco治疗播散性奴卡菌1例报道[J].国际呼吸杂志,2013,33(6):479-480.
[2]尚红,王毓三,申子瑜.全国临床检验操作规程[M].北京:人民卫生出版社,2014:680-681.
[3]Jeong JH,Moon SM,Park PW,et al.Multiple brain abscesses caused by Nocardia asiaticain a patient with systemic lupus erythematosus:the first case report and literature review[J].Ann Lab Med,2017,37(5):459-461.
[4]Ambrosioni J,Lew D,Garbino J.Nocardiosis:updated clinical review and experience at a tertiary center[J].Infection,2010,38(2):89-97.
[5]李路茜,张媛媛,刘海灿,等.16Sr DNA序列在诺卡菌菌种鉴定中的价值研究[J].中国人兽共患病学报,2015,31(11):1017-1022.
[6]Chen YC,Lee CH,Chien CC,et al.Pulmonary nocardiosis in southern Taiwan[J].J Microbiol Immunol Infect,2013,46(6):441-447.
[7]宋秀杰,路聪哲,顾珏,等.84例肺诺卡菌病文献回顾性分析1979-2011[J].临床肺科杂志,2013,18(12):2280-2282.
[8]程振娜,李刚,师志云,等.诺卡菌感染的临床特点分析[J].宁夏医科大学学报,2017,39(5):535-538.
[9]戴望春,曾庆思,周嘉璇,等.肺诺卡菌病胸部特征[J],中国医学影像技术.2015,31(7):1048-1052.
[10]Larruskain J,Idigoras P,Marimón JM,et al.Susceptibility of186Nocardia sp.isolates to 20antimicrobial agents[J].Antimicrob Agents Chemother,2011,55(6):2995-2998.
[11]Wang HL,Seo YH,LaSala PR,et al.Nocardiosis in 132patients with cancer:microbiological and clinical analyses[J].Am J Clin Pathol,2014,142(4):513-523.
[12]吴洁,辛晓峰.肺诺卡菌4例报告及文献复习[J].临床肺科杂志,2014,19(4):767-768.
[13]Rafiei N,Peri AM,Righi E,et al.Central nervous system nocardiosis in Queensland:a report of 20cases and review of the literature[J].Medicine(Baltimore),2016,95(46):e5255.
[14]王燕,殷红秋,隋秀丽.等.骨科患者诺卡菌属感染临床分布与耐药性分析[J].中华医院感染学杂志,2015,25(22):5119-5121.
[15]刘涛华,王颜颜,牟丽丽,等.11株临床诺卡菌16SrRNA及药敏分析[J].贵阳医学院学报,2016,41(3):268-271.
[16]Valdezate S,Garrido N,Carrasco G,et al.Resistance gene pool to co-trimoxazole in non-susceptible Nocardia strains[J].Front Microbiol,2015,6:376.
[17]Matin A,Sharma S,Mathur P,et al.Myelosuppression-sparing treatment of central nervous system nocardiosis in a multiple myeloma patient utilizing a tedizolid-based regimen:a case report[J].Int J Antimicrob Agents,2017,49(4):488-492.
[18]郭丽娜,孙军平,汪建新.利奈唑胺联合SMZco治疗播散性奴卡菌1例报道[J].国际呼吸杂志,2013,33(6):479-480.