某院诺卡菌病患者的临床特征和治疗情况分析

Analysis of Clinical Characteristics and Treatment of Patients with Nocardiosis in a Hospital

目的:分析医院诺卡菌病患者的流行病学特点和药物治疗情况,为诺卡菌病的诊治提供参考。方法:收集2017年1月—2021年12月西南医科大学附属中医医院收治的7例诺卡菌病患者作为研究对象,采集7例患者的年龄、基础疾病、病原菌、感染部位、临床表现、治疗用药、治疗结局等信息,分析其流行病学特点和合理用药情况。结果:7例诺卡菌病患者中,5例合并有基础疾病,其病原菌分别有巴西诺卡菌(4例)、星状诺卡菌(2例)、豚鼠耳炎诺卡菌(1例),而其感染部位则有皮肤(4例)、肺部(2例)、中枢神经系统(1例)和播散性(1例);在治疗方案上,有6例是以复方磺胺甲噁唑为基础联合其他抗菌药物,另有1例则使用了米诺环素+哌拉西林-他唑巴坦钠+莫西沙星治疗;从治疗结局看,7例患者最终均好转。结论:对于诺卡菌病,无论其感染部位是皮肤、肺部,抑或播散性,相关治疗指南均推荐首选复方磺胺甲噁唑,而此次调查也验证了此方案的有效性,但在临床上也要结合具体患者的免疫状态、严重程度、致病菌的菌种及其耐药结果等情况合理选择合适的药物。

Objective:To analyze the epidemiological characteristics and treatment of patients with nocardiosis in the hospital,and provide reference for the diagnosis and treatment of nocardiosis.Methods:7 patients with nocardiosis admitted to the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from January 2017 to December 2021 were selected as the research subjects,and the information of the 7 patients,such as age,underlying diseases,pathogenic bacteria,infection site,clinical manifestations,medications and treatment outcomes,was collected to analyze their epidemiological characteristics and rational drug use.Results:Among the 7 patients with nocardiosis,5 cases were complicated with underlying diseases,and the pathogenic bacteria included Nocardia brasiliensis(4 cases),Nocardia asteroides(2 cases),Nocardia otitidiscaviarum(1 case),and the infection sites included skin(4 cases),lungs(2 cases),central nervous system(1 case)and disseminated(1 case);for the treatment regimens,6 cases were treated with compound sulfamethoxazole-based combined with other antibacterial drugs,and 1 case was treated with minocycline+piperacillin-tazobactam sodium+moxifloxacin;for the treatment outcomes,all of the 7 cases finally improved.Conclusion:For nocardiosis,regardless of whether the infection site is skin,lungs or disseminated,compound sulfamethoxazole is recommended as the first option in the relevant treatment guidelines.This survey also verifies the effectiveness of this regimen,but clinically,appropriate drugs should be reasonably selected in combination with the patient's immune status,severity,specifies of pathogenic bacteria and their drug resistance results,etc.