肾移植受者的诺卡氏菌病:一家三级医疗中心的经验。

IF 1.6 4区 医学 Q4 IMMUNOLOGY
Rungmei Marak , Abdullah , Manas Behera , Anupma Kaul , Dharmendra Bhadauria , Narayan Prasad , Manas Patel , Ravi Kushwaha , Monika Yachha
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引用次数: 0

摘要

导言:肾移植受者感染机会性感染(包括诺卡菌)的风险增加。肾移植受者的诺卡菌病发病率为 0.4-1.3%。有关其流行病学和结果的数据十分有限:这是一项为期 10 年的回顾性观察研究,从 2012 年 1 月至 2021 年 12 月在印度北部的一家三级医疗中心进行,纳入并随访了所有感染诺卡氏菌的肾移植受者:结果:在 1108 名肾移植受者中,有 12 名(1.1%)患者感染了诺卡氏菌。所有患者均为活体肾移植受者,确诊时的平均年龄为(48.67 ± 12.60)岁。诺卡氏菌感染发生在移植后中位 26 个月(4-235 个月),其中 4 例(33.1%)发生在移植后一年内。7例(58.3%)接受复方新诺明预防治疗的患者发生了突破性感染。41.7%的病例(5例)在确诊诺卡氏菌的前一年发生过排斥反应。1例(8.3%)患者并发巨细胞病毒(CMV)感染。肺是最常受累的器官。所有病例的显微镜检查均呈阳性,10 例培养呈阳性。大多数(60%)分离株对复方新诺明有抗药性。所有检测到的分离菌株对阿米卡星、亚胺培南和利奈唑胺仍然敏感。完成抗生素治疗后,没有患者再感染诺卡菌。12个月的死亡率为66.7%(4人),只有一人的死亡与诺卡菌有关:结论:诺卡菌可能会在传统治疗窗口期之后引起晚期感染。结论:诺卡氏菌可能会在传统窗口期之后导致晚期感染,复方新诺明预防性治疗可能不足以预防诺卡氏菌感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Nocardiosis in kidney transplant recipients: A tertiary care center experience

Introduction

Kidney transplant recipients are at increased risk of opportunistic infections, including Nocardia. The incidence of nocardiosis in kidney transplant recipients is 0.4–1.3%. The data regarding its epidemiology and outcomes is limited.

Methods

This was a 10-year retrospective observational study from January 2012 to December 2021 at a tertiary care center in northern India, in which all kidney transplant recipients with Nocardia infection were included and followed.

Results

12 (1.1%) patients had a Nocardia infection among the 1108 kidney transplant recipients. All were living donor kidney transplant recipients, and the mean age at diagnosis was 48.67 ± 12.60 years. Nocardia infection occurred at a median of 26 months (range 4–235) post-transplantation, with 4 (33.1%) of the cases occurring within a year of transplant. Breakthrough infection occurred in 7 (58.3%) patients on cotrimoxazole prophylaxis. 41.7% (n = 5) cases had an episode of rejection in the preceding year of Nocardia diagnosis. Concurrent cytomegalovirus (CMV) infection was present in one (8.3%) case. The lung was the most frequently involved organ. Microscopy was positive in all the cases; while culture was positive in 10 cases, and antimicrobial susceptibility testing (AST) were performed for these isolates. The majority (60%) of isolates were resistant to cotrimoxazole. All tested isolates remained susceptible to Amikacin, Imipenem, and Linezolid. No patients experienced Nocardia recurrence after completion of antibiotic therapy. The mortality at 12 months was 66.7% (n = 4), and only one death was Nocardia-related.

Conclusion

Nocardia may cause a late-manifesting infection beyond the traditional window. The cotrimoxazole prophylaxis may not be sufficient for Nocardia prevention.

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来源期刊
Transplant immunology
Transplant immunology 医学-免疫学
CiteScore
2.10
自引率
13.30%
发文量
198
审稿时长
48 days
期刊介绍: Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.
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