Nocardial infections in bone marrow transplant recipients
Nocardial infections in bone marrow transplant recipients
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DOI：
10.1093/clinids/23.5.1012
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发表时间：
1996-11-01
影响因子：
11.8
通讯作者：
Dummer, JS
中科院分区：
文献类型：
--
作者：
Choucino, C;Goodman, SA;Dummer, JS
由诺卡氏菌引起的感染在骨髓移植(BMT)受者中很少被描述，我们回顾了在我们的骨髓移植受者中发生的6例诺卡氏菌病和以前文献中报道的4例。在我们机构，自体骨髓移植受者的医院感染率为0.2%(1/554)，异基因骨髓移植受者为1.7%(5/302)(优势比，9.3[95%可信区间，1.1-80.1]；P=.046)。所有10名患者都接受了免疫抑制药物治疗，除了一名异基因骨髓移植受者外，所有患者都患有急性或慢性移植物抗宿主病(GVHD)。4名患者在发生诺卡菌病之前曾广泛接触土壤或粉尘。70%的患者死亡，但与移植物抗宿主病和相关曲霉属侵袭性感染相关的并发症相比，由于进行性心血管感染而死亡的几率较低。尽管每周间歇性地接受两到三次甲氧苄氨嘧啶-磺胺甲恶唑(TMP-SMZ)预防，但仍有三名患者患有诺卡菌病。这些数据表明，院内感染是骨髓移植的一种罕见的重要并发症，并与侵袭性真菌感染的高发生率有关，间歇给予TMP-SMZ预防并不能可靠地预防感染。
Infections caused by Nocardia species have been infrequently described in bone marrow transplant (BMT) recipients, We reviewed six cases of nocardiosis occurring in our population of BMT recipients and the four cases previously reported in the literature. The rate of nocardial infection at our institution was 0.2% (1 of 554) among autologous BMT recipients and 1.7% (5 of 302) among allogeneic BMT recipients (odds ratio, 9.3 [95% confidence interval, 1.1-80.1]; P = .046). All 10 patients had received immunosuppressive medications, and all but one allogeneic BMT recipient had acute or chronic graft-vs.-host disease (GVHD). Four patients had extensive exposure to soil or dust before nocardiosis developed. Seventy percent of the patients died, but death was less often due to progressive nocardial infection than to complications of GVHD and associated invasive infection with Aspergillus species. Three patients had nocardiosis despite receiving prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) on an intermittent basis two or three times a week. These data show that nocardial infection is an important if infrequent complication of bone marrow transplantation and is associated with a high rate of invasive fungal infection, TMP-SMZ prophylaxis given intermittently does not reliably protect against infection.