Nontuberculous mycobacterial infections in hematopoietic stem cell transplant recipients: Characteristics of respiratory and catheter-related infections
Nontuberculous mycobacterial infections in hematopoietic stem cell transplant recipients: Characteristics of respiratory and catheter-related infections
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DOI：
10.1016/s1083-8791(00)70012-7
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发表时间：
2000-01-01
影响因子：
4.3
通讯作者：
Boeckh, M
中科院分区：
文献类型：
--
作者：
Gaviria, JM;Garcia, PJ;Boeckh, M
在20年的时间里，从6259例造血干细胞移植（HSCT）受者中分离出40株非结核分枝杆菌（NTM）（0.64%），其中28株被认为是可能或确定的感染（0.44%）。通过支气管肺泡灌洗（BAL）和/或活检获得的15株下呼吸道分离株中仅3株（鸟分枝杆菌复合体[n = 2]和戈登分枝杆菌[n = 1]）引起明确或很可能的下呼吸道疾病，而根据疾病控制和预防中心的定义，15株中的12株被认为可能引起下呼吸道疾病。HSCT后的中位诊断时间为251天。所有3例确诊为NTM疾病的患者均成功地使用3种抗菌药物治疗数月。23例患者发生导管相关感染，包括出口部位感染（n = 5）、隧道感染（n = 7）和导管相关菌血症（n = 11）。所有这些都是由快速生长的分枝杆菌引起的。HSCT后的中位诊断时间为61天。所有导管相关感染的患者均成功接受了平均2种抗生素治疗，出口部位感染的中位治疗时间为3周，隧道感染和导管相关菌血症的中位治疗时间为6周。所有隧道感染病例均行软组织清创术。23例导管相关感染患者中有21例导管被移除。另外两名患者被诊断为NTM，一名患有淋巴结炎，一名患有皮肤病变。总之，NTM感染在HSCT受者中并不常见，并且具有良好的临床预后。在通过BAL获得的大多数下NTM呼吸道分离株中，无法确定致病作用。然而，下呼吸道疾病可能在HSCT后晚期发生，如果患者对合并感染的治疗无效或存在组织感染或合并菌血症的证据，则应考虑下呼吸道疾病。治疗应使用2至3种抗菌药物，根据抗菌药物敏感性进行指导，隧道感染患者应进行额外的手术清创。
Over a 20-year period, 40 nontuberculous mycobacteria (NTM) were isolated from 6259 hematopoietic stem cell transplant (HSCT) recipients (0.64%), of which 28 were considered to have probable or definite infection (0.44%). Only 3 of 15 lower respiratory isolates obtained by bronchoalveolar lavage (BAL) and/or biopsy; (Mycobacterium avium complex [n = 2] and M gordonae [n = 1]) caused definite or probable lower respiratory tract disease, whereas 12 of 15 were considered to cause possible lower respiratory tract disease according to Centers for Disease Control and Prevention definitions. The median time to diagnosis was 251 days following HSCT. All 3 patients with definite NTM disease were successfully treated with 3 antimicrobials for several months. Twenty-three patients had catheter-related infections, including exit site infection (n = 5), tunnel infection (n = 7), and catheter-related bacteremia (n = 11). All were caused by rapidly growing mycobacteria. The median time to diagnosis was 61 days following HSCT. All patients with catheter-related infections were successfully treated with an average of 2 antibiotics for a median of 3 weeks for exit site infection and 6 weeks for tunnel infection and catheter-related bacteremia. Soft tissue debridement was performed in all cases with tunnel infection. The catheter was removed in 21 of 23 patients with catheter-related infections. Two additional patients were diagnosed, one with lymphadenitis and one with skin lesion, due to NTM. In conclusion, NTM infections are infrequent in HSCT recipients and carry a good clinical prognosis. In the majority of lower NTM respiratory isolates obtained by BAL, a pathogenic role could not be established. However, lower respiratory tract disease can occur late after HSCT and should be considered if patients fail to respond to the treatment of concomitant infections or if evidence of tissue infection or concomitant bacteremia is present. Therapy should be performed with 2 to 3 antimicrobials, guided by antimicrobial susceptibilities, with additional surgical debridement in patients with tunnel infection.