Management of infections due to nontuberculous mycobacteria in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Management of infections due to nontuberculous mycobacteria in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
复制标题
DOI：
10.1111/ctr.13588
复制
发表时间：
2019-09-01
影响因子：
2.1
通讯作者：
Daly, Jennifer S.
中科院分区：
文献类型：
--
作者：
Longworth, Sarah A.;Daly, Jennifer S.
这些来自美国移植传染病学会实践社区的更新指南回顾了移植前后非结核分枝杆菌感染的流行病学，诊断，预防和管理。NTM通常会导致五种不同的临床综合征之一：胸膜肺疾病、皮肤和软组织感染、骨关节感染、弥漫性疾病（包括导管相关感染引起的疾病）和淋巴结炎。这些感染的诊断可能具有挑战性，特别是当它们从非无菌空间分离时，因为它们在自然界中无处不在。因此，诊断这些病原体的肺部感染需要满足微生物学，放射学和临床标准，以解决这一问题。通常需要结合培养和分子诊断技术来进行物种水平的鉴定。由于药物毒性、需要长期多药治疗方案以及考虑到抗菌剂和免疫抑制剂之间复杂的药物相互作用，治疗方法因分离的菌种而异，并且很复杂。鉴于这些治疗挑战，应在医院和社区环境中做出努力，在可行的范围内限制对这些病原体的暴露。
These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the epidemiology, diagnosis, prevention, and management of nontuberculous mycobacterial infections in the pre- and post-transplant period. NTM commonly cause one of five different clinical syndromes: pleuropulmonary disease, skin and soft tissue infection, osteoarticular infection, disseminated disease, including that caused by catheter-associated infection, and lymphadenitis. Diagnosis of these infections can be challenging, particularly when they are isolated from nonsterile spaces, owing to their ubiquity in nature. Consequently, diagnosis of pulmonary infections with these pathogens requires fulfillment of microbiologic, radiographic, and clinical criteria to address this concern. A combination of culture and molecular diagnostic techniques is often required to make a species-level identification. Treatment varies depending on the species isolated and is complex, owing to drug toxicities, need for long-term multidrug regimens, and consideration of complex drug-drug interactions between antimicrobials and immunosuppressive agents. Given these treatment challenges, efforts should be made in both the hospital and community settings to limit exposure to these pathogens to the extent feasible.