Current treatment for nocardia infections

Introduction: Nocardiosis is an infectious actinomycetic disease with a variable clinical spectrum that makes it difficult to diagnose. It mainly affects immunosuppressed individuals. Advances in molecular genomic technology have helped in identifying new pathogenic Nocardia species. This has made identification of their specific antimicrobial sensitivity possible.

Areas covered: It is important to know the taxonomy, clinical features, diagnosis and precise species identification because of the multitude of pathogenic species involved and the different antibiotic susceptibility patterns. The authors review sulfonamides, aminoglycosides, penicillin derivatives, tetracyclines, glycylcyclines, oxazolidinones, carbapenems and the association of other potential drugs, the therapeutic effectiveness of traditional antimicrobials and new monotherapy and combined treatment alternatives. New oxazolidinones and the benzothiazinones are compounds that have been found effective in vitro and in experimental models.

Expert opinion: Clinicians should be aware of nocardiosis in patients with different forms of immunosuppression. The identification of organisms, their patterns of antibiotic susceptibility and the adverse effects related to these drugs must be considered. Treatments can vary from traditional schemes with trimethoprim–sulfamethoxazole to other combination therapies and new antibiotics and treatment modalities depending on the organ or site involved, the severity of infection and the presence of comorbidities.     

Successful treatment of methicillin-resistant Staphylococcus aureus pulmonary infection with linezolid in a patient with cystic fibrosis

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of pulmonary infection in patients with cystic fibrosis (CF). Because these organisms are frequently multidrug-resistant, most patients require intravenous therapy with vancomycin. We report on the first case of successful treatment of a pulmonary exacerbation due to MRSA in a CF patient with a new antimicrobial, linezolid. We demonstrated equivalence of intravenous and oral dosing in this patient, suggesting that oral linezolid may be an excellent alternative to intravenous vancomycin for CF patients infected with MRSA.     

高效液相色谱法测定人血清、脑脊液和胰液中利奈唑胺浓度

 目的 建立同时测定人血清、脑脊液、胰液中利奈唑胺药物浓度的HPLC测定方法。方法 以利培酮为内标物,在0.1 mol·L^-1NaOH碱性条件下甲基叔丁基醚-正丙醇=90∶10(V/V)液液提取,Shima-pack CLC-ODS-C₁₈(6.0 mm×150 mm,5 μm)色谱柱分离,流动相为甲醇-乙腈-磷酸缓冲溶液(0.02 mol·L^-1KH₂PO₄,H₃PO₄调pH 3.5)=20∶16∶64(V/V/V),流速1.0 mL·min^-1,柱温35 ℃,检测波长254 nm条件下测定。结果 血清中利奈唑胺在0.25~40.0 mg·L^-1内线性良好(r=0.999 9),3个浓度质控样本(0.8、8.0、25.0 mg·L^-1)的批内、批间变异(RSD)分别为1.64%~2.38%(n=5)、4.53%~6.34%(n=5),方法学和提取回收率分别为93.781%~97.393%(n=5)、72.318%~73.442%(n=5);脑脊液中在0.1~20.0 mg·L^-1内线性良好(r=0.999 3),3个浓度质控样本(0.2、2.0、15.0 mg·L^-1)的批内、批间变异(RSD)分别为3.84%~4.83%(n=5)、6.04%~8.16%(n=5),方法学和提取回收率分别为106.910%~110.971%(n=5)、73.226%~80.603%(n=5);胰液中在0.1~20.0 mg·L^-1内线性良好(r=0.999 4),3个浓度质控样本(0.2、2.0、15.0 mg·L^-1)的批内、批间变异(RSD)分别为2.96%~5.30%(n=5)、4.68%~6.40%(n=5),方法学和提取回收率分别为97.178%~105.072%(n=5)、73.333%~76.010%(n=5)。内标提取回收率＞87%。结论 本方法灵敏度高,准确性好,简便快捷,应用液液提取处理样本去除更多杂峰干扰,更广泛适用于临床,尤其适用于合并用药患者生物标本中利奈唑胺药物浓度的测定。     

利奈唑胺和万古霉素对重症监护治疗病房革兰阳性球菌感染患者治疗效果的Meta分析

目的:比较、评价利奈唑胺和万古霉素治疗重症监护治疗病房(intensive care unit,ICU)革兰阳性球菌感染患者的疗效及安全性。方法:采用Meta分析的方法,用计算机检索Pub Med、Cochrane Library、CNKI和万方数据库,评价筛选文献,纳入利奈唑胺和万古霉素的随机对照试验(RCT),并采用Rev Man 5.2进行Meta分析。结果:6个随机对照试验,共纳入革兰阳性球菌感染的ICU患者444名,其中利奈唑胺组218名,万古霉素组226名。Meta分析显示,临床治疗有效率,利奈唑胺优于万古霉素[OR=3.07,95%CI(1.76,5.34),P<0.01],细菌清除率上,利奈唑胺高于万古霉素[OR=3.83,95%CI(1.81,8.12),P=0.000 5];微生物学治愈率和不良反应发生率,利奈唑胺与万古霉素两组间差异均无统计学意义。结论:在治疗ICU重症患者革兰氏阳性球菌感染中,利奈唑胺在临床有效率和细菌清除率方面,明显优于万古霉素,而在微生物学治愈率和不良反应发生率上利奈唑胺则和万古霉素相当,但仍需要更大样本量、更加严格设计的随机对照试验进一步验证。     

利奈唑胺对高龄男性耐甲氧西林金黄色葡萄球菌患者血液生理指标影响及安全性分析

目的：观察利奈唑胺对耐甲氧西林金黄色葡萄球菌（MRSA）感染的高龄男性患者血液生理指标及安全性的影响。方法选取2012年4月至2013年3月在解放军总医院住院并确诊MRSA感染的46例高龄男性患者（83～95岁）,均给予利奈唑胺注射液治疗,0.6g、1次/12h,疗程10～14d。比较治疗前后红细胞（RBC）、血红蛋白（HB）、白细胞（WBC）、血小板（PLT）和网织红细胞（Ret）等血液生理指标变化。观察治疗期间出血不良反应。结果治疗后与治疗前比较,HB[（95.609±14.210） vs （102.478±15.941）g/L]、WBC＆#215;1012/L [（6.944±2.590） vs （8.728±2.277）]、Ret[（1.124%±0.844%） vs （1.789%±0.831%）]和PLT＆#215;109/L [（142.913±62.065） vs （227.304±56.250）]均显著降低,差异均有统计学意义（P＜0.01）。治疗期间共有22例患者发生出血倾向,出现2个部位出血患者10例（22%）,3个部位出血患者4例（9%）,≥4个部位出血患者2例。结论利奈唑胺能降低高龄男性患者HB、PLT、Ret水平,治疗期间需警惕出血并发症。     

重症患者利奈唑胺相关低钠血症危险因素的回顾性分析

目的 观察利奈唑胺治疗期间低钠血症的发生率,并确定其危险因素。方法 回顾性分析2017年1月至2019年7月杭州市西溪医院ICU 152名接受利奈唑胺治疗的住院患者。低钠血症定义为利奈唑胺治疗期间血钠含量≤134mmol/L。通过多元回归分析确定其危险因素。结果 28例( 23.3 % )患者出现低钠血症,其中2例为严重低钠血症。单因素和多因素Logistic回归分析表明,应用利奈唑胺前血浆C-反应蛋白( CRP )水平(β=0.010,OR=1.019,95%CI(1.005-1.033),P=0.007)以及合并使用脂肪乳氨基酸(18)注射液(β=-1.591,OR=0.151,95%CI(0.034-0.673),P=0.002)是低钠血症发生相关的独立变量。利奈唑胺治疗前,低钠血症组CRP水平显著高于非低钠血症组(t=-2.932,P= 0.004 )。在联合应用脂肪乳氨基酸(18)注射液的患者中,低钠血症发生的频率明显更高(x2=20.444,P = 0.003)。结论 使用利奈唑胺治疗的严重炎症患者和联合使用脂肪乳氨基酸(18)注射液的患者的血浆钠水平应该持续监测。