Treatment of pulmonary nocardiosis in heart-transplant patients: importance of susceptibility studies.
Pulmonary nocardiosis is an infrequent but insidious disease in transplant patients. It has occurred in our centre in 3 out of 233 heart-transplant recipients since 1988. Common clinical features were mild symptoms and a severe nodular lung involvement. Early diagnosis was based upon cultures of bronchoalveolar lavage or fine-needle aspirate specimens of the lung lesions. Susceptibility studies and tests of antibiotic synergism guided the therapy. Two patients were treated with a combination of piperacillin-tazobactam and ciprofloxacin, and one with imipenem and amikacin, for 3-4 wk followed by a 3-month course of trimethoprim-sulphamethoxazole. The nocardial disease was successfully treated in the 3 patients; however, one died of subsequent invasive pulmonary aspergillosis. In the absence of consensus on the length of therapy, this experience suggests that a synergistic combination of a beta-lactam/beta-lactamase inhibitor with ciprofloxacin or amikacin followed by a short course of trimethoprim-sulphamethoxazole may be effective in eradicating nocardial disease and may reduce the need for long-term treatment.
Tripodi
M F
MF
Institute of Medical Therapy, Second University of Naples, Via D. Cotugno 1, 80135 Naples, Italy. mariefranc.tripodi@unina2.it
Adinolfi
L E
LE
Andreana
A
A
Sarnataro
G
G
Durante Mangoni
E
E
Gambardella
M
M
Casillo
R
R
Farina
C
C
Utili
R
R
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D018893:Bronchoalveolar Lavage; D002939:Ciprofloxacin / Q000008:administration & dosage; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009615:Nocardia / Q000187:drug effects; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D010878:Piperacillin / Q000008:administration & dosage; D011183:Postoperative Complications; D000078142:Tazobactam; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D010397:Penicillanic Acid; D000078142:Tazobactam; D010878:Piperacillin