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1例肾移植术后互隔链格孢菌致肺部感染患者抗感染治疗的药学监护
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| 篇名： | 1例肾移植术后互隔链格孢菌致肺部感染患者抗感染治疗的药学监护 |
| TITLE： | Pharmaceutical care of anti-infective treatment for a case of pulmonary infection due to Alternaria alternata after renal transplantation |
| 摘要： | 目的 为肾移植术后互隔链格孢菌致肺部感染患者治疗方案的选择及药学监护提供参考。方法临床药师参与1例肾移植术后互隔链格孢菌致肺部感染患者的抗感染治疗过程，根据患者的临床表现及实验室检查结果并结合文献，临床药师认为患者可能为互隔链格孢菌导致的呼吸道过敏后继发肺部感染，不能排除军团菌和腺病毒感染。临床药师建议口服伏立康唑片抗真菌，莫西沙星片抗军团菌，减少他克莫司剂量，停用更昔洛韦；同时还密切监护患者伏立康唑用药期间的血药谷浓度及可能出现的不良反应。结果医生采纳临床药师建议，患者病情平稳后准予出院。结论互隔链格孢菌是免疫抑制患者尤其是同时伴有呼吸道过敏反应时的潜在致病菌，伏立康唑可作为其抗感染治疗的首选方案。临床药师通过调整伏立康唑剂量，延长疗程，监测患者肝功能及视觉功能，关注伏立康唑与免疫抑制剂的相互作用等药学服务手段，保障了患者的用药安全。 |
| ABSTRACT： | OBJECTIVE To provide a reference for the selection of anti-infection schemes and pharmaceutical monitoring of pulmonary infection due to Alternaria alternata after renal transplantation. METHODS The clinical pharmacist was involved in the anti-infective treatment of a patient with pulmonary infection caused by A. alternata after renal transplantation. After considering the patient’s clinical symptoms， laboratory test results， and pertinent literature， clinical pharmacists determined that the patient may have developed pulmonary infection as a result of respiratory allergy due to A. alternata. The potential for infections from both Legionella and adenovirus remained a possibility. Oral administration of Voriconazole tablets was recommended for fungal therapy， while Moxifloxacin tablets were suggested for treating Legionella. Additionally， it was advised to lower the dosage of tacrolimus and stop using ganciclovir. The pharmacists meticulously tracked the patient’s voriconazole trough levels and any adverse effects that might arise during the therapy. RESULTS The physician endorsed the clinical pharmacist’s recommendations， and the patient’s status was steady， permitting discharge. CONCLUSIONS A. alternata is a potential pathogen for immunosuppressed patients， particularly when they also experience respiratory allergic reactions. Voriconazole can serve as the first-line treatment for anti-infection therapy. Clinical pharmacists ensure the patient medication safety by adjusting the dosage of voriconazole， extending the treatment course， monitoring liver and visual functions， and being vigilant about the interaction between voriconazole and immunosuppressants. |
| 期刊： | 2025年第36卷第04期 |
| 作者： | 张瑞霞；王岩萍；高珊 |
| AUTHORS： | ZHANG Ruixia，WANG Yanping，GAO Shan |
| 关键字： | 互隔链格孢菌；真菌感染；肾移植；药学监护 |
| KEYWORDS： | Alternaria alternate； fungal infection； kidney transplantation； pharmaceutical monitoring |
| 阅读数： | 13 次 |
| 本月下载数： | 0 次 |
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