造血干细胞移植后并发阿萨希毛孢子菌血流感染1例并文献复习  

Bloodstream Infection with Trichosporon Asahii after Hematopoietic Stem Cell Transplantation:a Case Report and Literature Review

作　　者：林爱华[1] 张建民[1] 钟旭丽[1] Lin Aihua;Zhang Jianmin;Zhong Xuli(Children’s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院,北京100020

出　　处：《儿科药学杂志》2024年第11期33-37,共5页Journal of Pediatric Pharmacy

摘　　要：目的:探讨血液恶性肿瘤患儿造血干细胞移植后发生阿萨希毛孢子菌血流感染的治疗药物选择。方法:分析1例造血干细胞移植后处于免疫抑制状态下血流感染阿萨希毛孢子菌的病例资料,结合既往文献,讨论并分析阿萨希毛孢子菌血流感染的药物治疗方案。结果:患儿在艾沙康唑治疗过程中发生了阿萨希毛孢子菌血流感染,调整为伏立康唑和两性霉素B脂质体联合治疗后,体温恢复正常,炎性指标好转,但由于患儿移植后出现了严重的肺部排斥反应,肺出血未能得到有效控制,最终放弃治疗。结论:血液恶性肿瘤患儿血流感染阿萨希毛孢子菌病死率高,在临床实践中应结合病情、体外药敏试验结果选择单药或联合治疗。阿萨希毛孢子菌应首选唑类药物,体外活性最强的是伏立康唑。两性霉素B抗真菌活性不充分,但与伏立康唑的联合治疗方案可能较伏立康唑单药或艾沙康唑单药治疗更具优势。Objective:To explore the selection of therapeutic drugs for the treatment of bloodstream infection with Trichosporon asahii after hematopoietic stem cell transplantation in children with hematologic malignancies.Methods:Clinical data of a child with bloodstream infection with T.asahii after hematopoietic stem cell transplantation in the immunosuppressed state were analyzed,combined with previous literature,the therapeutic treatment of bloodstream infection with T.asahii was discussed and analyzed.Results:Bloodstream infection with T.asahii occurred during the treatment of isavuconazole.After adjusting to the combination treatment of voriconazole and amphotericin B liposome,the body temperature and inflammatory indicators were improved.However,due to the severe pulmonary rejection after transplantation,the pulmonary hemorrhage could not be effectively controlled,and finally the treatment was discontinued.Conclusion:Children with hematological malignancies have a high mortality rate due to bloodstream infection with T.asahii.In clinical practice,single or combination therapy should be selected based on patients’condition and in vitro drug sensitivity results.The preferred selection for T.asahii is triazole drugs,with voriconazole being the most active in vitro.Amphotericin B has insufficient antifungal activity,yet the combination therapy with voriconazole may be more advantageous than voriconazole or isavuconazole monotherapy.

关 键 词：阿萨希毛孢子菌 血流感染 造血干细胞移植 药物治疗 

分 类 号：R519[医药卫生—内科学]