Page 117 - 《中国药房》2025年4期

·药学服务·

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
Δ

1＊
张瑞霞 ，王岩萍 ，高 珊（1.天津市第一中心医院药学部，天津 300192；2.天津市安定医院药学部，天津
3
2
300222；3.唐山市妇幼保健院药剂科，河北 唐山 063000）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2025）04-0491-05
DOI 10.6039/j.issn.1001-0408.2025.04.18

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。
关键词 互隔链格孢菌；真菌感染；肾移植；药学监护

Pharmaceutical care of anti-infective treatment for a case of pulmonary infection due to Alternaria
alternata after renal transplantation
ZHANG Ruixia ，WANG Yanping ，GAO Shan（1. Dept. of Pharmacy， Tianjin First Central Hospital， Tianjin
3
2
1
300192， China；2. Dept. of Pharmacy， Tianjin Anding Hospital， Tianjin 300222， China；3. Dept. of Pharmacy，
Tangshan Maternal and Child Health Hospital， Hebei Tangshan 063000， China）
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.
KEYWORDS Alternaria alternate； fungal infection； kidney transplantation； pharmaceutical monitoring

真菌子囊菌门、座囊菌纲、孢腔菌科的链格孢属在 菌，与人类过敏性疾病密切相关，可诱发支气管哮喘、过
[1]
自然界中广泛分布，是土壤、植物、食物中常见的腐生 敏性鼻炎、特异性皮炎等 。互隔链格孢菌是链格孢属
中少数可引起人类感染的真菌之一，可引发皮肤感染、
Δ 基金项目 天津市卫生健康科技项目（No.KJ20226）；“白求恩·
角膜炎和鼻窦炎，还可导致少见的腹膜炎、骨髓炎和肺
求索-药学科研能力建设”项目（No.B-19-H-20200622）
＊第一作者 主管药师，硕士。研究方向：临床药学。电话：022- 炎，感染常发生在免疫抑制人群 [2―3] 。由互隔链格孢菌
23628982。E-mail：zrxhhhh@163.com 引起的肺部感染较为罕见，目前尚无权威指南提供其诊

中国药房 2025年第36卷第4期 China Pharmacy 2025 Vol. 36 No. 4 · 491 ·