1 例确诊为奥默柯达（毕赤）真菌血症的75 岁女性患者经卡泊芬净治疗后痊愈.该患者既往有冠状动脉粥样硬化性心脏病、高血压病、糖尿病及糖尿病肾病,近期因脑出血行脑内血肿置管引流术,术后因肺炎及呼吸衰竭行气管切开及机械通气,因消化道出血行全胃肠外营养.此后多次血液及静脉导管头培养均提示为奥默柯达真菌感染,先后给予氟康唑、伏立康唑、卡泊芬净及移除深静脉导管后血培养转阴,续用卡泊芬净21 d 并连续6 次血培养阴性考虑真菌血症治愈.目前报道的所有奥默毕赤真菌血症患者都存在免疫功能低下,卡泊芬净适合于肾功能不全患者,移除深静脉导管和停止静脉营养是治疗该病的重要措施,为避免复发抗真菌药物的疗程应在血培养阴性后维持2 周以上.%A case of 75-year-old woman patient diagnosed as Kodamaea (Pichia) ohmeri fungemia was recovered through the treatment of Caspofungin. The patient suffered coronary atherosclerotic heart disease, hypertensive disease, diabetes and diabetic nephropathy in the past, and was performed percutaneous catheter drainage in the intracerebral hematoma because of cerebral hemorrhage recently, and was taken incision of tracheal and mechanical ventilation after the operation because of the complication of pneumonia and respiratory failure, and was given total parenteral nutrition because of the severe ali -mentary tract hemorrhage. After that, multiple blood culture and culture of the tip of central venous catheter (CVC) all showed that there was Kodamaea ohmeri infection. The patient was cured after the treatment of Fluconazole, Voriconazole and the removal of CVC. Caspofungin was kept on for 21days and the blood culture showed 6 consecutive negative results, with the results, we considered that fungemia was cured. In recent reports, all patients with Kodamaea ohmeri fungemia had low immunity. Caspofungin was suitable for patients with renal insufficiency. The most important treatment for Kodamaea ohmeri fungemia is the removal of CVC and the withdrawal of parenteral alimentation. The antifungal treatment duration should be sustained for 2 weeks after the negative blood culture to avoid the recurrence of Kodamaea ohmeri fungemia.
展开▼
