肾移植术后真菌感染经验治疗

Empirical Treatment of Fungal Infection After Kidney Transplantation

目的讨论肾移植术后真菌感染的临床特征,评价其经验性治疗的意义。方法对25例肾移植术后患者的临床资料进行回顾性分析。结果 25例患者真菌感染阳性率为48%(12/25),其中3例伴皮肤感染。9例阳性患者均首选伏立康唑治疗,其他给予经验性抗真菌治疗,总有效率为84%(21/25)。结论面对复杂的真菌感染,尽早给予经验性治疗。对于一些病情相对较轻的患者,可以在寻求确诊依据的基础上,逐渐从先发治疗过渡到目标性治疗。因临床上还缺乏特异性的病原学诊断依据,目前经验性治疗仍是一个重要且必要的治疗策略。但在治疗过程中应避免抗真菌药物过度使用,临床上需要严格把握经验性治疗的指征。

Objective To explore significance of empirical treatment of fungal infection after kidney transplantation. Methods The clinical data of 25 patients of fungal infection after renal transplantation in our hospital were retrospectively analyzed. Results In 25 pa- tients ,test positive for fungus results were in 12 cases and the positive rate was 48% （ 12/25 ） , among them with the skin infection in 3 ca- ses. 9 cases preferred vorieonazole treatment, and the other empirical antifungal therapy. The total effective rate was 84% （21/25）. Con- clusion An empirical treatment should be conducted as soon as possible for severe fungal lung infection. For some patients with relatively mild infection, we can gradually seek transition to start therapy. Etiology empirical treatment is still an important and necessary treatmentstrategies because of lacking of specificity in clinical diagnosis. But the excessive use of antifungal drugs should be avoided in case of the antimicrobial drug resistance. Doctors should strictly abide by the empirical indications of treatment.