1例胃间质瘤合并椎体白假丝酵母感染患者抗真菌治疗的药学监护

Pharmaceutical Care in Antifungal Treatment for a Patient with Gastric Stromal Tumor Complicated by Candida Albicans Infection

目的:分析医院1例胃间质瘤合并椎体白假丝酵母感染患者抗真菌治疗的药学监护过程,为抗菌药物的合理选用和伊马替尼的用药安全提供参考。方法与结果:该患者(男,64岁)因“腰疼”入院,当前因胃间质瘤而长期使用伊马替尼;门诊胸腰段MR检查提示可能存在椎体感染性病变,遂经验性给予头孢哌酮-舒巴坦钠治疗;入院第5天,胸椎穿刺液检查回报白假丝酵母,遂改用卡泊芬净治疗;3 d后,根据药敏结果,将卡泊芬净调整为氟康唑;但又3 d后,患者腰背部疼痛加重,超敏C反应蛋白水平再次升高,医生与药师讨论后,又调整为卡泊芬净;入院第30天,行胸椎病灶刮除术;入院第46天,患者病情明显好转,感染指标明显下降,药师会诊后,考虑与伊马替尼的药物相互作用,建议换用氟康唑口服序贯治疗。结论:对于病因不明的感染患者,临床药师应协助医生及早明确病原菌,以开展针对性治疗,并根据抗感染治疗效果及时调整治疗方案,同时还应关注与其他药物的相互作用,以保证患者的用药安全。

Objective:To analyze the pharmaceutical care process in antifungal treatment for a patient with gastric stromal tumor complicated by Candida albicans infection in the hospital,and provide reference for the rational selection of antibacterial drugs and medication safety of imatinib.Methods and Results:The patient(male,64 years old)was admitted with"lower back pain"and treated with imatinib due to gastric stromal tumor for a long time.The outpatient thoracolumbar MRI suggested possible vertebral infectious lesions,leading to empirical treatment with cefoperazone-sulbactam sodium.On the 5th day of hospitalization,Candida albicans was identified in thoracic puncture fluid exami‐nation,prompting a switch to caspofungin.Three days later,based on drug susceptibility results,caspofungin was adjusted to fluconazole.However,three days after the adjustment,the patient's lower back pain worsened and high-sensitivity C-reactive protein(CRP)level increased again.After discussion between the physician and the pharmacist,it was adjusted back to caspofungin.On the 30th day,the patient underwent thoracic vertebral lesion debridement.On the 46th day,his condition significantly improved,infection indicators notably decreased.After consultation with a pharmacist,considering potential drug interactions with imatinib,a switch to oral fluconazole sequential therapy was recommended.Conclusion:For patients with unexplained infections,clinical pharmacists should assist physicians in early pathogen identification to initiate targeted treatment,and adjust the therapeutic regimen timely based on the effect of anti-infective therapy.Additionally,attention should be paid to interactions with other medications to ensure the medication safety of patients.