Lopez Rekha, Hunter Alistair Robert, Geoghegan Orla, Demertzi Elli
Department of Microbiology, Imperial College NHS Healthcare Trust, London, UK.
Trauma and Orthopaedics, Chelsea and Westminster, London, UK.
BMJ Case Rep. 2014 Oct 15;2014:bcr2014206520. doi: 10.1136/bcr-2014-206520.
A 51-year-old previously fit and healthy gentleman sustained a circular saw injury to his right thumb with partial amputation and an open multifragmentary fracture of his distal phalanx. He underwent open reduction and internal fixation under the hand surgery team. He developed a postoperative infection discharging pus 2 weeks postoperatively, which later grew Candida parapsilosis. He underwent radical debridement and removal of a K-wire, then a further second debridement 2 days later. Ceftriaxone was started empirically while awaiting cultures. Tissue and bone biopsy samples obtained in theatre all grew C. parapsilosis and he was started on caspofungin for 1 week, and switched on to oral fluconazole to complete a 6-week course. He has progressed well and has regained function in his thumb after 3 months, without any sign of ongoing infection.
一名51岁既往身体健康的男性，右手拇指被圆锯锯伤，造成部分截断以及远节指骨开放性多段骨折。他在手部外科团队的操作下接受了切开复位内固定术。术后2周，他发生了术后感染，有脓性分泌物排出，后来培养出近平滑念珠菌。他接受了根治性清创并取出一根克氏针，两天后又进行了一次清创。在等待培养结果期间，经验性地开始使用头孢曲松。术中获取的组织和骨活检样本均培养出近平滑念珠菌，于是开始给他使用卡泊芬净治疗1周，之后改用口服氟康唑以完成6周疗程。他恢复良好，3个月后拇指功能已恢复，且没有任何持续感染的迹象。
