常见的临床微生物简介.ppt

常見的臨床微生物簡介,萬芳醫院感染科歐聰億,格蘭氏染色and形狀,格蘭氏陽性,革蘭氏陽性球菌.,葡萄球菌-StaphylococcusStaphylococcusaureusStaphylococcusepidermidisCoagulasenegativestaphylococcus(CoNS),鏈球菌-streptococcusStreptococcuspneumoniae(pneumococcus)Viridansstreptococcus(hemolytyic)(綠色)GroupAstreptococcus(hemolytic)(全溶血)&GroupB,C,GGroupDstreptococcusEnterococcus,Staphylococcusaureus金黃色葡萄球菌,存在-前鼻腔,皮膚,雙手,器械臨床-蜂窩組織炎/毛囊炎/傷口/cvp/心內膜炎/關節炎/骨髄炎/治療-OSSA:Oxacillin2gmi.v.Q46hCefamezine1gmi.v.Q8hORSA:Vancomycin500mgivdq68hTargocid400mgivdQD,StaphylococcusepidermidisandCoNS,存在-皮膚,雙手,器械臨床肺炎/人工植入物/免疫力差的患者治療-OSSE:Oxacillin2gmi.v.Q46hCefamezine1gmi.v.Q8hORSA:Vancomycin500mgivdq68hTargocid400mgivdQD,Streptococcuspneumoniae(pneumococcus)肺炎雙球菌,存在-口腔,臨床肺炎/菌血症治療-PSSP:penicillin3muivq46h或者Cefamezine/ampicillinPRSP:Vancomycin(或者Targocid)+Ceftriaxone(Rocephin),Viridansstreptococcus(草綠色鏈球菌),存在-口腔,腸胃道臨床心內膜炎/腹腔內感染治療-penicillin3muivq46h(或者ampicillin)+Gentamicin,GroupA(B,C,G)streptococcus(hemolytic),存在-皮膚臨床蜂窩性組織炎/淋巴腺炎治療-penicillin3muivq46h(或者ampicillin)+clindamycin(cleocin),Enterococcussp,存在-腸胃道臨床腹腔內感染/心內膜炎/尿道感染治療-ampicillin2givQ6h或者Vancomycin(Targocid)(+Gentamicin),GroupDstreptococcus,存在-腸胃道臨床腹腔內感染/心內膜炎/大腸癌治療-ampicillin2givQ6h或者Vancomycin(Targocid),格蘭氏陽性桿菌,Bacillussp(anthrax,.LactobacillusspClostridiumsp(tentaus,botulism,difficle,perfringens,septicum.)(anaerobic),格蘭氏陰性,格蘭氏陰性球菌,Neisseriasp(meningitidis,gonorrhea.)Moraxellasp.Veillonellasp.,格蘭氏陰性桿菌(I),Enterobacteriaceae(E-coli)(Klebsiellasp/Enterobactersp/Serratiasp)(Proteussp/Morganellasp)(Citrobactersp)(Salmonellasp/shigellasp)VibrionaceaeVibriosp/Aeromonassp/.FastidiousGNBHaemophilussp/HACEK,格蘭氏陰性桿菌(II),NonfermentingGNBPseudomonassp/Acinetobactersp/StenotrophomonasspAnaerobicGNBbacteroidsp,Enterobacteriaceae(I),E-coliUTI/BTI/腹腔內感染/骨髓炎治療Ampicillin/Tazocin/cephalosporin/carbapenem/ofloxacin/baktar/GMKlebsiellapneumoniae(KP)UTI/BTI/腹腔內感染/肺炎/Liverabscess(DM,Taiwan)治療cephalosporin/carbapenem/ofloxacin/baktar/GM,Enterobacteriaceae(II),Enterobactersp/Serratiasp/Citrobactersp感染免疫力差的患者,需用後線抗生素ProteusspUTI(結石)/腹腔內感染Morganellasp-腹腔內感染,Salmonellasptyphi&non-typhoid,治療Ampicillin/Baktar/Rocephin/ciprofloxacinshigellasp痢疾,治療Ampicillin/Baktar/cephalosporin/ciprofloxacin,Vibriosp&Aeromonassp,Livercirrhosis/Steroidabuse/malignancy/(antacid?)壞死性筋膜炎(necrotizingfasciitis)/腹膜炎(spontaneousbacterialperitonitis)/拜血症(Septicemia)病程很快,48小時內死亡)治療第三代cephalosporin+tetracyclin或者ciprofloxacin(+開刀),Haemophilusinfluenzae,COPD病患,pneumonia治療Augmentin/Unasyn/cefuroxime.Haemophilusinfluenzae,typeBbabyandlittlechildrenmeningitis,NonfermentingGNB(I),院內感染,感染免疫力差的患者,需用後線抗生素PseudomonasaeruginosaAcinetobacterbaumanniiStenotrophomonasmaltophiliaBurkholderiapseudomalleiOther,NonfermentingGNB(II)(Pseudomonasaeruginosa),Pseudomonasaeruginosa綠膿桿菌Leukopenia的病人(Hema/oncology)骨髓炎IntravenousdrugabuserFolliculitiswaterpoolEcthymagangrenosumbacteremiawithvasculitisMalignantotitisexternaBronchiectasis,cysticfibrosisNosocomialinfectionTreatment:anti-pseudomonasagents,NonfermentingGNB(III)(Acinetobacterbaumannii),Acinetobacterbaumannii不動桿菌WaterDrysurfacesurvivemorethan14daysNosocomialinfectionTreatment:Sulbactam(+Ampicillin/Cefperazone/anti-pseudomonasagents),Carbapenem(+/-sulbactam),NonfermentingGNB(IV)(Stenotrophomonasmaltophilia),StenotrophomonasmaltophiliaNosocomialinfectionPneumoniamostcommoninfectionsiteResistanttocarbapenemTreatment:Baktar(TMP/SMZ)ShiomarineTicarcillin-clavulanate(+/-Aztreonam)Minocycline,NonfermentingGNB(V)(Burkholderiapseudomallei),Burkholderiapseudomallei類鼻疽糖尿病泥土-泰國北部,越南,華南,臺灣南部肺炎,肝脾膿瘍,攝護腺膿瘍,骨髓炎,Treatment:Ceftazidime(Fortum)+BaktarAugmentinRecurrence,AnaerobicGNB,Bacteroidfragilis腹腔內感染TreatmentMetronidazole/meropenem/Imipenem/Augmentin/Tazocin/flumarin/clindamycinSurgicalinterventionasneed,其他,SpirochetesAtypicalpneumoniapathogenRickettsialdiseasesMycobacterium,Spirochetes,格蘭氏陰性螺旋菌Syphilis梅毒penicillinLeptospirosis泥巴,老鼠,狗,豬.penicillin/tetracyclineLymediseasetetracycline,Atypicalpneumoniapathogen,Chlamydiapneumoniae鳥類LegionellapneumophilaCOPD,steroid,malignancy,較嚴重,與水有關Mycoplasma沒有細胞壁治療Erythromycin(Klaricid/azithromycin)/quinolone(levofloxacin)/tetracycline,Rickettsialdis