检验室证实法定 传染病处理流程

1、,感染症暨熱帶醫學科疾病 診斷及治療流程 目錄 法定傳染病處理流程 新感染症候群通報流程(I)(II) 抗生素使用原則 疑似肺結核 不同病況的肺結核病人治療藥物建議 加護病房病人發燒 細菌性腦膜炎 放置導管病人出現急性發燒 放置導管病人出現相關血流感染 放置導管病人出現菌血症 中性球低下病人發燒處理流程 感染性腹瀉 醫護及臨床工作者接觸HIV後處理流程 HIV接觸後預防性給藥方式 HIV 病人出現發燒 HIV 病人有發燒咳嗽症狀 HIV 病人腹瀉 HIV 病人口腔念珠菌感染 HIV 病人發生頭痛神智改變 HIV接觸後處理流程,檢驗室證實法定傳染病處理流程,臨床病理科(細菌組、病毒室) TB陽性

2、檢驗報告單 HIV陽性檢驗 (含AFB”+”及 TB 報告單(病毒室) culture: “Mycobacterium spp.”) 和其他陽性之法定 傳染病檢驗報告單 感管會 感管會 各科總醫師 感染科總醫師 填寫通報單 填寫通報單 醫勤組 (例假日時至醫勤組急診掛號櫃檯) 國防部 台北市 感管會 軍醫局 衛生局,新感染症候群通報流程(I),病患 臨床軍醫 護理站 感染管制委員會拿通報單及臨床資料表(病歷審查用) 檢體送至單一窗口並請醫師通知內湖衛生所(27911162-219)收取檢體 通報單第一聯及臨床資料表送至醫勤組姜小姐(17354),新感染症候群通報流程(II),注意事項 急性出血

3、熱症候群需送全血 急性腹瀉症候群通報定義，過去為健康之正常人，出現急性腹瀉，伴有嚴重病情，年齡大於五歲 檢體收集管請貼上疾管局的黃色專用標籤，並用拉鍊袋裝好 醫院實驗室可做的檢查：Adenovirus, Aeromonas spp.,Chloera, Campylobacter jejuni, Listeria monocytogenes, Rotavirus, typhoid fever 檢體有問題請電：27892137,Fever in ICU,加護病房病人發燒處理流程,Suspicion for bacterial meningitis,Papilledema and/or focal

4、neurologic deficits (excluding ophthalmoplegia),Absent Present,Obtain blood cultures,Empirical antimicrobial therapy,Obtain blood cultures and perform lumbar puncture STAT,CT scan of head,No mass lesion Mass lesion,CSF consistent with bacterial meningitis,Positive Gram stain or bacterial antigen tes

5、t result,Empirical antimicrobial therapy Specific antimicrobial therapy,Consider alternative diagnosis,細菌性腦膜炎處理流程,No,Yes,Lancet 1995;346:1675,If continued fever (no hypotension or organ failure),Seriously ill ; (hypotension, hypoperfusion, signs 34:730-51),Fever (temperature 38.3) + Neutropenia (500

6、 neutrophils/mm ),Low risk,High risk,Oral,iv,Vancomycin not needed,Vancomycin needed,Ciprofloxacin + Amoxicillin-clavulanate (adults only),Monotherapy,Cefepime, Ceftazidime, or Carbapenem,Vancomycin+,Aminoglycoside + Antipseudomonal penicillin, Cefepime, Ceftazidime, or Carbapenem,Two Drugs,Vancomyc

7、in + Cefepime, ceftazidime, or Carbapenem aminoglycoside,Reassess after 3-5 days,3,經過3-5日治療後病人退燒處理流程 (IDSA guideline Hughes WT et al CID 2002;34:730-51),Afebrile within first 3-5 days of treatment,No etiology identified,Etiology identified,Low risk,Adjust to most appropriate treatment,Change to: Cip

8、rofloxacin + Amoxicillin-clavulanate (adults) or cefixime (child),High risk,Continue same antibiotics,Discharge,經過3-5日治療後病人持續發燒處理流程 Guide to treatment of patients who have persistent fever after 3-5 days of treatment and for whom the cause of the fever is not found. (IDSA guideline CID 2002;34:730-5

9、1),Persistent fever during first 3-5 days of treatment: no etiology,Reassess patient on days 3-5,Continue initial antibiotics,Change antibiotics,Antifungal drug, with or without antibiotic change,If no change in patients condition (consider stopping vancomycin),If progressive disease, If criteria fo

10、r vancomycin are met,If febrile through days 5-7 and resolution of neutropenia is not imminent,抗生素治療期程之建議 (IDSA guideline Hughes WT et al CID 2002;34:730-51),Duration of antibiotic therapy,Afebrile by days 3-5,Persistent fever,ANC500 cells/mm for 2 consecutive days,ANC500 cells/mm by day 7,ANC500 ce

11、lls/mm,ANC500 cells/mm,Continue for 2 weeks,Stop 4-5 days after ANC500 cells/mm,Initial high risk ANC100 cells/mm Mucositis Unstable signs,Initial low risk Clinically well,Stop antibiotics 48 h after afebrile + ANC 500 cell/mm,Stop when afebrile for 5-7 days,Continue antibiotics,Reassess,Reassess,St

12、op if no disease and condition is stable,3,3,3,3,3,3,3,感染性腹瀉處理流程,Evaluate severity and duration Obtain history and physical examination Treat dehydration Report suspected outbreaks Check all that apply,Consider quinolone for suspected shigellosis in adults(fever, inflammation); macrolide for suspect

13、ed resistant,Culture or test for: Salmonella Shigella Campylobacter E. Coli O157:H7 (if blood in stool also test for Shiga toxin and refer isolates if toxin pos.) C. Difficile toxins AB (if antibiotics or chemotherapy taken in recent weeks),Test for C. Difficile toxins AB (In suspect nosocomial outb

14、reaks, in patients with bloody stools, and in infants, also add tests in panel A),A. Community acquired or travelers diarrhea (esp. if accompanied by significant fever or blood in stool),B. Nosocomial diarrhea (onset after 3 d in hospital),C.Persistent diarrhea7d (esp. if immunocomp romised),Consider parasites Giardia Cryptosporidium Cyclospora Isospora belli +Inflammatory scr