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1、常见的临床微生物简介格格兰兰氏染色氏染色 and 形状形状格兰氏阳性格兰氏阴性球菌格兰氏阳性球菌.格兰氏阴性球菌杆菌格兰氏阳性杆菌格兰氏阴性杆菌 -格格兰兰氏阳性氏阳性革革兰兰氏阳性氏阳性 球菌球菌.葡萄球菌-StaphylococcusStaphylococcus aureus Staphylococcus epidermidis Coagulase negative staphylococcus (CoNS)链球菌 - streptococcus Streptococcus pneumoniae (pneumococcus) Viridans streptococcus (hemolyty
2、ic)(绿色) Group A streptococcus ( hemolytic) (全溶血) & Group B, C, GGroup D streptococcus Enterococcus Staphylococcus aureus金黄色葡萄球菌金黄色葡萄球菌存在 - 前鼻腔, 皮肤, 双手, 器械临床 - 蜂窝组织炎/ 毛囊炎/ 伤口/ cvp / 心内膜炎/关节炎/骨髄炎/治疗 - OSSA : Oxacillin 2 gm i.v. Q46h Cefamezine 1 gm i.v. Q8h ORSA: Vancomycin 500 mg ivd q 68h Targocid 4
3、00mg ivd QD Staphylococcus epidermidis and CoNS 存在 - 皮肤, 双手, 器械临床 肺炎 / 人工植入物 / 免疫力差的患者治疗 - OSSE : Oxacillin 2 gm i.v. Q46h Cefamezine 1 gm i.v. Q8h ORSA: Vancomycin 500 mg ivd q 68h Targocid 400mg ivd QD Streptococcus pneumoniae (pneumococcus) 肺炎双球肺炎双球菌菌存在 -口腔, 临床 肺炎 / 菌血症治疗 - PSSP : penicillin 3mu
4、iv q46h 或者 Cefamezine / icillin PRSP: Vancomycin (或者Targocid) + Ceftriaxone (Rocephin) Viridans streptococcus (草草绿绿色色链链球菌球菌)存在 - 口腔, 肠胃道临床 心内膜炎 / 腹腔内感染治疗 - penicillin 3mu iv q46h ( 或者 icillin ) + Gentamicin Group A (B,C,G) streptococcus ( hemolytic) 存在 -皮肤临床 蜂窝性组织炎/ 淋巴腺炎治疗 - penicillin 3mu iv q46h (
5、 或者 icillin ) + clindamycin ( cleocin ) Enterococcus sp存在 -肠胃道临床 腹腔内感染/心内膜炎/尿道感染治疗 - icillin 2g iv Q6h 或者 Vancomycin (Targocid) ( + Gentamicin )Group D streptococcus 存在 -肠胃道临床 腹腔内感染/心内膜炎/大肠癌治疗 - icillin 2g iv Q6h 或者 Vancomycin (Targocid) 格格兰兰氏阳性杆菌氏阳性杆菌Bacillus sp ( anthrax,.Lactobacillus sp Clostrid
6、ium sp ( tentaus, botulism, difficle, perfringens, septicum.) ( anaerobic )格格兰兰氏阴性氏阴性格格兰兰氏阴性球菌氏阴性球菌Neisseria sp ( meningitidis, gonorrhea.) Moraxella sp .Veillonella sp.格格兰兰氏阴性杆菌氏阴性杆菌 (I)Enterobacteriaceae 1.(E-coli )2.(Klebsiella sp/ Enterobacter sp/ Serratia sp)3.(Proteus sp/ Morganella sp)4.( Cit
7、robacter sp)5.(Salmonella sp / shigella sp )Vibrionaceae Vibrio sp/ Aeromonas sp/.Fastidious GNBHaemophilus sp/HACEK格格兰兰氏阴性杆菌氏阴性杆菌 (II)Nonfermenting GNB 1.Pseudomonas sp/ 2.Acinetobacter sp/ 3.Stenotrophomonas spAnaerobic GNB bacteroid sp Enterobacteriaceae(I)E-coli 1.UTI / BTI / 腹腔内感染/ 骨髓炎2.治疗 Ampi
8、cillin/ Tazocin/ cephalosporin/ carbapenem / ofloxacin / baktar/ GMKlebsiella pneumoniae (KP) 1.UTI / BTI / 腹腔内感染/ 肺炎/ Liver abscess(DM,Taiwan)2.治疗cephalosporin/ carbapenem / ofloxacin / baktar/ GMEnterobacteriaceae(II)Enterobacter sp / Serratia sp /Citrobacter sp 感染免疫力差的患者, 需用后线抗生素Proteus sp UTI (结
9、石)/ 腹腔内感染Morganella sp- 腹腔内感染 ,Salmonella sp typhi & non-typhoid ,治疗 Ampicillin/Baktar/Rocephin/ciprofloxacinshigella sp 痢疾, 治疗 Ampicillin/Baktar/cephalosporin/ciprofloxacinVibrio sp & Aeromonas spLiver cirrhosis / Steroid abuse/ malignancy / (antacid ?)1.坏死性筋膜炎 ( necrotizing fasciitis ) / 腹膜炎 (spon
10、taneous bacterial peritonitis)/ 拜血症(Septicemia)病程很快,48小时内死亡)2.治疗 第三代cephalosporin+tetracyclin 或者 ciprofloxacin (+ 开刀) Haemophilus influenzaeCOPD 病患, pneumonia 治疗 Augmentin/ Unasyn / cefuroxime.Haemophilus influenzae, type B baby and little children meningitis Nonfermenting GNB (I)院内感染,感染免疫力差的患者, 需用后
11、线抗生素1.Pseudomonas aeruginosa 2.Acinetobacter baumannii3.Stenotrophomonas maltophilia 4.Burkholderia pseudomallei 5.Other Nonfermenting GNB (II) (Pseudomonas aeruginosa) Pseudomonas aeruginosa 绿脓杆菌1.Leukopenia 的病人 (Hema/oncology)2.骨髓炎 Intravenous drug abuser 3.Folliculitis water pool 4.Ecthyma gangre
12、nosum bacteremia with vasculitis 5.Malignant otitis externa 6.Bronchiectasis, cystic fibrosis 7.Nosocomial infection Treatment: anti-pseudomonas agentsNonfermenting GNB (III) (Acinetobacter baumannii) Acinetobacter baumannii 不动杆菌1.Water 2.Dry surface survive more than 14 days 3.Nosocomial infection
13、Treatment: 1.Sulbactam (+ Ampicillin / Cefperazone / anti-pseudomonas agents), 2.Carbapenem (+/- sulbactam) Nonfermenting GNB (IV) (Stenotrophomonas maltophilia ) Stenotrophomonas maltophilia1.Nosocomial infection 2.Pneumonia most common infection site 3.Resistant to carbapenemTreatment: 1.Baktar(TM
14、P/SMZ)2.Shiomarine3.Ticarcillin-clavulanate (+/- Aztreonam)4.Minocycline Nonfermenting GNB (V) ( Burkholderia pseudomallei ) Burkholderia pseudomallei 类鼻疽1.糖尿病2.泥土 - 泰国北部,越南,华南,台湾南部3.肺炎,肝脾脓疡,摄护腺脓疡,骨髓炎,Treatment: 1.Ceftazidime (Fortum) +Baktar 2.AugmentinRecurrence Anaerobic GNBBacteroid fragilis 腹腔内
15、感染Treatment 1.Metronidazole / meropenem / Imipenem/ Augmentin/ Tazocin/ flumarin /clindamycin 2.Surgical intervention as need 其其 他他SpirochetesAtypical pneumonia pathogenRickettsial diseasesMycobacterium Spirochetes格兰氏阴性螺旋菌Syphilis 梅毒 penicillin Leptospirosis 泥巴, 老鼠,狗,猪. penicillin / tetracyclineLyme
16、 disease tetracycline Atypical pneumonia pathogenChlamydia pneumoniae 鸟类Legionella pneumophila COPD, steroid, malignancy , 较严重, 与水有关Mycoplasma 没有细胞壁治疗Erythromycin (Klaricid/azithromycin) / quinolone (levofloxacin)/ tetracyclineRickettsial diseases台湾有下列三种1.Scrub typhus 恙虫病 (chigger, mite)2.Q-Fever 山区, 牛,羊,猫.3.Murine typhus 老鼠跳蚤(少见)Treatment: 1.Tetracycline 2.Quinolone Mycobacterium 分枝杆菌分枝杆菌TB (肺)结核病NTM (MOTT) 非结核分枝杆菌, 海水, 泥土 , 表浅层感染, 毒性更低MAC (Mycobacterium avium complex) 感染AIDS 患者 谢谢谢谢!
