常见的临床微生物简介.ppt

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1、常见的临床微生物简介 Still waters run deep.流静水深流静水深,人静心深人静心深 Where there is life,there is hope。有生命必有希望。有生命必有希望格蘭氏染色格蘭氏染色 and and 形狀形狀格蘭氏陽性格蘭氏陰性球菌格蘭氏陽性球菌.格蘭氏陰性球菌桿菌格蘭氏陽性桿菌格蘭氏陰性桿菌-格蘭氏陽性格蘭氏陽性革蘭氏陽性革蘭氏陽性 球菌球菌.葡萄球菌-StaphylococcusnStaphylococcus aureus nStaphylococcus epidermidis nCoagulase negative staphylococcus(Co

2、NS)鏈球菌-streptococcus Streptococcus pneumoniae(pneumococcus)Viridans streptococcus(hemolytyic)(綠色)Group A streptococcus(hemolytic)(全溶血)&Group B,C,GGroup D streptococcus Enterococcus Staphylococcus aureusStaphylococcus aureus金黃色葡萄球菌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:Oxacill

3、in 2 gm i.v.Q46h Cefamezine 1 gm i.v.Q8h ORSA:Vancomycin 500 mg ivd q 68h Targocid 400mg ivd QD Staphylococcus epidermidis and CoNSStaphylococcus epidermidis and CoNS 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:Oxacillin 2 gm i.v.Q46h Cefamezine 1 gm i.v.Q8h ORSA:Vancomycin 500 mg ivd q 68h Targocid 400mg

4、 ivd QD Streptococcus pneumoniae Streptococcus pneumoniae(pneumococcus)(pneumococcus)肺炎雙球菌肺炎雙球菌存在-口腔,臨床 肺炎/菌血症治療-PSSP:penicillin 3mu iv q46h 或者 Cefamezine/ampicillin PRSP:Vancomycin(或者Targocid)+Ceftriaxone(Rocephin)Viridans streptococcusViridans streptococcus(草綠色鏈球菌草綠色鏈球菌)存在-口腔,腸胃道臨床 心內膜炎/腹腔內感染治療-pe

5、nicillin 3mu iv q46h (或者 ampicillin)+Gentamicin Group A(B,C,G)streptococcusGroup A(B,C,G)streptococcus (hemolytic)(hemolytic)存在-皮膚臨床 蜂窩性組織炎/淋巴腺炎治療-penicillin 3mu iv q46h (或者 ampicillin)+clindamycin(cleocin)Enterococcus spEnterococcus sp存在-腸胃道臨床 腹腔內感染/心內膜炎/尿道感染治療-ampicillin 2g iv Q6h 或者 Vancomycin(Ta

6、rgocid)(+Gentamicin)Group D streptococcusGroup D streptococcus 存在-腸胃道臨床 腹腔內感染/心內膜炎/大腸癌治療-ampicillin 2g iv Q6h 或者 Vancomycin(Targocid)格蘭氏陽性桿菌格蘭氏陽性桿菌Bacillus sp(anthrax,.Lactobacillus sp Clostridium sp(tentaus,botulism,difficle,perfringens,septicum.)(anaerobic)格蘭氏陰性格蘭氏陰性格蘭氏陰性球菌格蘭氏陰性球菌Neisseria sp(meni

7、ngitidis,gonorrhea.)Moraxella sp.Veillonella sp.格蘭氏陰性桿菌格蘭氏陰性桿菌(I)I)Enterobacteriaceae 1.(E-coli)2.(Klebsiella sp/Enterobacter sp/Serratia sp)3.(Proteus sp/Morganella sp)4.(Citrobacter sp)5.(Salmonella sp/shigella sp)Vibrionaceae Vibrio sp/Aeromonas sp/.Fastidious GNBHaemophilus sp/HACEK格蘭氏陰性桿菌格蘭氏陰性桿

8、菌(II)II)Nonfermenting GNB 1.Pseudomonas sp/2.Acinetobacter sp/3.Stenotrophomonas spAnaerobic GNB bacteroid sp Enterobacteriaceae(I)Enterobacteriaceae(I)E-coli 1.UTI/BTI/腹腔內感染/骨髓炎2.治療 Ampicillin/Tazocin/cephalosporin/carbapenem/ofloxacin/baktar/GMKlebsiella pneumoniae(KP)1.UTI/BTI/腹腔內感染/肺炎/Liver absc

9、ess(DM,Taiwan)2.治療cephalosporin/carbapenem/ofloxacin/baktar/GMEnterobacteriaceae(II)Enterobacteriaceae(II)Enterobacter sp/Serratia sp/Citrobacter sp 感染免疫力差的患者,需用後線抗生素Proteus sp UTI(結石)/腹腔內感染Morganella sp-腹腔內感染,Salmonella sp typhi&non-typhoid,治療 Ampicillin/Baktar/Rocephin/ciprofloxacinshigella sp 痢疾,

10、治療 Ampicillin/Baktar/cephalosporin/ciprofloxacinVibrio sp&Aeromonas spVibrio sp&Aeromonas spLiver cirrhosis/Steroid abuse/malignancy/(antacid?)1.壞死性筋膜炎(necrotizing fasciitis)/腹膜炎(spontaneous bacterial peritonitis)/拜血症(Septicemia)病程很快,48小時內死亡)2.治療 第三代cephalosporin+tetracyclin 或者 ciprofloxacin(+開刀)Hae

11、mophilus influenzaeHaemophilus influenzaeCOPD 病患,pneumonia 治療 Augmentin/Unasyn/cefuroxime.Haemophilus influenzae,type B baby and little children meningitis Nonfermenting GNB(I)Nonfermenting GNB(I)院內感染,感染免疫力差的患者,需用後線抗生素1.Pseudomonas aeruginosa 2.Acinetobacter baumannii3.Stenotrophomonas maltophilia 4

12、.Burkholderia pseudomallei 5.Other Nonfermenting GNB(II)Nonfermenting GNB(II)(Pseudomonas aeruginosa)(Pseudomonas aeruginosa)Pseudomonas aeruginosa 綠膿桿菌1.Leukopenia 的病人(Hema/oncology)2.骨髓炎 Intravenous drug abuser 3.Folliculitis water pool 4.Ecthyma gangrenosum bacteremia with vasculitis 5.Malignant

13、otitis externa 6.Bronchiectasis,cystic fibrosis 7.Nosocomial infection Treatment:anti-pseudomonas agentsNonfermenting GNB(III)Nonfermenting GNB(III)(Acinetobacter baumannii)(Acinetobacter baumannii)Acinetobacter baumannii 不動桿菌1.Water 2.Dry surface survive more than 14 days 3.Nosocomial infection Tre

14、atment:1.Sulbactam(+Ampicillin/Cefperazone/anti-pseudomonas agents),2.Carbapenem (+/-sulbactam)Nonfermenting GNB(IV)Nonfermenting GNB(IV)(Stenotrophomonas maltophilia(Stenotrophomonas maltophilia )Stenotrophomonas maltophilia1.Nosocomial infection 2.Pneumonia most common infection site 3.Resistant t

15、o carbapenemTreatment:1.Baktar(TMP/SMZ)2.Shiomarine3.Ticarcillin-clavulanate(+/-Aztreonam)4.Minocycline Nonfermenting GNB(V)Nonfermenting GNB(V)(Burkholderia pseudomallei(Burkholderia pseudomallei )Burkholderia pseudomallei 類鼻疽1.糖尿病2.泥土-泰國北部,越南,華南,臺灣南部3.肺炎,肝脾膿瘍,攝護腺膿瘍,骨髓炎,Treatment:1.Ceftazidime(Fort

16、um)+Baktar 2.AugmentinRecurrence Anaerobic GNBAnaerobic GNBBacteroid fragilis 腹腔內感染Treatment 1.Metronidazole/meropenem/Imipenem/Augmentin/Tazocin/flumarin/clindamycin 2.Surgical intervention as need 其其 他他SpirochetesAtypical pneumonia pathogenRickettsial diseasesMycobacterium SpirochetesSpirochetes格蘭

17、氏陰性螺旋菌Syphilis 梅毒 penicillin Leptospirosis 泥巴,老鼠,狗,豬.penicillin/tetracyclineLyme disease tetracycline Atypical pneumonia pathogenAtypical pneumonia pathogenChlamydia pneumoniae 鳥類Legionella pneumophila COPD,steroid,malignancy,較嚴重,與水有關Mycoplasma 沒有細胞壁治療Erythromycin(Klaricid/azithromycin)/quinolone(le

18、vofloxacin)/tetracyclineRickettsial diseasesRickettsial diseases台灣有下列三種1.Scrub typhus 恙蟲病(chigger,mite)2.Q-Fever 山區,牛,羊,貓.3.Murine typhus 老鼠跳蚤(少見)Treatment:1.Tetracycline 2.Quinolone Mycobacterium Mycobacterium 分枝桿菌分枝桿菌TB (肺)結核病NTM(MOTT)非結核分枝桿菌,海水,泥土,表淺層感染,毒性更低MAC(Mycobacterium avium complex)感染AIDS 患者 謝謝謝謝!歐聰億