最新常见的临床微生物简介PPT课件.ppt

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1、常见的临床微生物简介常见的临床微生物简介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-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

2、療-ampicillin 2g iv Q6h 或者 Vancomycin(Targocid)(+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

3、氏陰性格蘭氏陰性格蘭氏陰性球菌格蘭氏陰性球菌Neisseria sp(meningitidis,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/.Fastidio

4、us GNBHaemophilus sp/HACEK格蘭氏陰性桿菌格蘭氏陰性桿菌(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 pneu

5、moniae(KP)1.UTI/BTI/腹腔內感染/肺炎/Liver abscess(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/Bakta

6、r/Rocephin/ciprofloxacinshigella sp 痢疾,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cephalospor

7、in+tetracyclin 或者 ciprofloxacin(+開刀)Haemophilus 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 ba

8、umannii3.Stenotrophomonas maltophilia 4.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

9、bacteremia with vasculitis 5.Malignant 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

10、than 14 days 3.Nosocomial infection Treatment: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 m

11、ost common infection site 3.Resistant to 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

12、,攝護腺膿瘍,骨髓炎,Treatment:1.Ceftazidime(Fortum)+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 disease

13、sMycobacterium SpirochetesSpirochetes格蘭氏陰性螺旋菌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Erythromy

14、cin(Klaricid/azithromycin)/quinolone(levofloxacin)/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 分分枝桿菌枝桿菌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!歐聰億结束语结束语谢谢大家聆听！谢谢大家聆听！33