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1、1,常見的臨床微生物簡介,萬芳醫院 感染科 歐聰億,2,格蘭氏染色 and 形狀,3,格蘭氏陽性,4,革蘭氏陽性 球菌.,葡萄球菌-Staphylococcus Staphylococcus aureus Staphylococcus epidermidis Coagulase negative staphylococcus (CoNS),鏈球菌 - streptococcus Streptococcus pneumoniae (pneumococcus) Viridans streptococcus (hemolytyic)(綠色) Group A streptococcus ( hemol
2、ytic) (全溶血) & Group B, C, G Group D streptococcus Enterococcus,5,Staphylococcus aureus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 : Oxacillin 2 gm i.v. Q46h Cefamezine 1 gm i.v. Q8h ORSA: Vancomycin 500 mg ivd q 68h Targocid 400mg ivd QD,6,Staphylococcus epidermid
3、is 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 ivd QD,7,Streptococcus pneumoniae (pneumococcus) 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
4、PRSP: Vancomycin (或者Targocid) + Ceftriaxone (Rocephin),8,Viridans streptococcus (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 - penicillin 3mu iv q46h ( 或者 ampicillin ) + Gentamicin,9,Group A (B,C,G) streptococcus ( 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 ) + clindam
5、ycin ( cleocin ),10,Enterococcus 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 (Targocid) ( + Gentamicin ),11,Group 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),12,格蘭氏陽性桿菌,Bacillus sp ( anthrax,. Lactobacillus sp Clostridium sp
6、( tentaus, botulism, difficle, perfringens, septicum.) ( anaerobic ),13,格蘭氏陰性,14,格蘭氏陰性球菌,Neisseria sp ( meningitidis, gonorrhea.) Moraxella sp . Veillonella sp.,15,格蘭氏陰性桿菌 (I),Enterobacteriaceae (E-coli ) (Klebsiella sp/ Enterobacter sp/ Serratia sp) (Proteus sp/ Morganella sp) ( Citrobacter sp) (Sa
7、lmonella sp / shigella sp ) Vibrionaceae Vibrio sp/ Aeromonas sp/. Fastidious GNBHaemophilus sp/HACEK,16,格蘭氏陰性桿菌 (II),Nonfermenting GNB Pseudomonas sp/ Acinetobacter sp/ Stenotrophomonas sp Anaerobic GNB bacteroid sp,17,Enterobacteriaceae(I),E-coli UTI / BTI / 腹腔內感染/ 骨髓炎 治療 Ampicillin/ Tazocin/ ceph
8、alosporin/ carbapenem / ofloxacin / baktar/ GM Klebsiella pneumoniae (KP) UTI / BTI / 腹腔內感染/ 肺炎/ Liver abscess(DM,Taiwan) 治療cephalosporin/ carbapenem / ofloxacin / baktar/ GM,18,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 Morgane
9、lla sp- 腹腔內感染 , Salmonella sp typhi & non-typhoid ,治療 Ampicillin/Baktar/Rocephin/ciprofloxacin shigella sp 痢疾, 治療 Ampicillin/Baktar/cephalosporin/ciprofloxacin,19,Vibrio sp & Aeromonas sp,Liver cirrhosis / Steroid abuse/ malignancy / (antacid ?) 壞死性筋膜炎 ( necrotizing fasciitis ) / 腹膜炎 (spontaneous ba
10、cterial peritonitis)/ 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),20,Haemophilus influenzae,COPD 病患, pneumonia 治療 Augmentin/ Unasyn / cefuroxime. Haemophilus influenzae, type B baby and little children meningitis,21,Nonfermenting GNB (I),院內感染,感染免疫力差的患者, 需用後線抗
11、生素 Pseudomonas aeruginosa Acinetobacter baumannii Stenotrophomonas maltophilia Burkholderia pseudomallei Other ,22,Nonfermenting GNB (II) (Pseudomonas aeruginosa),Pseudomonas aeruginosa 綠膿桿菌 Leukopenia 的病人 (Hema/oncology) 骨髓炎 Intravenous drug abuser Folliculitis water pool Ecthyma gangrenosum bacter
12、emia with vasculitis Malignant otitis externa Bronchiectasis, cystic fibrosis Nosocomial infection Treatment: anti-pseudomonas agents,23,Nonfermenting GNB (III) (Acinetobacter baumannii),Acinetobacter baumannii 不動桿菌 Water Dry surface survive more than 14 days Nosocomial infection Treatment: Sulbacta
13、m (+ Ampicillin / Cefperazone / anti-pseudomonas agents), Carbapenem (+/- sulbactam),24,Nonfermenting GNB (IV) (Stenotrophomonas maltophilia ),Stenotrophomonas maltophilia Nosocomial infection Pneumonia most common infection site Resistant to carbapenem Treatment: Baktar(TMP/SMZ) Shiomarine Ticarcil
14、lin-clavulanate (+/- Aztreonam) Minocycline,25,Nonfermenting GNB (V) ( Burkholderia pseudomallei ),Burkholderia pseudomallei 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) +Baktar Augmentin Recurrence,26,Anaerobic GNB,Bacteroid fragilis 腹腔內感染 Treatment Metronidazole
15、/ meropenem / Imipenem/ Augmentin/ Tazocin/ flumarin /clindamycin Surgical intervention as need,27,其 他,Spirochetes Atypical pneumonia pathogen Rickettsial diseases Mycobacterium,28,Spirochetes,格蘭氏陰性螺旋菌 Syphilis 梅毒 penicillin Leptospirosis 泥巴, 老鼠,狗,豬. penicillin / tetracycline Lyme disease tetracycli
16、ne,29,Atypical pneumonia pathogen,Chlamydia 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 (levofloxacin)/ tetracycline,30,Rickettsial diseases,台灣有下列三種 Scrub typhus 恙蟲病 (chigger, mite) Q-Fever 山區, 牛,羊,貓. Murine typhus 老鼠跳蚤(少見) Treatment: Tetracycline Quinolone,31,Mycobacterium 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,32,謝謝!,歐聰億,素材和资料部分来自网络，如有帮助请下载!,