常見(jiàn)的臨床微生物簡(jiǎn)介萬(wàn)芳醫(yī)院感染科歐聰億格蘭氏染色and形狀格蘭氏陽(yáng)性格蘭氏陰性球菌格蘭氏陽(yáng)性球菌........格蘭氏陰性球菌桿菌格蘭氏陽(yáng)性桿菌格蘭氏陰性桿菌------格蘭氏陽(yáng)性革蘭氏陽(yáng)性球菌...........葡萄球菌-StaphylococcusStaphylococcusaureus

StaphylococcusepidermidisCoagulasenegativestaphylococcus(CoNS)鏈球菌-streptococcus

Streptococcuspneumoniae(pneumococcus)

Viridansstreptococcus(αhemolytyic)(綠色)GroupAstreptococcus(βhemolytic)(全溶血)&GroupB,C,G…GroupDstreptococcus

EnterococcusStaphylococcusaureus

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(nèi)膜炎/關(guān)節(jié)炎/骨髄炎/治療--OSSA:Oxacillin2gmi.v.Q4~6h

Cefamezine1gmi.v.Q8hORSA:Vancomycin500mgivdq6~8h

Targocid400mgivdQD

StaphylococcusepidermidisandCoNS

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:Oxacillin2gmi.v.Q4~6h

Cefamezine1gmi.v.Q8hORSA:Vancomycin500mgivdq6~8h

Targocid400mgivdQDStreptococcuspneumoniae(pneumococcus)肺炎雙球菌存在--口腔,臨床–

肺炎/菌血癥治療--PSSP:penicillin3muivq4~6h

或者Cefamezine/ampicillinPRSP:Vancomycin(或者Targocid)+Ceftriaxone(Rocephin)Viridansstreptococcus

(草綠色鏈球菌)存在--口腔,腸胃道臨床–

心內(nèi)膜炎/腹腔內(nèi)感染治療--penicillin3muivq4~6h(或者ampicillin)

+GentamicinGroupA(B,C,G)streptococcus

(βhemolytic)

存在--皮膚臨床–

蜂窩性組織炎/淋巴腺炎治療--penicillin3muivq4~6h(或者ampicillin)

+clindamycin(cleocin)Enterococcussp存在--腸胃道臨床–

腹腔內(nèi)感染/心內(nèi)膜炎/尿道感染治療--ampicillin2givQ6h或者Vancomycin(Targocid)

(+Gentamicin)GroupDstreptococcus

存在--腸胃道臨床–

腹腔內(nèi)感染/心內(nèi)膜炎/大腸癌治療--ampicillin2givQ6h或者Vancomycin(Targocid)格蘭氏陽(yáng)性桿菌Bacillussp(anthrax,......LactobacillusspClostridiumsp(tentaus,botulism,difficle,perfringens,septicum.......)(anaerobic)格蘭氏陰性格蘭氏陰性球菌Neisseriasp(meningitidis,gonorrhea...)

Moraxellasp...Veillonellasp...格蘭氏陰性桿菌(I)Enterobacteriaceae–(E-coli)(Klebsiellasp/Enterobactersp/Serratiasp)(Proteussp/Morganellasp)(Citrobactersp)(Salmonellasp/shigellasp)Vibrionaceae–Vibriosp/Aeromonassp/...FastidiousGNB–Haemophilussp/HACEK格蘭氏陰性桿菌(II)NonfermentingGNB–Pseudomonassp/

Acinetobactersp/

StenotrophomonasspAnaerobicGNB–bacteroidspEnterobacteriaceae(I)E-coli–UTI/BTI/腹腔內(nèi)感染/骨髓炎治療–Ampicillin/Tazocin/cephalosporin/carbapenem/ofloxacin/baktar/GMKlebsiellapneumoniae(KP)–UTI/BTI/腹腔內(nèi)感染/肺炎/Liverabscess(DM,Taiwan)治療–cephalosporin/carbapenem/ofloxacin/baktar/GMEnterobacteriaceae(II)Enterobactersp/Serratiasp/Citrobactersp–感染免疫力差的患者,需用後線抗生素Proteussp—UTI(結(jié)石)/

腹腔內(nèi)感染Morganellasp--腹腔內(nèi)感染,Salmonellasp–typhi&non-typhoid,治療–Ampicillin/Baktar/Rocephin/ciprofloxacinshigellasp–痢疾,治療–Ampicillin/Baktar/cephalosporin/ciprofloxacinVibriosp&AeromonasspLivercirrhosis/Steroidabuse/malignancy/(antacid?)壞死性筋膜炎(necrotizingfasciitis)/腹膜炎(spontaneousbacterialperitonitis)/拜血癥(Septicemia)

病程很快,48小時(shí)內(nèi)死亡)治療–第三代cephalosporin+tetracyclin

或者ciprofloxacin(+開(kāi)刀)HaemophilusinfluenzaeCOPD病患,pneumonia治療–Augmentin/Unasyn/cefuroxime....Haemophilus

influenzae,typeB–babyandlittlechildrenmeningitisNonfermentingGNB(I)院內(nèi)感染,感染免疫力差的患者,需用後線抗生素PseudomonasaeruginosaAcinetobacterbaumanniiStenotrophomonasmaltophiliaBurkholderiapseudomallei

Other…NonfermentingGNB(II)

(Pseudomonasaeruginosa)

Pseudomonasaeruginosa–綠膿桿菌Leukopenia

的病人(Hema/oncology)骨髓炎–Intravenousdrugabuser

Folliculitis–waterpool

Ecthymagangrenosum–bacteremiawithvasculitisMalignantotitisexternaBronchiectasis,cysticfibrosis

NosocomialinfectionTreatment:anti-pseudomonasagentsNonfermentingGNB(III)

(Acinetobacterbaumannii)

Acinetobacterbaumannii–不動(dòng)桿菌WaterDrysurface–survivemorethan14days

NosocomialinfectionTreatment:

Sulbactam(+Ampicillin/Cefperazone/anti-pseudomonasagents),

Carbapenem(+/-sulbactam)NonfermentingGNB(IV)

(Stenotrophomonasmaltophilia

)

StenotrophomonasmaltophiliaNosocomialinfectionPneumonia–mostcommoninfectionsiteResistanttocarbapenemTreatment:Baktar(TMP/SMZ)ShiomarineTicarcillin-clavulanate(+/-Aztreonam)MinocyclineNonfermentingGNB(V)

(Burkholderiapseudomallei

)

Burkholderiapseudomallei–類鼻疽糖尿病泥土--泰國(guó)北部,越南,華南,臺(tái)灣南部肺炎,肝脾膿瘍,攝護(hù)腺膿瘍,骨髓炎,Treatment:

Ceftazidime(Fortum)+BaktarAugmentinRecurrenceAnaerobicGNBBacteroidfragilis腹腔內(nèi)感染Treatment–Metronidazole/meropenem/Imipenem/Augmentin/Tazocin/flumarin

/clindamycin

Surgicalinterventionasneed其他SpirochetesAtypicalpneumoniapathogenRickettsialdiseasesMycobacteriumSpirochetes格蘭氏陰性螺旋菌Syphilis梅毒–penicillin

Leptospirosis–泥巴,老鼠,狗,豬.....penicillin/tetracyclineLymedisease–tetracyclineAtypicalpneumoniapathogenChlamydiapneumoniae–鳥(niǎo)類Legionellapneumophila–COPD,steroid,malignancy,較嚴(yán)重,與水有關(guān)Mycoplasma–沒(méi)有細(xì)胞壁治療–Erythromycin(Klaricid/azithromycin)/quinolone(levofloxacin)/tetracyclineRickettsialdise