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常見的臨床微生物簡介

常見的臨床微生物簡介. 萬芳醫院 感染科 歐聰億. 格蘭氏染色 and 形狀. 格蘭氏陽性. 葡萄球菌- Staphylococcus Staphylococcus aureus Staphylococcus epidermidis Coagulase negative staphylococcus (CoNS). 鏈球菌 - streptococcus Streptococcus pneumoniae (pneumococcus) Viridans streptococcus (αhemolytyic)( 綠色)

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常見的臨床微生物簡介

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  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. 葡萄球菌-Staphylococcus Staphylococcus aureus Staphylococcus epidermidis Coagulase negative staphylococcus (CoNS) 鏈球菌 - streptococcus Streptococcus pneumoniae (pneumococcus) Viridans streptococcus (αhemolytyic)(綠色) Group A streptococcus (β hemolytic) (全溶血) & Group B, C, G… Group D streptococcus Enterococcus 革蘭氏陽性 球菌...........

  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. Q4~6h Cefamezine 1 gm i.v. Q8h • ORSA: Vancomycin 500 mg ivd q 6~8h Targocid 400mg ivd QD

  6. Staphylococcus 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. Q4~6h Cefamezine 1 gm i.v. Q8h • ORSA: Vancomycin 500 mg ivd q 6~8h 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 q4~6h 或者 Cefamezine / ampicillin • 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 q4~6h ( 或者 ampicillin ) + Gentamicin

  9. Group A (B,C,G) streptococcus (β hemolytic) • 存在 --皮膚 • 臨床 –蜂窩性組織炎/ 淋巴腺炎 • 治療 -- penicillin 3mu iv q4~6h ( 或者 ampicillin ) + clindamycin ( 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 ( 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) • (Salmonella sp / shigella sp ) • Vibrionaceae – Vibrio sp/ Aeromonas sp/... • Fastidious GNB–Haemophilus 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/ cephalosporin/ 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 • Morganella 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 bacterial 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 – bacteremia 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: • Sulbactam (+ 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 • Ticarcillin-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 / 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 – tetracycline

  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

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