常见的临床微生物简介

1、常见的临床微生物简介格兰氏染色 and 形状格兰氏阳性格兰氏阴性球菌格兰氏阳性球菌.格兰氏阴性球菌杆菌格兰氏阳性杆菌格兰氏阴性杆菌 -格兰氏阳性革兰氏阳性 球菌.葡萄球菌-StaphylococcusStaphylococcus aureus Staphylococcus epidermidis Coagulase negative staphylococcus (CoNS)链球菌 - streptococcus Streptococcus pneumoniae (pneumococcus) Viridans streptococcus (hemolytyic)(绿色) Group A str

2、eptococcus ( hemolytic) (全溶血) & Group B, C, GGroup D streptococcus Enterococcus Staphylococcus aureus金黄色葡萄球菌存在 - 前鼻腔, 皮肤, 双手, 器械临床 - 蜂窝组织炎/ 毛囊炎/ 伤口/ cvp / 心内膜炎/关节炎/骨髄炎/治疗 - OSSA : Oxacillin 2 gm i.v. Q46h Cefamezine 1 gm i.v. Q8h ORSA: Vancomycin 500 mg ivd q 68h Targocid 400mg ivd QD Staphylococcus

3、 epidermidis and CoNS 存在 - 皮肤, 双手, 器械临床 肺炎 / 人工植入物 / 免疫力差的患者治疗 - OSSE : Oxacillin 2 gm i.v. Q46h Cefamezine 1 gm i.v. Q8h ORSA: Vancomycin 500 mg ivd q 68h Targocid 400mg ivd QD Streptococcus pneumoniae (pneumococcus) 肺炎双球菌存在 -口腔, 临床 肺炎 / 菌血症治疗 - PSSP : penicillin 3mu iv q46h 或者 Cefamezine / icillin

4、 PRSP: Vancomycin (或者Targocid) + Ceftriaxone (Rocephin) Viridans streptococcus (草绿色链球菌)存在 - 口腔, 肠胃道临床 心内膜炎 / 腹腔内感染治疗 - penicillin 3mu iv q46h ( 或者 icillin ) + Gentamicin Group A (B,C,G) streptococcus ( hemolytic) 存在 -皮肤临床 蜂窝性组织炎/ 淋巴腺炎治疗 - penicillin 3mu iv q46h ( 或者 icillin ) + clindamycin ( cleocin

5、 ) Enterococcus sp存在 -肠胃道临床 腹腔内感染/心内膜炎/尿道感染治疗 - icillin 2g iv Q6h 或者 Vancomycin (Targocid) ( + Gentamicin )Group D streptococcus 存在 -肠胃道临床 腹腔内感染/心内膜炎/大肠癌治疗 - icillin 2g iv Q6h 或者 Vancomycin (Targocid) 格兰氏阳性杆菌Bacillus sp ( anthrax,.Lactobacillus sp Clostridium sp ( tentaus, botulism, difficle, perfri

6、ngens, septicum.) ( anaerobic )格兰氏阴性格兰氏阴性球菌Neisseria sp ( meningitidis, gonorrhea.) Moraxella sp .Veillonella sp.格兰氏阴性杆菌 (I)Enterobacteriaceae (E-coli )(Klebsiella sp/ Enterobacter sp/ Serratia sp)(Proteus sp/ Morganella sp)( Citrobacter sp)(Salmonella sp / shigella sp )Vibrionaceae Vibrio sp/ Aerom

7、onas sp/.Fastidious GNBHaemophilus sp/HACEK格兰氏阴性杆菌 (II)Nonfermenting GNB Pseudomonas sp/ Acinetobacter sp/ Stenotrophomonas spAnaerobic GNB bacteroid sp Enterobacteriaceae(I)E-coli UTI / BTI / 腹腔内感染/ 骨髓炎治疗 Ampicillin/ Tazocin/ cephalosporin/ carbapenem / ofloxacin / baktar/ GMKlebsiella pneumoniae (

8、KP) UTI / BTI / 腹腔内感染/ 肺炎/ Liver abscess(DM,Taiwan)治疗cephalosporin/ carbapenem / ofloxacin / baktar/ GMEnterobacteriaceae(II)Enterobacter sp / Serratia sp /Citrobacter sp 感染免疫力差的患者, 需用后线抗生素Proteus sp UTI (结石)/ 腹腔内感染Morganella sp- 腹腔内感染 ,Salmonella sp typhi & non-typhoid ,治疗 Ampicillin/Baktar/Rocephi

9、n/ciprofloxacinshigella sp 痢疾, 治疗 Ampicillin/Baktar/cephalosporin/ciprofloxacinVibrio sp & Aeromonas spLiver cirrhosis / Steroid abuse/ malignancy / (antacid ?)坏死性筋膜炎 ( necrotizing fasciitis ) / 腹膜炎 (spontaneous bacterial peritonitis)/ 拜血症(Septicemia)病程很快,48小时内死亡)治疗 第三代cephalosporin+tetracyclin 或者 c

10、iprofloxacin (+ 开刀) Haemophilus influenzaeCOPD 病患, pneumonia 治疗 Augmentin/ Unasyn / cefuroxime.Haemophilus influenzae, type B baby and little children meningitis Nonfermenting GNB (I)院内感染,感染免疫力差的患者, 需用后线抗生素Pseudomonas aeruginosa Acinetobacter baumanniiStenotrophomonas maltophilia Burkholderia pseudo

11、mallei Other Nonfermenting GNB (II) (Pseudomonas aeruginosa) Pseudomonas aeruginosa 绿脓杆菌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 Treat

12、ment: anti-pseudomonas agentsNonfermenting GNB (III) (Acinetobacter baumannii) Acinetobacter baumannii 不动杆菌Water Dry surface survive more than 14 days Nosocomial infection Treatment: Sulbactam (+ Ampicillin / Cefperazone / anti-pseudomonas agents), Carbapenem (+/- sulbactam) Nonfermenting GNB (IV) (

13、Stenotrophomonas maltophilia ) Stenotrophomonas maltophiliaNosocomial infection Pneumonia most common infection site Resistant to carbapenemTreatment: Baktar(TMP/SMZ)ShiomarineTicarcillin-clavulanate (+/- Aztreonam)Minocycline Nonfermenting GNB (V) ( Burkholderia pseudomallei ) Burkholderia pseudoma

14、llei 类鼻疽糖尿病泥土 - 泰国北部,越南,华南,台湾南部肺炎,肝脾脓疡,摄护腺脓疡,骨髓炎,Treatment: Ceftazidime (Fortum) +Baktar AugmentinRecurrence Anaerobic GNBBacteroid fragilis 腹腔内感染Treatment Metronidazole / meropenem / Imipenem/ Augmentin/ Tazocin/ flumarin /clindamycin Surgical intervention as need 其 他SpirochetesAtypical pneumonia p

15、athogenRickettsial diseasesMycobacterium Spirochetes格兰氏阴性螺旋菌Syphilis 梅毒 penicillin Leptospirosis 泥巴, 老鼠,狗,猪. penicillin / tetracyclineLyme disease tetracycline Atypical pneumonia pathogenChlamydia pneumoniae 鸟类Legionella pneumophila COPD, steroid, malignancy , 较严重, 与水有关Mycoplasma 没有细胞壁治疗Erythromycin (Klaricid/azithromycin) / quinolone (levofloxacin)/ tetracyclineRickett