????? and ??

1
??????????

• ???? ???
• ???

2
????? and ??
3
?????
4
????? ??...........

• ????-Staphylococcus
• Staphylococcus aureus
• Staphylococcus epidermidis
• Coagulase negative staphylococcus (CoNS)

• ??? - streptococcus
• Streptococcus pneumoniae (pneumococcus)
• Viridans streptococcus (ahemolytyic)(??)
• Group A streptococcus (ß hemolytic) (???)
  Group B, C, G
• Group D streptococcus
• Enterococcus

5
Staphylococcus aureus???????

• ?? -- ???, ??, ??, ??
• ?? -- ?????/ ???/ ??/ cvp / ????/???/???/
• ?? -- 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 epidermidis and CoNS

• ?? -- ??, ??, ??
• ?? ?? / ????? / ???????
• ?? -- 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) ?????

• ?? --??,
• ?? ?? / ???
• ?? -- PSSP penicillin 3mu iv q46h
• ?? Cefamezine / ampicillin
• PRSP Vancomycin (??Targocid) Ceftriaxone
  (Rocephin)

8
Viridans streptococcus (??????)

• ?? -- ??, ???
• ?? ???? / ?????
• ?? -- penicillin 3mu iv q46h
• ( ?? ampicillin )
• Gentamicin

9
Group A (B,C,G) streptococcus (ß hemolytic)

• ?? --??
• ?? ??????/ ????
• ?? -- penicillin 3mu iv q46h
• ( ?? ampicillin )
• clindamycin ( cleocin )

10
Enterococcus sp

• ?? --???
• ?? ?????/????/????
• ?? -- ampicillin 2g iv Q6h ?? Vancomycin
  (Targocid)
• ( Gentamicin )

11
Group D streptococcus

• ?? --???
• ?? ?????/????/???
• ?? -- ampicillin 2g iv Q6h ?? Vancomycin
  (Targocid)

12
???????

• Bacillus sp ( anthrax,......
• Lactobacillus sp
• Clostridium sp ( tentaus, botulism, difficle,
  perfringens, septicum.......) ( anaerobic )

13
?????
14
???????

• Neisseria sp ( meningitidis, gonorrhea...)
• Moraxella sp ...
• Veillonella sp...

15
??????? (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 GNBHaemophilus sp/HACEK

16
??????? (II)

• Nonfermenting GNB
• Pseudomonas sp/
• Acinetobacter sp/
• Stenotrophomonas sp
• Anaerobic GNB bacteroid sp

17
Enterobacteriaceae(I)

• E-coli
• UTI / BTI / ?????/ ???
• ?? Ampicillin/ Tazocin/ cephalosporin/
  carbapenem / ofloxacin / baktar/ GM
• Klebsiella pneumoniae (KP)
• UTI / BTI / ?????/ ??/ Liver abscess(DM,Taiwan)
• ??cephalosporin/ carbapenem / ofloxacin /
  baktar/ GM

18
Enterobacteriaceae(II)

• Enterobacter sp / Serratia sp /Citrobacter sp
  ?????????, ???????
• Proteus sp UTI (??)/ ?????
• Morganella sp-- ????? ,
• Salmonella sp typhi non-typhoid ,??
  Ampicillin/Baktar/Rocephin/ciprofloxacin
• shigella sp ??, ?? Ampicillin/Baktar/cephalos
  porin/ciprofloxacin

19
Vibrio sp Aeromonas sp

• Liver cirrhosis / Steroid abuse/ malignancy /
  (antacid ?)
• ?????? ( necrotizing fasciitis ) / ???
  (spontaneous bacterial peritonitis)/
  ???(Septicemia)?????,48?????)
• ?? ???cephalosporintetracyclin ?? ciprofloxacin
  ( ??)

20
Haemophilus influenzae

• COPD ??, pneumonia
• ?? Augmentin/ Unasyn / cefuroxime....
• Haemophilus influenzae, type B baby and little
  children meningitis

21
Nonfermenting GNB (I)

• ????,?????????, ???????
• Pseudomonas aeruginosa
• Acinetobacter baumannii
• Stenotrophomonas maltophilia
• Burkholderia pseudomallei
• Other

22
Nonfermenting GNB (II) (Pseudomonas aeruginosa)

• Pseudomonas aeruginosa ????
• Leukopenia ??? (Hema/oncology)
• ??? 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 ????
• 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 ???
• ???
• ?? -- ????,??,??,????
• ??,????,?????,???,
• Treatment
• Ceftazidime (Fortum) Baktar
• Augmentin
• Recurrence

26
Anaerobic GNB

• Bacteroid fragilis
• ?????
• Treatment
• Metronidazole / meropenem / Imipenem/ Augmentin/
  Tazocin/ flumarin /clindamycin
• Surgical intervention as need

27
? ?

• Spirochetes
• Atypical pneumonia pathogen
• Rickettsial diseases
• Mycobacterium

28
Spirochetes

• ????????
• Syphilis ?? penicillin
• Leptospirosis ??, ??,?,?..... penicillin /
  tetracycline
• Lyme disease tetracycline

29
Atypical pneumonia pathogen

• Chlamydia pneumoniae ??
• Legionella pneumophila COPD, steroid, malignancy
  , ???, ????
• Mycoplasma ?????
• ??Erythromycin (Klaricid/azithromycin) /
  quinolone (levofloxacin)/ tetracycline

30
Rickettsial diseases

• ???????
• Scrub typhus ??? (chigger, mite)
• Q-Fever ??, ?,?,?......
• Murine typhus ????(??)
• Treatment
• Tetracycline
• Quinolone

31
Mycobacterium ????

• TB (?)???
• NTM (MOTT) ???????, ??, ?? , ?????, ????
• MAC (Mycobacterium avium complex) ??AIDS ??

32
??!

• ???