铜绿假单胞菌

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telcontar
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76727
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铜绿假单胞菌
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2011-04-02 10:16:36
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铜绿假单胞菌
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铜绿假单胞菌
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  1. 铜绿假单胞菌的生物学性状
    Gram-negative non-fermenting, motile bacillus; known for blue-green pus (pyocyanin and pyoverdin pigments)
  2. 铜绿假单胞菌常从何处被培养出?
    Lab: culture of sputum, endotracheal aspirate, bronchoscopic specimens, urine, blood, abscess fluid, joint fluid, or CSF
  3. 铜绿假单胞菌的生活环境
    Nonfastidious organism, can inhabit a variety of environments including soil and water (hot tubs, sinks, water faucets, respirators, disinfectants and contact lens cleaning solutions). Produces biofilm.
  4. 铜绿假单胞菌耐药机制:
    Drug resistance mechanisms: includes active efflux pumps, chromosomal and inducible beta-lactamases, plasmid-mediated ESBLs (TEM, SHV, CTX-M), and altered permeability. Loss of protein porin OprD results in resistance to carbapenems, specifically imipenem.
  5. 铜绿假单胞菌常致何种疾病?
    Nosocomial, opportunistic pathogen, especially in setting of immunocompromised host or foreign body (central line or urinary catheter).
  6. 铜绿假单胞菌常定植于何种疾病的肺部?
    Chronic colonizer of cystic fibrosis lung
  7. 铜绿假单胞菌是何种疾病的常见病原菌?
    Cause of pneumonia (ventilator-associated), UTI, bacteremia (neutropenia), post-neurosurgical meningitis, post-surgical infections, and hot-tub folliculitis
  8. 铜绿假单胞菌导致坏死性脓疮的机制:
    Cause of ecthyma gangrenosum: infarcted skin lesions, due to vascular invasion with heavy organism burden; uncommon and seen mostly in immune suppressed or critically ill patients
  9. 感染铜绿假单胞菌的常见危险因素
    Risk factors include immunosuppression, DM, skin burns, cystic fibrosis and AIDS.
  10. 铜绿假单胞菌耐药株常见于:
    Multidrug resistance likely in those with recent abx therapy (past 90d),hospital stay > 4d, high rate of abx resistance in facility, residence in chronic care facility.
  11. 与铜绿假单胞菌相关的既往史有:
    Historically associated with high mortality in febrile neutropenia (bacteremia, pneumonia and skin and soft tissue infections) and infected burn wounds (heavy bacterial growth in burn eschar).
  12. 铜绿假单胞菌常见感染部位
    • Respiratory: pneumonia (nosocomial, CF, AIDS) & lung abscesses
    • GU: UTI/pyelonephritis (complicated by obstruction, manipulation, or foreign body)
    • CV: endocarditis (IDU); bacteremia, line sepsis
    • Skin: ecthyma gangrenosum (neutropenia); cellulitis (DM, IDU, post-operative); folliculitis; abscesses; noma neonatorum (gangrenous stomatitis)
    • ENT: otitis externa, malignant otitis externa (DM); chronic otitis media; sinusitis (AIDS)
    • CNS: brain abscesses; meningitis (post-neurosurgical)
    • Bone/joint: vertebral, sternoclavicular or pelvic bone infections (IDU); osteochondritis of foot (following penetrating injuries through tennis shoes)
    • Eye: keratitis, endophthalmitis
  13. 怎样防止铜绿假单胞菌的医源性感染
    Prevention of nosocomial transmission with infection control: isolate infected pts, require hand-washing by staff & visitors.
  14. 对有肺部疾病的患者的处理
    In patients w/ chronic lung disease (e.g., CF), good pulmonary toilet (mucolytic agents, chest PT, postural drainage) are important adjunctive treatment measures.
  15. 对怀疑铜绿假单胞菌的重症患者的治疗原则:
    In seriously ill, empiric treatment with concern for P. aeruginosa should use two active agents from two different classes. Once susceptibilities known, narrow to one drug according to susceptibility report.
  16. 治疗铜绿假单胞菌感染何种方案可能增强疗效?
    Double coverage using high doses of synergistic antibiotic combinations (B-lactam + aminoglycoside) may improve outcomes of serious infections but remains controversial.
  17. 对于多耐药铜绿假单胞菌可能有效的药物是:
    Multi-drug resistant strains may be susceptible to colistin or polymyxin B.
  18. 感染铜绿假单胞菌,何种病人需要提高氨基苷类抗生素的剂量?
    Pts with CF, pregnancy, burns, and critical illnesses may require higher doses of aminoglycosides. Monitor serum drug levels.
  19. 治疗铜绿假单胞菌感染的直接依据:
    Use susceptibilities to guide final choices. Drugs that include activity against P. aeruginosa listed below but increasing resistance identified especially with ticarcillin, ciprofloxacin, levofloxacin.
  20. 哌拉西林用于治疗铜绿假单胞菌时的剂量及注意事项:
    Piperacillin 3g IV q4h or 4g IV q6h. Piperacillin/tazobactam offers no advantage for most isolated compared to piperacillin alone since most resistance is not beta-lactamase related.
  21. 替卡西林用于铜绿假单胞菌时的治疗方案:
    Ticarcillin 3 IV q4h (increasing resistance seen)
  22. 头孢类用于铜绿假单胞菌治疗的方案
    • Cefepime 1-2g IV q8h
    • or ceftazidime 2g IV q8h
  23. 碳青霉烯类用于铜绿假单胞菌的方案
    • Imipenem 1g IV q6-8h;
    • meropenem 1gm IV q8h;
    • doripenem 500mg IV q8h

    (carbapenemase-producing strains increasingly identified)
  24. 环丙沙星用于铜绿假单胞菌的方案及注意事项:
    Ciprofloxacin 400mg IV q8h or 750mg PO q12h, increasing risk of resistance; would not use as empiric monotherapy
  25. 氨曲南用于铜绿假单胞菌的治疗方案
    Aztreonam 2g IV q8h
  26. 氨基苷类用于铜绿假单胞菌的治疗方案及注意事项:
    • Gentamicin or tobramycin 3 mg/kg loading dose then 2 mg/kg IV q8h or 5-7 mg/kg IV every day or amikacin 8 mg/kg loading dose then 7.5mg/kg IV q12h. Monotherapy reserved for UTIs. Note: amikacin > tobramycin > gentamicin with respect to P. aeruginosa susceptibility percentages at most institutions. Irreversible
    • vestibular and cochlear toxicity with greater cumulative dose and duration of tx.
  27. 铜绿假单胞菌的治疗疗程:
    Duration: uncomplicated UTI, 3-5d; urosepsis, 2 wks; pyelonephritis, 2-3 wks; pneumonia, >8-14d; bacteremia after removal of line, 7-10d; bacteremia with neutropenia, >14d or until neutrophil count recovered

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