感染內科簡介.ppt

Pneumonia Community-acquired pneumonia 肺實質的急性感染，發生在未住院或住院未滿48 小時之病人。病患胸部X 光片上有新出現之浸潤，同時表現出急性感染的症狀，如發熱、體溫過低、發抖、出汗、（新出現的）咳嗽（有痰或沒痰）、痰色改變、胸部不適、氣促，其他非特定性症狀（疲倦、肌痛、腹痛、食慾差、頭痛），或聽診之異常（支氣管音，加上/或是局部囉音）。 Hospital-acquired pneumonia 住院48 小時後，或上次住院結束後14 天之內發生之肺實質的急性感染。胸部X 光片上有新出現或持續進展（24 小時）之浸潤，同時以下條件至少有兩項存在: (1).發熱：體溫之上昇≥1℃，或體溫≥38.3℃，或＜35℃ (2).白血球上升：白血球之增加＞原來值之25%，或白血球＞10,000/μl 或 3000/ μl (3).膿性氣管抽吸液或痰：革蘭氏染色呈現＞25 嗜中性白血球/低倍視野（100×)。 Ventilator-associated pneumonia, VAP 為使用呼吸器48 小時以後產生的院內肺炎。 Healthcare-associated pneumonia, HCAP 肺炎病患有下列情況者稱之。在90 天內曾在急性病醫院住院大於二天以上者、住在安養院或長期照護機構的患者、30 天內接受針劑抗生素、化療、傷口照護的病患，洗腎的病人。這些病患得到肺炎應考慮多重抗藥的菌株感染 社區肺炎之嚴重度分類 CURB-65： 年齡≧65 歲，新發生的意識狀態混亂，BUN 20mg/dl，RR≧ 30 /分，血壓下降（收縮壓小於90 mmHg 或舒張壓小於60mmHg）10；以上每項代表一分，最高五分。 pneumonia severity index 社區肺炎常見致病菌 院內肺炎常見致病菌及相關臨床病徵 Soft tissue infection Cellulitis and erysipelas Similar symptoms/ signs Lymphangitis, inflammation of regional lymph nodes Vesicles, bullae, and ecchymoses or petechiae Different symptoms/ signs cellulitis: deeper dermis and subcutaneous fat Erysipelas: the upper dermis and superficial lymphatics a clear line of demarcation between involved and uninvolved tissue MICROBIOLOGY? The most common pathogens beta-hemolytic streptococci Staphylococcus aureus, including MRSA gram-negative aerobic bacilli Other pathogens Animal bites: Pasteurella multocida and Capnocytophaga canimorsus Water exposure: Aeromonas hydrophila and Vibrio vulnificus Clostridium species Pelvic LND: Streptococcus agalactiae Penetrating wound: Pseudomonas aeruginosa Others Treatment Elevation the affected area facilitates gravity drainage of edema and inflammatory substances Manage the underlying condition tinea pedis, lymphedema, and chronic venous insufficiency Antibiotics treatment NECROTIZING FASCIITIS? a deep seated infection of the subcutaneous tissue that results in progressive destruction of fascia and fat Type I mixed infection occurs after surgical procedures, diabetes, peripheral vascular disease