武汉站4细菌耐药变迁与抗菌药物合理使用(23947KB).pptVIP

屎肠球菌对抗菌药的耐药率高于粪肠球菌，但氯霉素反之（26.2% Vs 3.9%）。 102株VRE中，粪肠球菌7株、屎肠球菌95株可分型51株VRE中，vanA 34株（均为屎肠球菌）、 vanB 14株（3株粪肠+11株屎肠）、（屎肠） * * The presence of some organisms, such as Propionibacterium acnes, in blood culture is unlikely to indicates true bacteremia, unless the patient is at special risk. The presence of some organisms, such as Staphylococcus aureus, should be assumed to indicate true bacteremia unless proven otherwise. Identification of coagulase-negative staphylococci in blood is one of the major reasons for vancomycin use in the United States, but most often these organisms are contaminants. The first step to interpret blood culture results when coagulase-negative staphylococci are identified is to assess the pre-test probability of true bacteremia. Some patients, including those with endovascular implants and other prosthetic devices, are at increased risk for coagulase-negative staphylococcal bacteremia. Likewise, neutropenic patients are at increased risk. Vascular catheters also increase the risk, but most coagulase-negative cultures in catheterized patients without other risk factors are contaminants. In patients who are critically ill, treatment is usually indicated until true bacteremia is excluded in the differential diagnosis. Additional information can help assess the post-test probability of true bacteremia. If more than one specimen is growing coagulase-negative staphylococci, then true bacteremia is more likely than when a single specimen is positive. If more than one culture is positive, comparing the antibiograms can help determine if they are similar (more likely to represent true bacteremia) or different (less likely). The best method for assessing true bacteremia is to compare genotypes of the suspect strains. This method is not widely available and results are usually not timely enough to guide therapy. * 1.痰涂片是否可以见白细胞与孢子或假菌丝的相关性 2.培养与涂片结果一致 3.影像学支持 4.G试验阳性 5.规范的抗生素治疗无效 6.病理学证据：肺穿组织中菌丝穿插、菌丝或孢子周围白细胞浸润 呼吸道念珠菌定值or 感染？ * * 某男，36岁，三天前突发阴囊肿痛，当地医