临床耐药梨与分析.ppt

* * * * * * * * * Legionella, which comprises more than 40 species, including pneumophila, is widespread in water and, also, soil. The organism lives and grows in amebas.1,2 Water temperatures from 32°C to 45°C encourage growth of the pathogen.1 Legionella infection is spread by water—not person to person, as are the other two main AP pathogens.1 The Legionella organism has a cell wall and is a gram-negative bacillus.2,3 In the human host, Legionella is an intracellular organism: it lives in macrophages.1,2 According to a meta-analysis, the mortality rate due to Legionella spp CAP was 14.7%, which is higher than for the rates already mentioned for M. pneumoniae and C. pneumoniae.1,4 As with these other two organisms, Legionella spp pneumonia (or Legionnaires’ disease) shows great variability, from approximately 0.7% to 16.2% of all CAP. A number of studies of CAP patients in selected populations have identified Legionella spp in 0.7% to 13% of outpatients and 1.7% to 16.2% of inpatients.1,5 Slide 24 * * * * * * * * * * * Prevalence of MDR Tuberculosis among New Cases of Tuberculosis, 1994-2002, and Countries with at Least One Reported Case of XDR Tuberculosis as of January 2007. Data are from the World Health Organization. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Dr.HU Bijie * 4种常见医院感染类型中均有上升趋势 * Dr.HU Bijie * 不同部位的常见感染真菌 肺：念珠菌、曲菌、隐球菌、毛霉菌、组织胞浆菌、球孢子菌 中枢：念珠菌、隐球菌、曲菌、球孢子菌 消化：念珠菌 泌尿生殖：念珠菌、芽生菌。 心血管：念珠菌、曲菌、毛霉菌 眼、耳、鼻：念珠菌、曲菌、毛霉菌、镰刀菌。 血管内导管：真菌占14% 导尿管：真菌占22.4% * Dr.HU Bijie * 【病例】 心脏移植后肺部阴影 男，61岁，4年前开始出现活动后心悸、气促，诊断为“心肌炎后心肌病”，于2007年5月21日于全麻下行原位心脏移植术。 术后第19天出现发热、体温最高达39.5℃，咳少量黄痰，无气急、咯血、胸痛等症状。 体检：一般情况好，呼吸频率16次/分，无气急、紫绀。双肺呼吸音清，未闻及干湿啰音。 * Dr.HU Bijie * 2007-6-15胸部CT:右肺上叶见一团块状高密度影，约4.5×3.0cm，周围有晕轮征；左肺上叶见一结节影1.0×1.0cm。余两肺散在片状高密度影，边缘模糊。 * Dr.HU Bijie * 痰普通培养4次，其中3次为黄曲霉（＋＋）；痰真菌培养4次，其中3次为黄曲霉（＋＋）。 血清半乳甘露聚糖（GM）测定2次分别为0.78 0.43。 血常规示：WBC 7.7*109/L N% 89.7%。 * Dr.HU Bijie * 【病例】乳腺癌根治术后化疗6次再放疗，咳嗽气急半年伴间歇性发热 女，47岁，浙江象山人。 6月余前出现咳嗽、少量白色泡沫样痰，伴气急，时有发热。无咯血、胸痛等