铜绿偎单胞菌 郭佳玮、马欣纯、熊万峰
铜绿假单胞菌 郭佳玮、马欣纯、熊万峰
CONTENT I Identification 1.1 Nomenclature 1.2 Biology lI Pathogenesis Ill Diagnosis Treatments
CONTENT I Identification 1.1 Nomenclature 1.2 Biology II Pathogenesis III Diagnosis & Treatments
Nomenclature Pseudomonas econs(pseudes uovos(monos aeruginosa aeruginosus< aerugo aes
Nomenclature • Pseudomonas ψευδής (pseudḗs) μόνος (mónos) • aeruginosa aeruginosus< aerugo< aes
·B| ue-Green biology pyocyanin(blue ) and pyoverdine green) Gram-negative; bacillus with unipolar motility Oxidase(+); glucose(+ but lactose (-
biology • Blue-Green pyocyanin (blue) and pyoverdine (green) • Gram-negative; bacillus with unipolar motility • Oxidase(+); glucose(+) but lactose(-)
pathogenesis Details and common Infections associations High-risk groups Pneumonia Diffuse bronchopneumonia Cystic fibrosis patients Associated with a purple black skin lesion ecthyma Septic shock gangrenosum Neutropenic patients Urinary tract infection Urinary tract catheterization Premature infants and Gastrointestinal infection Necrotising enterocolitis neutropenic cancer patients Skin and soft tissue Hemorrhage and necrosis Burns victims and patients infections with wound infections
pathogenesis Infections Details and common associations High-risk groups Pneumonia Diffuse bronchopneumonia Cystic fibrosis patients Septic shock Associated with a purpleblack skin lesion ecthyma gangrenosum Neutropenic patients Urinary tract infection Urinary tract catheterization Gastrointestinal infection Necrotising enterocolitis Premature infants and neutropenic cancer patients Skin and soft tissue infections Hemorrhage and necrosis Burns victims and patients with wound infections
antibiotic-inactivating Drug Resistance enzymes biofilm multidrug efflux pumps
Drug Resistance • antibiotic-inactivating enzymes • biofilm • multidrug efflux pumps
Specimen Gram stain> gram-negative rods and or white blood cells Diagnosis Clear colonies on mac conkey agar “脓液、创面渗出液、痰、尿和血· Confirmatory tests: production of the 等标本,直接接种于血琼脂平板, blue-green pigment pyocyanin on cetrimide 根据菌落大小,绿色色素及生化反 应等鉴定。 garand growth at42℃C 《医学微生物学》P170·TS| slant: distinguish nonfermenting Pseudomonas species from enteric pathogens in faecal specimens When P aeruginosa is isolated from a normally sterile site(blood, bone, deep collections) it is generally considered dangerous, and almost always requires treatment. However, P aeruginosa is frequently isolated from nonsterile sites (mouth swabs, sputum, etc. ),and, under these circumstances, it may represent colonization and not infection
Diagnosis • Specimen + Gram stain → gram-negative rods and/or white blood cells • Clear colonies on MacConkey agar • Confirmatory tests: production of the blue-green pigment pyocyanin on cetrimide agarand growth at 42℃ • TSI slant :distinguish nonfermenting Pseudomonas species from enteric pathogens in faecal specimens. • When P. aeruginosa is isolated from a normally sterile site (blood, bone, deep collections), it is generally considered dangerous, and almost always requires treatment. However, P. aeruginosa is frequently isolated from nonsterile sites (mouth swabs, sputum, etc.), and, under these circumstances, it may represent colonization and not infection. “脓液、创面渗出液、痰、尿和血 等标本,直接接种于血琼脂平板, 根据菌落大小,绿色色素及生化反 应等鉴定。” ——《医学微生物学》P170
Guide treatment according to laboratory sensitivities rather than choosing an Treatment antibiotic empirically Widespread resistance to many common 应加强医用仪器的消毒,防止医源 first-line antibiotics>carbapenems 性感染;同时应注意医务人员与患 者及患者间的交叉感染。可选用氨 polymyxins and more recently tigecycline 基糖苷类和β-内酰胺类抗生素联合治 considered to be the drugs of choice 疗 B-lactamase inhibitors such as sulbactam in 《医学微生物学》P170 combination with antibiotics> enhance antimicrobial action even in the presence of a certain level of resistance Combination therapy after rigorous antimicrobial susceptibility testing has been found to be the best course of action in the treatment of multidrug-resistant P aerugInosa. Some next-generation antibiotics are active against P aeruginosa include doripenem ceftobiprole, and ceftaroline. need more clinical trials)
Treatment • Guide treatment according to laboratory sensitivities rather than choosing an antibiotic empirically. • Widespread resistance to many common first-line antibiotics → carbapenems, polymyxins and more recently tigecycline considered to be the drugs of choice. • β-lactamase inhibitors such as sulbactam in combination with antibiotics → enhance antimicrobial action even in the presence of a certain level of resistance. • Combination therapy after rigorous antimicrobial susceptibility testing has been found to be the best course of action in the treatment of multidrug-resistant P. aeruginosa. • Some next-generation antibiotics are active against P. aeruginosa include doripenem, ceftobiprole, and ceftaroline.(need more clinical trials) 应加强医用仪器的消毒,防止医源 性感染;同时应注意医务人员与患 者及患者间的交叉感染。可选用氨 基糖苷类和β-内酰胺类抗生素联合治 疗。 ——《医学微生物学》P170
Antibiotics that may have activity against P. aeruginosa include: aminoglycosides(gentamicin, amikacin Treatment tobramycin but not kanamycin quinolones(ciprofloxacin, levofloxacin, but not moxifloxacin cephalosporins (ceftazidime, cefepime cefoperazone, cefpirome, ceftobiprole, but not cefuroxime, cefotaxime, or ceftriaxone antipseudomonal penicillins: carboxypenicillins (carbenicillin and ticarcillin) and ureidopenicillins(mezlocillin azlocillin and piperacillin). P aeruginosa is intrinsically resistant to all other penicillins. carbapenems(meropenem imipenem doripenem, but not ertapenem polymyxins (polymyxin B and colistin)[42] monobactams (aztreonam) PS: Fluoroquinolone is one of the few antibiotics widely effective against P aeruginosa >avoid the development of resistant strains Infection is superficial and limited >topical gentamicin or colistin may be used
Treatment • Antibiotics that may have activity against P. aeruginosa include: • aminoglycosides (gentamicin, amikacin, tobramycin, but not kanamycin ) • quinolones (ciprofloxacin, levofloxacin, but not moxifloxacin ) • cephalosporins (ceftazidime, cefepime, cefoperazone, cefpirome, ceftobiprole, but not cefuroxime, cefotaxime, or ceftriaxone ) • antipseudomonal penicillins: carboxypenicillins (carbenicillin and ticarcillin), and ureidopenicillins (mezlocillin, azlocillin, and piperacillin). P. aeruginosa is intrinsically resistant to all other penicillins . • carbapenems (meropenem, imipenem, doripenem, but not ertapenem ) • polymyxins (polymyxin B and colistin)[42] • monobactams (aztreonam ) • P.S: Fluoroquinolone is one of the few antibiotics widely effective against P. aeruginosa → avoid the development of resistant strains. Infection is superficial and limited → topical gentamicin or colistin may be used
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