【正文】 ? Hospital environment, without thorough disinfection of medical devices, blood products, etc. 71 高危人群 Highrisk groups ? 慢性疾病患者，如腫瘤、糖尿病以及肝硬化患者等 ? Patients with chronic diseases such as cancer, diabetes and liver cirrhosis, etc. ? 免疫抑制劑及激素的使用者 ? Immunosuppressive drugs and hormone users ? 化療及放療患者 ? Chemotherapy and radiotherapy in patients ? 手術(shù)及麻醉患者 ? Surgery and anesthesia in patients ? 使用介入性診斷與治療的患者 ? Use of interventional diagnosis and treatment of patients ? 廣譜抗生素使用者 ? Broadspectrum antibiotic users 72 （二）常見臨床類型 Common clinical types ? 1 下呼吸道感染：最常見 ? Lower respiratory tract infection: the most mon ? 2 尿路感染 ? Urinary Tract Infection ? 3 手術(shù)切口感染：外源性和內(nèi)源性 ? Surgical wound infection: exogenous and endogenous ? 4 胃腸道感染 ? Gastrointestinal infections ? 5 血液感染 ? Blood infection ? 6 皮膚和軟組織感染 ? Skin and soft tissue infections 73 二、檢查項目和臨床應用inspection items and clinical applications 74 （一）醫(yī)院感染病原體檢查項目和臨床應用 inspection items and clinical applications for Hospital Infection 75 ? 基本原則與病原體感染類似，但更應注意正常菌群的污染以及條件致病菌在醫(yī)院感染中的地位。 ? Difficult for high culture or bacterial culture: the integrated use of immunology or molecular biology, such as Mycobacterium tuberculosis and Helicobacter pylori infection. ? 細菌培養(yǎng)是最重要的確診方法。 ? ESBL producing bacteria, regardless of the oute of in vitro drug sensitivity tests, to penicillin, cephalosporins and aztreonam treatment were ineffective. 54 6. 耐萬古霉素的腸球菌Vanycin resistant enterococci ? 定義 : 對 30μg萬古霉素紙片抑菌圈直徑 ≤19mm， 或MIC≥32μg/ml應視為耐萬古霉素腸球菌（ vanycin resistant enterococcus， VRE）。 For all βlactam drugs are ineffective, and aminoglycosides, macrolides, clindamycin and tetracycline antibiotics such as multidrug resistant. The preferred drug for the treatment of vanycin. 48 2. 氨基糖苷類抗生素高耐藥腸球菌Highresistant enterococci aminoglycosides ? 對氨基糖苷類和青霉素等作用于細胞壁的等抗生素聯(lián)用無效。 ? Bacteria can be determined that the test drugs in the body after administration of conventional doses to achieve plasma concentrations inhibit or kill. ? 耐藥（ resistant， R）：表示測試菌不能被測定藥物常規(guī)劑量給藥后在體內(nèi)達到的血藥濃度所抑制或殺滅，治療無效。 – lactamase, carbapenemase, aminoglycoside inactive enzyme。 內(nèi)酰胺酶、多重耐藥等； ? Gramnegative bacillus: 223。 ? is the only show that the existence of a positive pathogen nucleic acid, whether being infected should be bined with clinical specific analysis. 30 （四）病原體的分離培養(yǎng)與鑒定 (Four) Isolation, culture and identification of pathogens 1 細菌感染性疾病病原體的分離培養(yǎng) 1 Isolation and culture the pathogens of bacterial infections ? 明確感染病原體； ? Clear the pathogens。 ? 評價：為臨床初步診斷提供依據(jù)。 ? 2 Delay in delivery of the specimens。 ? 采集部位應首先清除污物、消毒皮膚； ? Firstly remove dirt, disinfect the skin around collection site。 ? 排便困難者或嬰兒采用直腸拭子采集，置于有保存液的試管內(nèi)送檢； ? Apply rectal swab for infants or difficult defecation, place it with preservation solution in the test tube for examination。 if antibiotic treatment has been used, collect blood before the next administration。 ? Take effective prevention measures to prevent infection to cause widespread damage. 3 基本程序 Basic Procedures ? 正確采集和運送標本； ? Correct collection and transportation of specimens ? 初步診斷：直接鏡檢，免疫學和分子生物學檢測； ? Initial diagnosis: direct microscopy, immunology and molecular biology examination。 ? 確定診斷：病原體的分離、鑒定及藥敏實驗，報告結(jié)果； ? Determined diagnosis: pathogen isolation, identification and sensitivity test, reporting results。 ? 以無菌法由肘靜脈穿刺，一般成人采血量每次 10~20ml，嬰兒和兒童 15ml ，在床邊接種； ? Puncture cubital vein by a sterile method, in general, 10 ~ 20ml blood per time for adult, 15ml for infants and children, and inoculate at the bedside。 ? 懷疑霍亂弧菌感染引起的腹瀉，將標本置于堿性蛋白胨水或卡 布（ CaryBlair）運送培養(yǎng)液送檢； ? Suspected infections caused by Vibrio cholerae, the specimens were placed in alkaline peptone water or card cloth (CaryBlair) transport medium for examination。 ? 標本較少則需加入無菌生理鹽水以防干燥； ? Fewer samples must be added to sterile saline to prevent drying。 ? 3 The specimen is leaking。 ? Evaluation: available basis for the preliminary clinical diagnosis. 24 革蘭氏（染色）陽性球菌 Gram (staining)positive cocci 革蘭氏（染色）陰性桿菌 Gram (staining)negative bacilli 25 抗酸染色陽性桿菌（抗酸桿菌） Acidfast stainpositive bacilli (Acidfast bacilli) 26 （二）病原體特異性抗原檢查 (Two) Pathogenspecific antigen test ? 免疫熒光技術(shù) ? Immunofluorescence technique ? 酶聯(lián)免疫技術(shù) ? ELISA ? 化學發(fā)光技術(shù) ? Chemiluminescence technology ? 乳膠凝集試驗 ? Latex agglutination test ? 對流免疫電泳 ? Counter immuno electrophoresis ? 蛋白質(zhì)芯片 ?