【正文】 sides ? 對氨基糖苷類和青霉素等作用于細(xì)胞壁的等抗生素聯(lián)用無效。 ? Definition:1μg oxacillin disk inhibition zone diameter 19mm and MIC 2μg/ml should be regarded as penicillinresistant Streptococcus pneumoniae 50 臨床意義 Clinical significance ? PRSP對氨芐西林、 氨芐西林 /舒巴坦、 頭孢唑啉的臨床治療療效很差，治療時參考藥敏結(jié)果選擇藥物，經(jīng)驗治療重癥感染時，可用頭孢曲松或頭孢噻肟聯(lián)合萬古霉素用藥。 βlactamases: hydrolyzed βlactam antibiotics. ? 臨床意義：（ 1）流感嗜血桿菌、淋病奈瑟菌以及卡拉莫拉菌等陽性，表示對青霉素、氨芐西林以及阿莫西林耐藥。 Clinical significance: (1), Haemophilus influenzae, Neisseria gonorrhoeae, and karaokepositive microanisms in Mora, said to penicillin, ampicillin and amoxicillin resistance. (2) such as Staphylococcus and Enterococcus, the positive that penicillin, penicillin amino group, carboxyl group of penicillin and penicillinresistant ureabased group. 52 5. 產(chǎn)超廣譜 β內(nèi)酰胺酶 (extend spectrum βlactamase, ESBL)的腸桿菌科細(xì)菌 Producing ESBL Enterobacteriaceae ? 超廣譜 β內(nèi)酰胺酶是由質(zhì)粒介導(dǎo)的 β 內(nèi)酰胺酶，可水解青霉素類、頭孢菌素和氨曲南，主要在大腸埃希菌和克雷伯菌屬等腸桿菌科細(xì)菌中產(chǎn)生。 ? 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(yīng)視為耐萬古霉素腸球菌（ vanycin resistant enterococcus， VRE）。另外氯霉素、紅霉素、四環(huán)素（或多西環(huán)素、或米諾環(huán)素）及利福平可用于 VRE株。Refers to a variety of infectious diseases, biological pathogens (pathogens, parasites) caused by human infectious parasitic diseases and nonmunicable diseases. 59 一、流行病學(xué)和臨床類型Epidemiology and clinical types 60 （一）流行病學(xué) Epidemiology ? 新傳染病陸續(xù)被發(fā)現(xiàn)，老傳染病死灰復(fù)燃 ? Been discovered new infectious diseases, the resurgence of old diseases ? 多重耐藥株 ? Multidrug resistant strains ? 新醫(yī)療技術(shù)的開展 ? The launching of new medical technologies 61 （二）臨床類型 Clinical types ? 臨床常見病原體為：細(xì)菌、真菌、病毒、支原體、衣原體、螺旋體、立克次體以及寄生蟲等。 ? Common bacteria: direct microscopic examination is often used, Isolation and identification of antigen. ? 病原體抗體檢測。 ? Difficult for high culture or bacterial culture: the integrated use of immunology or molecular biology, such as Mycobacterium tuberculosis and Helicobacter pylori infection. ? 細(xì)菌培養(yǎng)是最重要的確診方法。 ? Dynamic detection of serological 65 第六節(jié) 醫(yī)院感染常見病原體檢測Detection of mon pathogens of nosoial infection 66 ? 醫(yī)院感染（ nosoial infection）：又稱醫(yī)院獲得性感染（ hospital acquired infection），指患者在入院時不存在，也不處于潛伏期，而在醫(yī)院內(nèi)發(fā)生的感染，包括醫(yī)院內(nèi)獲得的而在出院后發(fā)病的感染。 ? Nosoial infection (nosoial infection): also known as hospitalacquired infection (hospital acquired infection), that does not exist on admission of patients, nor in the incubation period, while in the hospital infections occurred, including the hospital after discharge from hospital acquired disease in Infection. Generalized infection, not only by means of hospital inpatients, including outpatient, hospital staff, visiting officers and escort personnel. 67 一、流行病學(xué)和臨床類型Epidemiology and clinical types 68 （一）流行病學(xué)Epidemiology 69 1. 病原學(xué) Pathogen ? 細(xì)菌是最常見的病原體。 ? Trend: increasing the proportion of Gramnegative bacteria, Grampositive cocci ratio decreased. ? 罕見細(xì)菌變成流行株：陰溝腸桿菌、洋蔥假單孢菌，軍團(tuán)菌等 ? Strains of bacteria bee rare: Enterobacter cloacae, Pseudomonas onion, Army monocytogenes ? 其它：病毒、真菌等 ? Other: viruses, fungi, etc 70 2. 感染源 Source of infection ? 住院病人、醫(yī)院職工、探視人員、陪伴人員； ? Patients, hospital staff, visiting staff, his panion。 ? 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(yīng)用inspection items and clinical applications 74 （一）醫(yī)院感染病原體檢查項目和臨床應(yīng)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(yīng)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。 ? 定期對醫(yī)療器械的消毒效果進(jìn)行監(jiān)測：高壓蒸氣、紫外線、化學(xué)消毒劑