臨床常見病原體檢測

Examinationofclinicalcommonpathogens呼吸內科熊維寧DepartmentofRespiratoryMedicineXiong,Weining臨床常見病原體檢測

Examinationofclin1目的

Objective確定感染的發生和性質，及早明確診斷；Determinetheoccuringandnatureofinfection,andmakediagnosisearly;盡早選擇適當的治療方案；Selecttheappropriatetreatmentassoonaspossible;采取有效的預防措施，防止感染可能廣泛傳播所造成的危害。Takeeffectivepreventionmeasurestopreventinfectiontocausewidespreaddamage.目的

Objective確定感染的發生和性質，及早明確診斷；2根本程序

BasicProcedures正確采集和運送標本；Correctcollectionandtransportationofspecimens初步診斷：直接鏡檢，免疫學和分子生物學檢測；Initialdiagnosis:directmicroscopy,immunologyandmolecularbiologyexamination;確定診斷：病原體的別離、鑒定及藥敏實驗，報告結果；Determineddiagnosis:pathogenisolation,identificationandsensitivitytest,reportingresults;合理用藥Appropriatedruguse根本程序

BasicProcedures正確采集和運送標本3第一節

SectionOne標本的采集運送、實驗室評價和檢查方法Transportationandcollectionofspecimen,laboratoryevaluationandexaminationmethods第一節

SectionOne標本的采集運送、實驗室評價和檢4一、標本采集和運送One.CollectionandtransportationofSpecimen一、標本采集和運送5根本原那么

Basicprinciples根據病史與臨床表現確定標本采集的時間、部位、種類和數量，盡量采集病變明顯部位標本；Accordingtohistoryandclinicalmanifestationstodeterminethecollectiontime,location,typeandquantityofspecimens,collectspecimensatsignificantpartsoflesions;無菌操作，防止污染；Useaseptictechniquetopreventcontamination;采取適宜的方式進展儲存，盡快送檢；Appropriatewaytostore,assoonaspossibleforexamination;要視所有標本為傳染品，高度危險性的標本要有明顯標識，急癥或危重患者標本要特別注明。Toviewallthespecimensforinfectious,highriskspecimensshouldbeclearlymarked,acuteorcriticallyillpatientspecimensshouldbespecified.根本原那么

Basicprinciples根據病史與臨床表6臨床常見病原體檢測英文版課件7臨床常見病原體檢測英文版課件8〔二〕尿液

(Two)Urine無菌采集中段尿；Sterilecollectionofmid-portionurine;如考慮厭氧菌感染，采取膀胱穿刺法采集標本，無菌厭氧小瓶運送；Ifconsiderationofanaerobicinfections,applybladderpuncturetocollectspecimens,transportthemwithsterileanaerobicvial;排尿困難者考慮導尿采集標本。Applycatheterizationtocollectspecimensfordysuriapatients.〔二〕尿液

(Two)Urine無菌采集中段尿；9〔三〕糞便

(Three)Stool挑取膿、血或粘液局部于清潔容器中送檢；Pickpus,bloodormucusfromstollintocleancontainersforexamination;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送檢；Applyrectalswabforinfantsordifficultdefecation,placeitwithpreservationsolutioninthetesttubeforexamination;疑心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〔Cary-Blair〕運送培養液送檢；SuspectedinfectionscausedbyVibriocholerae,thespecimenswereplacedinalkalinepeptonewaterorcard-cloth(Cary-Blair)transportmediumforexamination;傳染性腹瀉應連續送檢3次。Continuousexamination3timesforinfectiousdiarrhea.〔三〕糞便

(Three)Stool挑取膿、血或粘液局部于10〔四〕呼吸道標本

(Four)Respiratoryspecimens類型：鼻咽拭子，痰和經氣管采集的標本；Types:nasopharyngealswab,sputum,andspecimenscollectedthroughtracheal上呼吸道存在正常菌群，在采集標本與結果分析時應予考慮。Thereisnormalflorainupperrespiratorytract,thespecimenscollectionandresultsanalysisshouldbeconsidered.〔四〕呼吸道標本

(Four)Respiratorysp11〔五〕腦脊液與其他無菌體液

(Five)Cerebrospinalfluidandothersterilebodyfluids腦脊液應立即保溫送檢或床邊接種；CSFshouldbetransportedimmediatelywithinsulationorculturedbedside；胸腔積液、腹腔積液和心包積液等應采集較大量標本送檢，離心后再接種培養。Pleuraleffusion,ascitesandpericardialeffusionwithalargevolumeshouldbecollected,centrifugatedandthencultured.〔五〕腦脊液與其他無菌體液

(Five)Cerebrosp12〔六〕眼、耳部標本

(Six)Eye,earspecimens拭子采樣Swabsamples〔六〕眼、耳部標本

(Six)Eye,earspeci13〔七〕泌尿生殖道標本

(Seven)Urogenitalspecimens男性：無菌采集尿道口分泌物或前列腺液；Male:urethraorprostaticfluidsecretionswithsterilecollection;女性：無菌采集陰道或宮頸分泌物。Female:vaginalorcervicalsecretionscollectedaseptically.〔七〕泌尿生殖道標本

(Seven)Urogenital14〔八〕創傷、組織和膿腫標本

(Eight)Trauma,organization,andabscessspecimens對損傷范圍較大的創傷，從不同部位采集多份標本；Onawiderrangeoftraumainjuries,specimenscollectedfrommanydifferentparts;采集部位應首先去除污物、消毒皮膚；Firstlyremovedirt,disinfecttheskinaroundcollectionsite;標本較少那么需參加無菌生理鹽水以防枯燥；Fewersamplesmustbeaddedtosterilesalinetopreventdrying;開放性膿腫及膿性分泌物：用無菌棉纖采取膿液或病灶深局部泌物；Openabscessandpurulentsecretions:collectdeepdischargepusorlesionswithsterilecottonfibers;封閉性膿腫用注射器抽取；Collectspecimeninclosedabscesswithasyringe;疑心厭氧菌感染，應隔絕空氣采集。Suspectedanaerobicinfections,collectionshouldbeisolatedfromair.〔八〕創傷、組織和膿腫標本

(Eight)Trauma,15〔九〕血清

(Nine)Serum用于檢測特異性抗體；Forthedetectionofspecificantibodies;血液自然凝固后吸取血清，滅活補體。Drawserumafternaturalcoagulationofblood,theninactivatecomplement.〔九〕血清

(Nine)Serum用于檢測特異性抗體；16二、標本的實驗室質量評估標準

Two.Standardoflaboratoryqualityassessmentofspecimens二、標本的實驗室質量評估標準

Two.Standardo17檢驗申請單的根本內容

ThebasiccontentofanapplicationforexaminationThepatient,snameandhospitalnumber.Ageandsex.Collectiondateandtime.Suspecteddiagnosis.Exactnatureandsourceofthespecimen.Immunizationhistoryandantimicrobialtherapy.Objective.Signedbyphysician.檢驗申請單的根本內容

Thebasiccontento18標本接收和拒收準那么

Receptionandrejectioncriteriaforspecimens1Theinformationonthelabeldoesnotexistornotmatchtheinformationontherequisition;2Delayindeliveryofthespecimens;3Thespecimenisleaking;4Thespecimenhasbeentransportedattheimpropertemperatureorinimpropermedium.標本接收和拒收準那么

Receptionandrejec195Contaminatedsamples;6Thequantityofspecimenisinsufficientfortesting;7Duplicatesubmissionofspecimens(exceptbloodcultures);8Thetransportationofspecimensofsevereinfectiousdiseasesshouldcomplywiththerelevantrules.5Contaminatedsamples;20三、檢查方法

Three.Examinationmethods

三、檢查方法

Three.Examinationmeth21〔一〕直接顯微鏡檢查

(One)Directmicroscopicexamination不染色標本檢查法：用于觀察病原體的生長、形態與運動等特性；Notstainedspecimentestmethod:toobservethegrowth,shapeandmotioncharacteristicsofpathogens;評價：局部病原體可借此初步診斷。Evaluation:forsomepathogens,theinitialdiagnosiscanbetaken.〔一〕直接顯微鏡檢查

(One)Directmicros22染色標本檢查法：觀察細菌的形態、染色性或觀察宿主細胞內包涵體的特征；Stainedspecimentestmethod:toobservebacterialmorphology,stainingorobservethecharacteristicsoftheinclusionbodiesinhostcell;評價：為臨床初步診斷提供依據。Evaluation:availablebasisforthepreliminaryclinicaldiagnosis.染色標本檢查法：觀察細菌的形態、染色性或觀察宿主細胞內包涵體23革蘭氏〔染色〕陽性球菌Gram(staining)-positivecocci革蘭氏〔染色〕陰性桿菌Gram(staining)-negativebacilli革蘭氏〔染色〕陽性球菌革蘭氏〔染色〕陰性桿菌24抗酸染色陽性桿菌〔抗酸桿菌〕Acid-faststain-positivebacilli(Acid-fastbacilli)抗酸染色陽性桿菌〔抗酸桿菌〕25〔二〕病原體特異性抗原檢查

(Two)Pathogen-specificantigentest免疫熒光技術Immunofluorescencetechnique酶聯免疫技術ELISA化學發光技術Chemiluminescencetechnology乳膠凝集試驗Latexagglutinationtest對流免疫電泳Counterimmunoelectrophoresis蛋白質芯片Proteinchips〔二〕病原體特異性抗原檢查

(Two)Pathogen-s26病原體特異性抗原檢測結果評價

Evaluationofpathogen-specificantigentestresults如果能排除穿插抗原的影響，病原體抗原檢測可明確感染的病原體。Iftheimpactofcross-antigencanbeexcluded,pathogenantigentestcouldcleartheinfectionofpathogens.病原體特異性抗原檢測結果評價

Evaluationofp27〔三〕病原體核酸檢查

(Three)Pathogennucleicacidtest聚合酶鏈式反響：擴增病原體微生物特異的DNA或RNA片段；Polymerasechainreaction(PCR):amplifythespecificfragmentsofDNAorRNAofmicrobialpathogens;實時熒光定量PCR技術；Real-timePCR;核酸探針雜交技術：通過序列的探針與標本中的病原體的核苷酸雜交，用以了解病原體的有無；Nucleicacidprobehybridization:hybridizationbetweentheknownsequenceoftheprobeandthenucleotideofpathogensinthesamples,toexplorewhetherpathogensexist;基因芯片技術。GenechiporDNAmicroarray.〔三〕病原體核酸檢查

(Three)Pathogennu28病原體核酸檢查結果評價

EvaluationofpathogenDNAtestresults是檢測病原體微生物最靈敏的方法，但具有一定的假陽性與假陰性；isthemostsensitivedetectionmethodformicrobialpathogens,buthassomefalsepositiveandfalsenegative;陽性只說明存在某種病原體的核酸，是否正被感染應結合臨床具體分析。istheonlyshowthattheexistenceofapositivepathogennucleicacid,whetherbeinginfectedshouldbecombinedwithclinicalspecificanalysis.病原體核酸檢查結果評價

Evaluationofpath29〔四〕病原體的別離培養與鑒定

(Four)Isolation,cultureandidentificationofpathogens1細菌感染性疾病病原體的別離培養1Isolationandculturethepathogensofbacterialinfections明確感染病原體；Clearthepathogens;為臨床提供體外抗微生物藥物敏感試驗結果。Providevitrotestresultsofanti-microbialdrugsensitivityforclinical.〔四〕病原體的別離培養與鑒定

(Four)Isolatio302不能人工培養的病原體感染性疾病2Notcultivatedpathogensofinfectiousdisease將標本接種易感動物、雞胚或行細胞培養。Specimenswereinoculatedintosusceptibleanimals,eggsorcelllines.2不能人工培養的病原體感染性疾病31〔五〕血清學實驗

(Five)Serologicaltest特異性IgM可作為感染性疾病的早期診斷指標，且可區分原發與復發感染；SpecificIgMcanbeindicatorofearlydiagnosisforinfectiousdiseasesandcandistinguishbetweenprimaryandrecurrentinfections;特異性IgG，尤其雙份血清的滴度呈4倍或4倍以上升高，考慮現癥感染。ForIgG,thetiterofdoubleserumhigher4timesormorethan4times,currentpathogeninfectionshouldbeconsidered.〔五〕血清學實驗

(Five)Serologicalte32第二節病原體耐藥性檢測

SectiontwoDetectionofpathogendrugresistance

第二節病原體耐藥性檢測

SectiontwoDetec33抗生素壓力Antibioticpressure抗生素壓力34一、耐藥性及其發生機制

One.Drugresistanceanditsmechanism

一、耐藥性及其發生機制

One.Drugresistan35〔一〕耐藥病原體

(One)Drugresistantpathogens革蘭氏陰性桿菌：?-內酰胺酶、超廣譜?-內酰胺酶(ESBL)、Ⅰ類?-內酰胺酶、多重耐藥等；Gram-negativebacillus:?-lactamase,extendedspectrum?-lactamase(ESBL),Ⅰtype?-lactamases,multidrugresistance,etc.;革蘭氏陽性球菌：耐甲氧西林葡萄球菌(MRS)、耐青霉素肺炎鏈球菌(PRSP)、耐萬古霉素腸球菌(VRE)、高耐氨基糖苷類抗生素腸球菌。Gram-positivecoccus:methicillin-resistantStaphylococcus(MRS),penicillin-resistantStreptococcuspneumoniae(PRSP),vancomycin-resistantenterococcus(VRE),enterococcuswithhighresistancetoaminoglycosideantibiotics.〔一〕耐藥病原體

(One)Drugresistant36〔二〕耐藥機制

(Two)Drugresistancemechanism1細菌水平和垂直傳播耐藥基因的整合子系統；1Horizontalandverticaltransmissionofbacterialdrugresistancegenesthroughintegrons;2產生滅活抗生素的水解酶和鈍化酶,如ESBLs，AmpC?-內酰胺酶，碳青霉烯酶，氨基糖苷類鈍化酶；2proteolyticenzymeandinactiveenzymeproducedforinactivationofantibiotics,suchasESBLs,AmpC?–lactamase,carbapenemase,aminoglycosideinactiveenzyme;〔二〕耐藥機制

(Two)Drugresistance373細菌抗生素作用靶位的改變；3Changesinthebacterialantibioticstarget；4細菌膜外排泵出系統；4Bacterialmembraneeffluxpumpsystem；5細菌生物膜的形成。5Bacterialbiofilm(BF)formation.3細菌抗生素作用靶位的改變；38二、檢查工程、結果和臨床應用examinationprojects,resultsandclinicalapplication二、檢查工程、結果和臨床應用39〔一〕藥物敏感試驗

Drugsensitivitytest抗微生物藥物敏感試驗(antimicrobialsusceptibilitytest,AST)對敏感性不能預測的臨床別離菌株進展藥敏試驗，以指導臨床選擇治療藥物。ASTcannotbepredictedonthesensitivityofclinicalisolatesforsusceptibilitytestingtoguideclinicaltreatmentofdrug〔一〕藥物敏感試驗

Drugsensitivitytes40目的

Objective臨床別離菌株，如不能對抗生素敏感性進展預測，必須常規進展藥敏試驗。Clinicalisolates,iftheycannotpredictthesensitivitytoantibioticsshouldberoutinesusceptibilitytesting臨床治療效果差而考慮調整抗菌藥物時。Poorclinicaltreatmenttoconsideradjustingtheantimicrobialdrugs.了解細菌耐藥的流行病學情況。Understandtheepidemiologyofbacterialresistance.評價新抗菌藥物的抗菌譜和抗菌活性等。Evaluationofnewantibioticsandantibacterialactivityofantibacterialspectrum.目的

Objective臨床別離菌株，如不能對抗生素敏感性進41方法

Methods1K-B紙片瓊脂擴散法〔Kirby-Bauerdiscagardiffusionmethod〕方法

Methods1K-B紙片瓊脂擴散法〔Kirby-B42參照NCCLS標準

NCCLSstandardreference敏感〔susceptible，S〕：表示測試菌能被測定藥物常規劑量給藥后在體內到達的血藥濃度所抑制或殺滅。Bacteriacanbedeterminedthatthetestdrugsinthebodyafteradministrationofconventionaldosestoachieveplasmaconcentrationsinhibitorkill.耐藥〔resistant，R〕：表示測試菌不能被測定藥物常規劑量給藥后在體內到達的血藥濃度所抑制或殺滅，治療無效。Testbacteriathatcannotbemeasuredafteradministrationofconventionaldoseofdruginthebodytotheplasmaconcentrationsinhibitorkill,thetreatmentineffective.中介(intermediate，I):該范圍作為敏感與耐藥之間的緩沖區，防止由于微小技術誤差影響實驗結果。Therangeasabufferbetweensensitiveandresistanttoavoidtheimpactofthesmalltechnicalerrorresults.參照NCCLS標準

NCCLSstandardrefer432稀釋法〔Dilutiontest〕最低抑菌濃度〔MIC〕：能夠抑制檢測菌肉眼可見生長的最低藥物濃度稱為測定藥物對檢測菌的最低抑菌濃度。Minimuminhibitoryconcentration(MIC):Detectionofbacteriaabletoinhibitvisiblegrowthoftheminimumdrugconcentrationdeterminationofdrugsonthedetectionofbacteriaknownastheminimuminhibitoryconcentration.3E試驗法〔Etest〕4耐藥篩選試驗Drugscreeningtest5折點敏感試驗Sensitiveturningpointtest2稀釋法〔Dilutiontest〕44〔二〕耐藥菌監測試驗Resistanttomonitortest由于細菌存在一種或幾種耐藥機制，造成了細菌的多重耐藥性。單一的藥敏試驗已不能完全表示細菌的耐藥性，必須進展一些特殊的耐藥性監測試驗。Becausethereisoneorseveralbacterialresistancemechanisms,resultinginmultipledrugresistanceofbacteria.Singlesusceptibilitytestcannotfullyexpressthedrugresistanceofbacteriatoberesistanttosomespecialmonitoringtests.〔二〕耐藥菌監測試驗Resistanttomonitor451.耐甲氧西林的葡萄球菌〔methecillinresistancestaphylococcus，MRS〕1μg甲氧西林(苯唑青霉素)紙片的抑菌圈直徑≤10mm，或MIC≥4μg/ml的金黃色葡萄球菌,1μg苯唑青霉素紙片的抑菌圈直徑≤17mm，或MIC≥0.5μg/ml的凝固酶陰性葡萄球菌稱耐甲氧西林葡萄球菌。1μgofmethicillin(oxacillin)paperoftheinhibitionzonediameter≤10mm,orMIC≥4μg/mlStaphylococcusaureus,1μgoxacillindiskinhibitionzonediameter≤17mm,orMIC≥0.5μg/mlofcoagulase-negativemethicillin-resistantStaphylococcusaureus,said1.耐甲氧西林的葡萄球菌〔methecillinresi46臨床意義

Clinicalsignificance對所有β-內酰胺類藥物均無效,并對氨基糖苷類、大環內酯類、克林霉素和四環素等抗生素多重耐藥。治療首選藥物為萬古霉素。Forallβ-lactamdrugsareineffective,andaminoglycosides,macrolides,clindamycinandtetracyclineantibioticssuchasmulti-drugresistant.Thepreferreddrugforthetreatmentofvancomycin.臨床意義

Clinicalsignificance對所有472.氨基糖苷類抗生素高耐藥腸球菌High-resistantenterococciaminoglycosides對氨基糖苷類和青霉素等作用于細胞壁的等抗生素聯用無效。Theroleofaminoglycosidesandpenicillinandotherantibioticsinthecellwallcombinedwithnullandvoid.2.氨基糖苷類抗生素高耐藥腸球菌High-resistan483.耐青霉素的肺炎鏈球菌

Penicillin-resistantStreptococcuspneumoniae定義：1μg苯唑青霉素紙片的抑菌圈直徑<19mm且MIC>2μg/ml應視為耐青霉素肺炎鏈球菌〔penicillinresistantstreptococcuspneumonia，PRSP〕。Definition:1μgoxacillindiskinhibitionzonediameter<19mmandMIC>2μg/mlshouldberegardedaspenicillin-resistantStreptococcuspneumoniae3.耐青霉素的肺炎鏈球菌

Penicillin-resis49臨床意義

ClinicalsignificancePRSP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，治療時參考藥敏結果選擇藥物，經歷治療重癥感染時，可用頭孢曲松或頭孢噻肟聯合萬古霉素用藥。PRSPtoampicillin,ampicillin/sulbactam,cefazolinpoorclinicalefficacyofthetreatmentdrugofchoicewhendrugsusceptibilityresultsforreference,experiencethetreatmentofsevereinfection,canbecombinedceftriaxoneorcefotaximetovancomycintherapy.臨床意義

ClinicalsignificancePRSP504.β-內酰胺酶的檢測

β-lactamasedetectionβ-內酰胺酶：可水解β-內酰胺類抗生素。β-lactamases:hydrolyzedβ-lactamantibiotics.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。〔2〕葡萄球菌屬以及腸球菌屬等，陽性表示對青霉素、氨基組青霉素、羧基組青霉素以及脲基組青霉素耐藥。Clinicalsignificance:(1),Haemophilusinfluenzae,Neisseriagonorrhoeae,andkaraoke-positivemicroorganismsinMora,saidtopenicillin,ampicillinandamoxicillinresistance.(2)suchasStaphylococcusandEnterococcus,thepositivethatpenicillin,penicillinaminogroup,carboxylgroupofpenicillinandpenicillin-resistanturea-basedgroup.4.β-內酰胺酶的檢測

β-lactamasedete515.產超廣譜β-內酰胺酶(extendspectrumβ-lactamase,ESBL)的腸桿菌科細菌ProducingESBLEnterobacteriaceae超廣譜β-內酰胺酶是由質粒介導的β-內酰胺酶，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菌中產生。Extendedspectrumβ-lactamasemediatedbyplasmidβ-lactamases,canbehydrolyzedpenicillins,cephalosporinsandaztreonam,mainlyinEscherichiacoliandKlebsiellaspeciesandotherEnterobacteriaceaeGenerated.5.產超廣譜β-內酰胺酶(extendspectrum52臨床意義

Clinicalsignificance產ESBL細菌，不管體外藥物敏感試驗結果如何，對青霉素類、頭孢菌素類和氨曲南治療均無效。ESBLproducingbacteria,regardlessoftheoutcomeofinvitrodrugsensitivitytests,topenicillin,cephalosporinsandaztreonamtreatmentwereineffective.臨床意義

Clinicalsignificance產ESB536.耐萬古霉素的腸球菌Vancomycinresistantenterococci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〔vancomycinresistantenterococcus，VRE〕。Definition:paper30μgvancomycininhibitionzonediameter≤19mm,orMIC≥32μg/mlshouldbeconsideredasVRE.6.耐萬古霉素的腸球菌Vancomycinresista54臨床意義

Clinicalsignificance耐萬古霉素腸球菌目前尚無有效的治療方法，但是對青霉素敏感的VRE可用青霉素和慶大霉素聯合治療，假設對青霉素耐藥而不是高水平耐氨基糖苷類可用白霉素和慶大霉素。另外氯霉素、紅霉素、四環素〔或多西環素、或米諾環素〕及利福平可用于VRE株。Vancomycinresistantenterococciiscurrentlynoeffectivetreatment,buttheVREtopenicillin-sensitivepenicillinandgentamicincombinationtherapycanbeused,ifnotthehigh-levelresistancetopenicillin-resistantavailableaminoglycosidesneomycinandcelebrategreatwhiteAdriamycin.Additionofchloramphenicol,erythromycinandtetracycline(ordoxycycline,orminocycline)andrifampincanbeusedforVREstrains.臨床意義

Clinicalsignificance耐萬古霉55〔三〕病原菌耐藥基因的檢測Detectionofpathogenresistancegenes更早Earlier確證Confirmed準確Accurate金標準Goldstandard〔三〕病原菌耐藥基因的檢測Detectionofpath56第三節臨床感染常見病原體檢查Checkthecommonpathogensofclinicalinfection

第三節臨床感染常見病原體檢查Checkthecommo57感染性疾病指各種生物性病原體〔病原微生物、寄生蟲〕寄生人體所引起的傳染性感染疾病和非傳染性感染疾病。Referstoavarietyofinfectiousdiseases,biologicalpathogens(pathogens,parasites)causedbyhumaninfectiousparasiticdiseasesandnon-communicablediseases.感染性疾病指各種生物性病原體〔病原微生物、寄生蟲〕寄生人體所58一、流行病學和臨床類型Epidemiologyandclinicaltypes一、流行病學和臨床類型Epidemiologyandc59〔一〕流行病學Epidemiology新傳染病陸續被發現，老傳染病死灰復燃Beendiscoverednewinfectiousdiseases,theresurgenceofolddiseases多重耐藥株Multi-drugresistantstrains新醫療技術的開展Thelaunchingofnewmedicaltechnologies〔一〕流行病學Epidemiology新傳染病陸續被發現，老60〔二〕臨床類型Clinicaltypes臨床常見病原體為：細菌、真菌、病毒、支原體、衣原體、螺旋體、立克次體以及寄生蟲等。Commonclinicalpathogens:bacteria,fungi,viruses,mycoplasma,chlamydia,spirochetes,rickettsia,andparasites.〔二〕臨床類型Clinicaltypes臨床常見病原體為：61二、檢查工程和臨床應用inspectionitemsandclinicalapplications二、檢查工程和臨床應用inspectionitems62〔一〕細菌感染檢查工程的選擇

Theselectionofcheckingprojectsonbacterialinfection普通細菌：常采用直接鏡檢、別離培養與鑒定、抗原檢測。Commonbacteria:directmicroscopicexaminationisoftenused,Isolationandidentificationofantigen.病原體抗體檢測。Antibodydetectionofpathogens難培養或培養要求高的細菌：綜合運用免疫學或分子生物學檢測，如結核分枝桿菌感染以及幽門螺桿菌感染等。Difficultforhighcultureorbacterialculture:theintegrateduseofimmunologyormolecularbiology,suchasMycobacteriumtuberculosisandHelicobacterpyloriinfection.細菌培養是最重要確實診方法。Bacterialcultureisthemostimportantdiagnosticmethod.〔一〕細菌感染檢查工程的選擇

Theselectiono63〔二〕實驗結果分析和臨床應用Analysisandclinicalapplicationofexperimentalresults顯微鏡檢查或別離培養的陰性結果不能完全排除感染；Microscopyorisolationandcultureofnegativeresultscannotbecompletelyruledoutinfection共同抗原引起的穿插反響；Antigeniccross-reactivitycausedbythecommon核酸檢測的假陽性；False-positivenucleicaciddetection血清學的動態檢測。Dynamicdetectionofserological〔二〕實驗結果分析和臨床應用Analysisandcli64第六節醫院感染常見病原體檢測Detectionofcommonpathogensofnosocomialinfection

第六節醫院感染常見病原體檢測Detectionofco65醫院感染〔nosocomialinfection〕：又稱醫院獲得性感染〔hospitalacquiredinfection〕，指患者在入院時不存在，也不處于潛伏期，而在醫院內發生的感染，包括醫院內獲得的而在出院后發病的感染。廣義的醫院感染對象不僅指住院患者，還包括門診病人、醫院職工、探視人員與陪護人員等。Nosocomialinfection(nosocomialinfection):alsoknownashospital-acquiredinfection(hospitalacquiredinfection),thatdoesnotexistonadmissionofpatients,norintheincubationperiod,whileinthehospitalinfectionsoccurred,includingthehospitalafterdischargefromhospitalacquireddiseaseinInfection.Generalizedinfection,notonlybymeansofhospitalinpatients,includingoutpatient,hospitalstaff,visitingofficersandescortpersonnel.醫院感染〔nosocomialinfection〕：又稱醫66一、流行病學和臨床類型Epidemiologyandclinicaltypes一、流行病學和臨床類型Epidemiologyandc67〔一〕流行病學Epidemiology〔一〕流行病學Epidemiology68病原學

Pathogen細菌是最常見的病原體。Bacterialisthemostcommonpathogens.變化趨勢：革蘭氏陰性桿菌比例在增加，革蘭氏陽性球菌比例在減少。Trend:increasingtheproportionofGram-negativebacteria,Gram-positivecocciratiodecreased.罕見細菌變成流行株：陰溝腸桿菌、洋蔥假單孢菌，軍團菌等Strainsofbacteriabecomerare:Enterobactercloacae,Pseudomonasonion,Armymonocytogenes其它：病毒、真菌等Other:viruses,fungi,etc病原學

Pathogen細菌是最常見的病原體。692.感染源

Sourceofinfection住院病人、醫院職工、探視人員、陪伴人員；Patients,hospitalstaff,visitingstaff,hiscompanion;醫院環境、未徹底消毒的醫療器械、血液制品等。Hospitalenvironment,withoutthoroughdisinfectionofmedicaldevices,bloodproducts,etc.2.感染源

Sourceofinfection住院病人70高危人群

High-riskgroups慢性疾病患者，如腫瘤、糖尿病以及肝硬化患者等Patientswithchronicdiseasessuchascancer,diabetesandlivercirrhosis,etc.

免疫抑制劑及