复旦大学：《医学微生物学 Medical Microbiology》学生讨论课课件_铜绿假单胞菌

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 purple￾black 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

1]罗勤,金守光.铜绿假单胞菌Ⅲ型分泌系统的分子调控机制[微生物 学报,2008(10:1413-1417 [2].褚海青,李惠萍,何国钧.铜绿假单胞菌的耐药机制[.中国抗感染化 疗杂志,2003(01):5457 3]胡晓梅,胡福泉.铜绿假单胞菌的细胞间信号联系及其在感染中的作 用U中华医院感染学杂志,2006(04:478-480 4]朱佑明,罗永艾,李文桂.铜绿假单胞菌分子生物学研究进展[.中国 病原生物学杂志,201012)944947. [5]佟若菲,陈朝晖.铜绿假单胞菌感染的抗菌药物治疗[.天津药学, 2012(01):70-73 ·(6]_张连波,高庆国,张广.铜绿假单胞菌生物被膜研究进展囗].中国实验 诊断学,2009(01):137-140 刀],王浦华沈通葛海燕.铜绿假单胞菌制剂在恶性肿瘤中的辅助治 疗作用可.世界华人消化杂志,2010(30)3171-3174 8]、毛德强,卢仙娥铜绿假单胞菌致病、耐药机理研究进展[].国外医学. 临床生物化学与检验学分册,2001(03):142-143 ·[9]马全玲.铜绿假单胞菌分型方法研究进展[.江西医学检验, 2003(03):189-190

• [1] 罗勤, 金守光. 铜绿假单胞菌Ⅲ型分泌系统的分子调控机制[J]. 微生物 学报, 2008(10):1413-1417. • [2] 褚海青, 李惠萍, 何国钧. 铜绿假单胞菌的耐药机制[J]. 中国抗感染化 疗杂志, 2003(01):54-57. • [3] 胡晓梅, 胡福泉. 铜绿假单胞菌的细胞间信号联系及其在感染中的作 用[J]. 中华医院感染学杂志, 2006(04):478-480. • [4] 朱佑明, 罗永艾, 李文桂. 铜绿假单胞菌分子生物学研究进展[J]. 中国 病原生物学杂志, 2010(12):944-947. • [5] 佟若菲, 陈朝晖. 铜绿假单胞菌感染的抗菌药物治疗[J]. 天津药学, 2012(01):70-73. • [6] 张连波, 高庆国, 张广. 铜绿假单胞菌生物被膜研究进展[J]. 中国实验 诊断学, 2009(01):137-140. • [7] 王浦华, 沈通一, 葛海燕. 铜绿假单胞菌制剂在恶性肿瘤中的辅助治 疗作用[J]. 世界华人消化杂志, 2010(30):3171-3174. • [8] 毛德强, 卢仙娥. 铜绿假单胞菌致病、耐药机理研究进展[J]. 国外医学. 临床生物化学与检验学分册, 2001(03):142-143. • [9] 马全玲. 铜绿假单胞菌分型方法研究进展[J]. 江西医学检验, 2003(03):189-190