Fournier's gangrene

Fournier's gangrene

簡介:
-為泌尿科急症, 是一種壞死性感染(厭氧&嗜氧菌混合)或壞疽, 常侵犯會陰部。
-它首次被 Baurienne in 1764 and is named after a French venereologist, Jean Alfred Fournier following 5 cases he presented in clinical lectures in 1883.

危險因子:
   -糖尿病, 酗酒, 營養不良, 免疫抑制者

治療:
-抗生素 (Tazocin)
-清創
-高壓氧(for 厭氧菌)

預後:
經以上治療, 死亡率仍高達 40%.  78% (if 到院時已呈sepsis)
     "Fournier's gangrene: risk factors and strategies for management". World J Surg 30 (9): 1750–4.

腸球菌感染

治療
`                               E. faecalis                E.faecium
  PCN G                        +
  AMG                          S (synergistic)          S (gentamicin only)
  ampi/amo                   +                                +
  pip/tazo                      +
  imipenem                   +

  Tigecycline                +                                +
  vancomycin               +
  Teicoplanin (targocid) +
  Linezolid                    +                               +         
  Daptomycin               +                               +
  quinupristin-dalfopristin -                           +
  FQ (cravit/avelox)     +
        cipro                     -

  Cephalosporin          -

Stenotrophomonas maltophilia感染

Stenotrophomonas maltophilia感染的抗生素治療

http://www.nics.org.tw/old_nics/magazine/17/05/17-5-04.htm

新一代的 fluoroquinolones (如levofloxacin或moxifloxacin)有相當好的抗菌活性，可考慮做為經驗性的投藥予S. maltophilia感染之患者。

TMP-SMZ已不適宜做為經驗性治療的給藥。其餘如一般常用的β-lactam類抗生素、aminoglycoside、carbapenems對S. maltophilia抗菌活性不佳，臨床上不宜使用。