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1
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: & ( )18 .. , . 213 2002 400 fax 210 6039640 http://www.ifet.gr e-mail: info@ifet.gr
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2014
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:
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2. 90% - 80% . Strep-test - , , , (
) , ) - , ) , ) Streptococcus pyogenes (GAS).
2. 15% - -. >80% .
3. Centor: Centor ( 1 2).
Centor : 0 1 . 2 3 Strep-test, , 4 ( Strep-test).
4. , -
7
6
1. . :
- , -
(.. , ): .
-, -
, :
(. 1).
V 1.500.000 iu x 2 10
1000 mg x 1 500 mg x 2 10
G 1.200.000 iu , IM
500 mg x 2 10
150 mg x 2 300 mg x 1 10
500 mg x 1 1g x 1 5 3
300 x 3 10 , . . .
1: Centor
Centor Centor
:1
, , : 1
( ) : 1
> 38C: 1
3-14 : 1 15-45 : 0 >45 : -1
2: A Centor
0 ,
1 (Strep-test?)
2 Strep-test: (+) 3 Strep-test: (+)
4 Strep-test
( 10) ("evidence based") - .
11. po - - .. + (1000 mg x 2) - (600 mg x 3) .
12. - - 20%-30%.
1. Casey JR., Pichichero ME. Meta-analysis of cephalosporins versus penicillin fortreatment of group A streptococcal tonsillopharyngitis in adults. Clin Infect Dis2004; 38:1526-34.
2. Malli E, Tatsidou E, Damani A, et al. Macrolide-resistant Streptococcuspyogenes in Central Greece: prevalence; mechanism and molecularidentification. Int J Antimicrob Agents 2010; 35:614-5.
3. Shulman ST, Bisno AL, Clegg HW, et al. Clinical Practice Guideline for theDiagnosis and Management of Group A Streptococcal Pharyngitis: 2012Update by the Infectious Diseases Society ofAmerica. Clin Infect Dis 2012; 55: e86102.
9
8
, -. , , - (.. , Lemierre,..) .
5. ASTO -. - , - , .
6. ASTO. . ( - , - ) - 3.
7. , , - ( Strep-test) - - 3.
8. .9. , -
, .
10. po 5-
3: -- .
300 mg x 3 10
- 1000 mg x 2 10
V 1.5 . iu x 4 10 600 mg x 1 4
4 : . : 4 -, . : 5-12 , . - : 1-4 >4 , . : >12 .
10
1. : , -, , , , - , , .
2. : >65 , - , 3, 5 , , .
3. .4. -
NaCl , . .
5. Streptococcus pneumoniae Haemophilus influenzae. , Staphylococcus aureus , .
6. , , (>50%). , , Streptococcus pneumoniae Haemophilus influenzae. , , - . , .
7. - 5-7 .
8. - .
9. () / .
11
, CT MRI, .
2
) , , 10 ,
) > 39 C, 1
) 5-6 -, , ( )
-
' 3 + 4
' 3 + 4
2-3 -
3-5
-
3-5
3-5
3-5
5-7
7-10
7
10
O
13
1 g x 3 po
+ 1 g x 2 po
' po ( )
500 mg x 2 (. 8)
A 500 mg/24 (. 8
1. (. ).2. (
30 mg/kg/ 8 po).3. 10 (
6).4. : Streptococcus pneumoniae, Haemophilus influenzae, Moraxella
catarrhalis.5. (I)
, (II) - .
6. Pseudomonas aeruginosa - ( ). Pseudomonas aeruginosa - - (swimmers ear) (2%).
7. ( - ) po (- ), - in vitro.
8. (>30%) .
1. Cunningham M, Guardiani E, Kim HJ, et al. Otitis Media. FutureMicrobiol 2012 7; 733-53
2. Toll EC, Nunez DA. Diagnosis and treatment of acute otitis media: review.J Laryngol. Otol 2012 126; 976-83
10. - ( ) , , - .
11. .
1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline foracute bacterial rhinosinusitis in children and adults. Clin Infect Dis2012;54:e72112.
2. Grivea IN, Sourla A, Ntokou E, et al. Macrolide resistance determinants amongStreptococcus pneumoniae isolates from carriers in Central Greece. BMCInfect Dis 2012;12:255.
3. Maraki S, Mantadakis E, Samonis G. Serotype distribution and antimicrobialresistance of adult Streptococcus pneumoniae clinical isolates over the period2001-2008 in Crete, Greece. Chemotherapy 2010;56:325-332.
12
: .
/ 1g x 2, po 100mg x 2 200mg x 1, po 100mg x 2 200mg x 1, po 500mg x 1, po - 400mg x 1, po 500mg x 1, po 400mg x 1, po 750mg x 1, IV 400mg x 1, IV
2 g x 1, IV
15
()
[Global Initia-tive for Chronic Obstrucive Lung Disease (GOLD) 2006]
1. - , / , - (GOLD 2006).
2. XA , - . -, , , (Gold II, updated 2006).
3. ( - ) 3
.
Haemophilus influenzae Streptococcus pneumoniae Moraxella catarrhalis : Chlamydophila pneumoniae
, . I: Enterobacteriaceae
Pseudomonas aeruginosa (Klebsiella pneumoniae,Escherichia coli, Proteus spp,Enterobacter spp, )
. II- IV: Pseudomonas aeruginosa
Pseudomonasaeruginosa *
FEV1/FVC < 0,70
FEV1 80%
M
FEV1/FVC < 0,70
50% FEV1 < 80%
FEV1/FVC < 0,70
30% FEV1 < 50%
V
FEV1 < 30%
FEV1 < 50% +
- (>40%) .
(FEVI< 50%, 4 , , 2 , po ) .
- (.. 250mg x1/24, - 250 mg x 1/ 6-12 )
1. Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention ofexacerbations of COPD. N Engl J Med 2011; 365: 689-98
2. Balter MS, La Forge J, Low DE, et al. Canadian Infectious Disease Society.Canadian guidelines for the management of acute exacerbations of chronic
bronchitis. Review. Can Respir J 2003; 10 (Suppl B): 3-32.3. Global Initiative for Obstructive Lung Disease. Global strategy for the
diagnosis, management, and prevention of chronic obstructive pulmonary
disease [executive summary]. Updated 2004.
17
Anthonisen, , . , . .
4. : (30-50%), (40-50%) (5-10%) (. ).
5. , : Streptococcus pneumoniae, Haemophilus spp, Moraxellacatarrhalis.
6. Pseudomonas spp: , FEVI < 35%, , , -.
7. 3 , , .
8. 7 .9. :
500 mg x 1 (x 3 ) po 500 mg x 2 po (ER) 1000 mg x 1 150 mg x 2 300 mg x 1 po 1g/8 po / 1g/12 po - 500 mg/12 po 500 mg/12 po 100mg/ 12 po 500 mg/24 po 400 mg/24 po 750 mg/12 po (
Pseudomonas aeruginosa) -
, -, - -
16
19
18
CURB-65 CRB-65
CURB-65:
> 40 mg/dlA 30/min < 90 mmHg 60 mmHg 65
0 1 2
1
(1,5%)
2
(9,2%)
'
, - . - CURB-65 (Confusion, lood Urea, Respiratory rate, Blood pressure) 65 . , ' . . .
- -
3
3
(22%)
- -
,
- 4 5
CRB-65
1. > 65 2. 3. 30 / min4. < 90 mmHg, < 60 mmHg
0 1-2
1,2% 8,15%
3 4
31%
'
-
: CURB-65
1. : Streptococcus pneumoniae Mycoplasma pneumoniae Haemophilus influenzae Chlamydophila pneumoniae Moraxella catarrhalis Legionella spp ( ) (, , , , -
, .. -)
Staphylococcus aureus ( : )
[ , (RSV)]
2. (--) - (- shock) - - - 3.
3. () - .
1. Mandell A, Wunderink RG, Anzueto A, et al., Management of CommunityAcquired Pneumonia In Adults, Clin Infect Dis 2007; 44: S27-72
2. The British Thoracic Society Guidelines for the Management of CommunityAcquired Pneumonia in Adults, Update 2009. Thorax 64: Supplement III
3. Watkins RR, Lemonovich TL. Diagnosis and Management of Community-Acquired Pneumonia in Adults, Am Fam Physic 2011; 83: 1299-306
21
500 mg/24 po 500 mg/12 po - 1000 mg/24 po (1 ). 3. (., , Legionella). - 3, - ( 750 mg/24 po 400 mg/24 po), 3 ( ) 400mg x 2 po. 7-10 , 5 (500mg/24 po).
20
/ ' +
(1g/6 po)
3
- 3
23
22
- , - ( , ), - , -- - ( ) -.
: 15-30%
eisseria gonorrhoeae, Corynebacterium diphtheriae, Arcanobacteriumhaemolyticum,Yersinia spp,, Francisella tularensis
, , , Coxsackie, CMV, HSV, EBV,
HIV ( )
, , ,
/ (Strep-test)
- V. : V (50.000-100.000 U/kg 2-3 x 10 ) (50-90 mg/kg 2-3 x 7-10 ) (1, 2 ) x 5-10 ( 15-20%)
15mg/kg/24 (2 ) x 7-10 12mg/kg/24 (1 ) x 5
20mg/kg/24 (1 ) x3
1. -
2. -
- 3. (2-3 10
)4. :
, , ,
: , , , ,
, PANDAS
5. - . : 20-30 mg/kg/24 10 / 90 mg/kg/24 10 / 50-100 mg/kg/24 10 G IM 20 mg/kg/24
po (2 ) 4 20mg/kg/24 (1 ) x 3
6. -
A
Strep-test
< 30 30-90 < 30 > 90
-
> 10 , ,
, ,
< 6 A
- 90mg/kg/24 2-
3 7 2 - 3
- 48-72 ( )
- 7 -
10, 14,
21, 28 6 (- , , , )
25
- . 25 / 5 . /.
-
: -
6 6 (, , -)
: 10 < 2 >2 , 5-7 >6
24
A
> 6, , -
( )
< 6 -
> 6, ,
( )
24-48
;
, -
, 2-3
90mg/kg/24 2
48-72
;
-
/ 90mg/kg/24 2 5-7 50mg/kg/24 1
10mg/kg/24 1 3 30mg/kg/24
27
OIMEI OYPOTIKOY
: E 1
:2-3
:3
:7
, ( 4)
A 2,3
E
K :
B 3
A
N : N 400mg x 2po O
200mg x 2po 500mg x 2po 500mg 1 po - 600mg x 1 po
- 960mg 2po ( )
- 3g
A 1g x 3 po ( -)
N 100mg x 3 po ' ' 400m x 2 po
: :
- B, gram(-) -, Staphylococcus aureus, HSV, CMV, Listeria
3 - 3 Streptococcus pneumoniae, RSV, Chlamydia, I
(nfluenza, uman etapneumovirus, ocavirus), Bordetellapertussis, Mycoplasma pneumoniae. .
3 -5 , S. pneumoniae, M. pneumoniae
> 5 S. pneumoniae, M. pneumoniae, Chlamydophila pneumoniae,
B. pertussis, Mycobacterium tuberculosis, MRSA PVL(+)/MSSA, Gram , , Legionella
M (4 - 4 ) -
< 5 1 5 1 , -
-, /
, , , . , , .
1. Devitt M. PIDS and IDSA issue management guidelines for community-acquired pneumonia in infants and young children. Am Fam Physician 2012;86:196-202.
2. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and managementof acute otitis media. Pediatrics 2013; 131:e964-99.
3. Schauner S, Erickson C, Fadare K, et al. Community-acquired pneumonia inchildren: a look at the IDSA guidelines. J Fam Pract 2013; 62:9-15.
4. Shulman ST, Bisno AL, Clegg HW. et al. Clinical practice guideline for thediagnosis and management of group A streptococcal pharyngitis: 2012 updateby the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:1279-82.
26
29
28
1. -: .. ( ). . ( ). - ( ). (, )(
). + . (, -, -
). - - - (
im iv). (----
E - 2 6, 3 ' ,
4
A (, -, ):
--
4
A (, -, ):
--
- po
O
M K : / , -
,
A < 60
:10
E ( 3-5) :- 240mg/24- N 300mg/24- T 240mg/24- A 1000mg/24
E ' - :- 1 g x 3 - 1,5 g x 2 - 1 g x 2 - 1 g x 3
- 750mg x 2 po - 750mg x 1 po - 600mg x 1 po
31
30
4. ( 2 6 3 )) (> 95% ) : --
x 3 x7 ( ), 400mg x 2 x7 , 3g po.
: sex, sex- (.. 50mg 240mg - sex) 12 .
6 - : - 6-12 50mg/24, -- 240mg/24 , 200mg/24 100mg/24 250mg/24 ( ).
) (>95% ). :
- (), -, ,
: 14 . 12
: 6 . 12
5. : 10 ( po ). ,
1. Guinto VT, Deguia B, Festin MR, et al. Different antibiotic regimens for treating
asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2010 (9):CD007855.
2. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelinesfor the treatment of acute uncomplicated cystitis and pyelonephritis inwomen:A 2010 update by the Infectious Diseases Society of America and theEuropean Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52e:103-20.
3. Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of Americaguidelines for the diagnosis and treatment of asymptomatic bacteriuria inadults. Clin Infect Dis 2005; 40:64.
-). -. , - .
. (--)
2. ( ). : - ()
() - (
)
3. : 5 po -
. /15. . - (50mg/24) (500mg/24)po .
: . : . -: : -
(3) . - Foley ( -). Foley ( - ) .
: 24-48 ( ). 3-5 .
M H - .
33
32
: -V (> 3 ) (2 6
3 )
-
T/ 2-3mg/kg TMP 5 mg/kg 2 /
1-2 mg/kg 1
2 10-12 mg/kg 1
1 < 2
A
-
-IV
-
2
2 -V .
A
, , , ,
(, , , -
) (
)
- ( )
; : 100.000 cfu/ml : 50.000 cfu/ml : > 50.000 cfu/ml
-
: - (2 3 , /, -, - )
(IV) (per os);: 1-3 per os , IV : 3-7
:
: 2 O : 21 : > 21
1. Urinary Tract Infection Steering Committee on Quality Improvement andManagement. Urinary tract infection: Clinical practice guideline for thediagnosis and management of the initial UTI in febrile infants and children 2to 24 months. Print, 0031-4005; Online, 1098-4275). (2011)www.pediatrics.org/cgi/doi/10.1542/peds. 2011-1330
2. Wald ER, Applegate KE, Bordley C, et al. American Academy of Pediatrics.Clinical practice guideline for the diagnosis and management of acute bacterialsinusitis in children aged 1 to 18 years. Pediatrics 2013; 132:e262-80.
KOITI
35
34
Candida albicans Trichomonas vaginalis ( )
- 7-14
- 100, 150,200 mg po 3
- - 100, 150, 200 mgpo - 6
- 150mgpo
- I 200mg/12 po x 1 200mg/24 po x 3
- -
500mg 300mg x 1 x3
1200mg 400mg x 1 x3
150mg
- 500mg/12 po 7
- 300mg/12 po 7
- x5
- - x 7
- - x 3
M 2g - 500mg /12 po 7 T 2g po
- 10-20% - 80-90% , ,, , , - , - , pH 4.5
- 10-50%
- 50-90% , ,, -, (70%), (10-30%), pH >4.5,
4 /
, - .
24-72 -
(600mg/24 x 15 ).9. ,
Chlamydia,Neisseria gonorrhoea, HPV HSV.
10. ( / - ).
1. Brocklehurst P, Gordon A, Heatly E, et al. Antibiotics for treating bacterialvaginosis in pregnancy. Cochrane Database Syst Rev. 2013;1:CD000262.
2. Sherrard J, Donders G,White D, et al. European (IUSTI/WHO) guideline onthe management of vaginal discharge, 2011. Int J STD AIDS 2011; 22: 421-9.
3. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines,2010. MMWR Recomm Rep 2010 Dec 17;59(RR-12):1-110.
37
1. : - , ( 4 /), - Candida non albicans, (.. , ).
2. Gram- (.. Escherichia coli, Proteus spp, Klebsiellaspp, Pseudomonas spp) .
3. Trichomonas vaginalis, . Candida albicans ( ).
4. Gram: (i) ( -), (ii) clue cells (- Gram -). : Gardnerella vaginalis (90%) Prevotella spp, Mycoplasma spp, Bacteroides spp >40 .
5. (250mg/8 po 7 ) (300mg/12 po 7 ) - ( ) .
6. , , - .
7. - , - , , .
8. , 14 po 150mg - 6 + Candida(.. Candida glabrata ).
36
39
OYPHPITI
38
1. Gram- (.. , , -,) .
2. - .
3. Chlamydiatrachomatis .
4. , , - . HIV .
5. 3-6 .
6. , .
7. .
8. - .
9. .. ( , - ), (Reiters, Behcets,Wegeners) .
10. 2 , .
11. ( ) - Ureaplasma urealyticum,Mycoplasma genitalium,Trichomonas vaginalis - (. ).
12. 30% , ( -).
1. Maldonado NG,Takhar SS. Update on Emerging Infections: ews from the Centers forDisease Control and Prevention. Update to the CDCs Sexually Transmitted DiseasesTreatment Guidelines, 2010: Oral cephalosporins no longer a recommended treatmentfor gonococcal infections. Ann Emerg Med 2013; 61:91-5
2. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010.MMWR Recomm Rep. 2010; 59 (RR-12):1-110
5-10% X ,
Gram(-)
- Gram
40% X
-
Gram (>5)
100mg x 2 po x 7 +
A 1 g po
(, -, )x 7
2g po +
A 1g po
M
1. Chlamydia trachomatis2. Ureaplasma urealyticum3. ycoplasma genitalium4.Trichomonas vaginalis
A 100mg x 2po x 7 - 1g po
( - X / O)
M-eisseria gonorrhoeae
125mg
K 400mg po
2g im
:> 5 Gram
> 10 1
41
POTATITI
40
1. International Prostatitis Colaborative Network, - 4 : I: . -. II: . . III: . III: EPS VB3 , III: - EPS VB3. - . IV: . / , , EPS VB3, . ( .. Ca ) -.
E 1: Stamey-Mears
VB1 VB2 EPS VB3
K
(~200ml)
(10ml)
(10ml)
(10ml)
VB1=Voided Bladder 1, VB2= Voided Bladder 2, EPS=Expressed Prostate Secretions,VB3= Voided Bladder 3 ( )
: EPS / VB3 > VB2 VB1 1 log .
OYPHPA
Y--
E -
(3-5 )
(.. ) -
Stamey-Meares
M (X
O )
T--(960mg x 2 per os)
KN 400mg x 2 500mg x 2 O 200mg x 2 500mg po x 2(600mg x 1)
4-6
4-6
H1
A
100mg x 2
K500mg x 2
K
Stamey-Meares
( 1)
( )
, , > 3
(Escherichia coli)
43
42
1. 2. Staphylo-
coccus aureus, -. S.aureus - :. Mupirocin 7 (2-3 / 24).
..
(-).
. 70C, , 48.
3. (. )
( 1g 3po)
500mg 3po 600mg 3po
- -
: Staphylococcus aureus
X - -
-
2. -.
3. .4. -
.5.
/ . -- - .
1. Cohen JM, Fagin AP, Hariton E, et al. Therapeutic intervention for chronicprostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review andmeta-analysis. PLoS One 2012; 7 (8):e41941.
2. Grabe M, Bjerklund-Johansen TE, Botto H, et al. European Association ofUrology: Guidelines on urological infections. 2011.
45
-
44
A , - , .
( - )
(B ).
K
(10 )
- A (90%)
Staphylococcus aureus (10%)
Y
Y
V M po(B )
A + 1000mg x 2po
K 600mg x 3po
:
1. , (.. , ), (.. ) IV. E - .
2. - .3. (,
, ) MRSA (Methicillin Resistant Staphylococcus aureus) MRSA.
4. - (20%-30%).
() ()
: - , , C G Staphylococcus aureus ( 10%)
. .
V ( -) 1.5 ui 4po ( )
+ 1000 mg x 3 po
600mg 3 po ( 4)
150mg 2po 500mg 2po 500mg/24
: 10 ( )
2.4-3.6 . ui IM [1.2-
1.8 . ui 3
( 12-18 )].
: V 1,5 . iu po,
12 ( )
12-18 ( 3)
47
(Flesh eating disease)
46
OIMEI AO HMATA ANPN KAI ZN
- (
)
I T T
Td TIG Td TIG
3 OXI OXI OXI
< 3 NAI NAI NAI OXI
A + 1 g x 2 po x 5-7
E 400mg x 1 po T 100mg x 2 po +
M 500mg x 3 po
1. T .
2. Y .T Pasteurella multocida ( - ), Staphylococcus aureus, Streptococcus spp. Capnocytophaga spp. [Gram (+) ,Fusobacterium spp. Gram (-) ].
3. O ( 24) - .
4. T - .
O A T
E 5 . E 10 . T (
4948
(-)
(-)
6 ( 1) ( )
-
(
)
CRP
- (20% ). : Staphylococcus aureus, Streptococcus spp,
Staphyloccus epidermidis. IV Pseudomonas aeruginosa Salmonella spp
K , ,TKE, CRP, - 99mTc-MDP 3 , MRI CT MRI
:
, - , , . , - 1987. 2012 - , - . 30 - ( ), . . 100%, - . - ( ) :
) > 5min ( 15 min)
) ( - , , ) ( )
1. - .
2. - - .... (www.keelpno.gr)
3. - 24. ....
1. WHO 6 August 2010, 85th Year No. 32, 2010, 85, 3093202.
(www.keelpno.gr) 13 20133. May AK. Skin and soft tissue infections: the new surgical infection guidelines.
Surg infect 2011; 12:179-844. Moran GJ, Abrahamian FM, Lovecchio F, et al. Acute bacterial skin infections:
developments since 2005 Infectious Disease Society of America (IDSA)guidelines. J Emerg Med 2013; 44:e397-412
1. , -, , , - . , .... (. 15)
2. - . - - .
3. .
4. .. .. Brucella, Mycobacterium tuberculosis, - ( , ).
5150
TKE, CRP , CT, MRI 3
99Tc - MDP
(>3) . . 3 .
: gram-
1:
/ (960mg/12 po) (600mg/8 po) ( )
1g/8 po Na (500mg/8 po)
[900mg (600+300)/24 po]. 2 .
1. , .
2. .. .
3. iv - Gram (-) .
1. Liu C, Bayer A, Cosqrove SE, et al. Clinical Practice Guidelines by the InfectiousDiseases Society of America for the Treatment of Methicillin-ResistantStaphylococcus Aureus Infections in Adults and Children. Clin Infect Dis 2011;52: 285-92
2. Mathews CJ, Weston VC, Jones A, et al. Bacterial septic arthritis in adults.Lancet 2010; 375: 846-55
3. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and Management ofProsthetic Joint Infection: Clinical Practice Guidelines by the InfectiousDiseases Society of America Clin Infect Dis 2013; 56:1-10
. : (45%), (15%). 88% - : , , , () .. : Gram (+) .
. : >50.000/mm , Gram , Ziehl Neelsen .
.: . MRI: - .
Gram (-) : (2g/24 IV) (2g/8 IV) (400 mg/8 IV).
Gram (+) : (1g/12 IV) (10mg/kg/24 IV) (6-8 mg/kg 24). - 3g/6 IV ( - ).
2 iv peros 2-4 .
52
53
Gram (+) (90%) Gram (-) Staphylococcus aureus (44%), Neisseria gonorrhoeae MycobacteriumStreptococcus pyogenes Neisseria meningitidis tuberculosisStreptococcus pneumoniae Pseudomonas aeruginosa Brucella spp
( )
54
YNPOMO
2. - , po (- ) . . -.
3. : 750 mg x 2po x 3 - 500 mg x 1po x 3.
4. Campylobacter jejuni: 500 mg x 1po x 3.5. E. Coli 0157:7 -
- .
55
+ 300mg x 1 po 1000mg x 1 po 500 mg x 4 po x 3
B -
(. 5)
1. 2.A
HIV3. M -
1. E -: K-
K
Isospora belli M-
2.
( 1)
3. -
4. CMV
I - -
Campylobacter
spp (. 3 4)
K
Y
()
:
HIV (+).
:
( 4 )
IAPPOKO
( 7 )
1. (I) , (2) , (3) , (4) , (5)
57
1. Cheng C, McDonald JR, Thielman NM. Infectious diarrhea in developed anddeveloping countries. J Clin Gastroenterol 2005; 39: 757-73
2. Guerrant RL, Gilder TV, Steiner TS, et al. Practice Guidelines for theMangement of Infectious Diarrhea. IDSA Guidelines, Clin Infect Dis 2001; 32:331-51
3. OMGE Practice Guideline: Acute diarrhea in adults. 2005http://www.omge.org/guides/
4. Thielman NM., Guerrant RL. Acute infectious diarrhea. N Eng J Med 2004;350:38-47
56
(. )
- - -
-
, , ,
, - -, / ( - ).
/
2//
( )
( / )
/
1.
: 8-12 cmH20
90 mmHg 65mmHg
0.5 ml/Kg / 92%
70%
2. /
3. - (50%) , - .
4.
) / .
) - (, ).
) bolus . .
) : -
)
:
2
59
58
-
2 :
> 38C < 36C
> 90/
> 20/ PaCO2* 12.000/mm3 10% -
-
. :
: PaO2/FiO2** 2
: 1.5 : / . , -
.
< 90 mmHg , -
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1. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: Inter-national guidelines for management of severe sepsis and septic shock: 2008Crit Care Med 2008; 236: 296-327
2. Kumar A, Roberts D,Wood KE, et al. Duration of hypotension before initiationof effective antimicrobial therapy is the critical determinant of survival inhuman septic shock. Crit Care Med 2006; 34: 1589-96
3. Kumar A, Zarychanski R, Light B, et al. Early combination antibiotic therapyyields improved survival compared with monotherapy in septic shock: apropensity-matched analysis. Crit Care Med 2010; 38: 1773-85
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