132.3 🩺 內科專科考前版

132.3.0.1 1️⃣ 22E 更新

• Bronchoscopic drainage + ELectromagnetic Navigation (ENB) for peripheral abscess
• Anaerobic culture techniques improving (16S sequencing); not always done routinely
• Beta-lactamase + Bacteroides resistance rising → ampicillin-sulbactam preferred over clindamycin in severe
• NTM lung abscess increasing: M. avium, M. abscessus — long combination therapy

132.3.0.2 2️⃣ Lemierre Syndrome (注意!)

• Fusobacterium necrophorum post-pharyngitis
• Internal jugular vein septic thrombophlebitis + septic pulmonary emboli + cavities
• 多年輕健康人, 女性常見
• Treatment: β-lactam ± metronidazole × 4-6 週 + anticoagulation (controversial; many do)

132.3.0.3 3️⃣ 台灣 context

• 多由 anaerobes; clindamycin 仍 commonly used
• TB endemic — every cavity 必排除 (smear + culture + GeneXpert MTB)
• Klebsiella lung abscess + diabetes 在台灣 不少 (hypervirulent K. pneumoniae causing also liver abscess)

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