154.2 📚 國考版

154.2.0.1 必背 — 鑑別

• Gram + cocci in chains, catalase -, bile esculin +, NaCl 6.5% +
• 之前歸 Group D Strep

154.2.0.2 必背 — 臨床

• UTI #1 (尤其 nosocomial, catheter)
• IE 5-15% (3rd most common cause)
• Bacteremia, intra-abdominal

154.2.0.3 必背 — 治療

條件	首選
E. faecalis, sensitive	Ampicillin ± gentamicin
Amp-R E. faecium	Vancomycin
VRE	Linezolid 或 Daptomycin (HD)
IE	Amp + gent × 4-6 wk 或 amp + ceftriaxone × 6 wk

154.2.0.4 必背 — 內在 R

• All cephalosporins (即使 sensitive in vitro 也 fail)
• Clindamycin
• TMP-SMX in vivo
• Aminoglycoside 低 level (但 high-level synergy)

154.2.0.5 必背 — HLAR

• Gentamicin MIC > 500 → 失去 cell wall synergy
• → 改 amp + ceftriaxone (no need synergy)

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