179.3 🩺 內科專科考前版

179.3.0.1 1⃣ Polymicrobial Concept

  • Anaerobic syndromes rarely monomicrobial
  • Mixed aerobe + anaerobe; synergy enhances virulence
  • 倧倚 culture difficult to obtain anaerobic specimens (open to air → die)
  • Anaerobic blood culture bottles routine
  • Empirical cover both unless specific monomicrobial suspected

179.3.0.2 2⃣ Anaerobic Specimen Handling

  • Specimen in anaerobic transport medium (Port-A-Cul)
  • Plate within 2 hr
  • Avoid surface swabs (overgrown by aerobes)
  • Aspirate / tissue better
  • 抗生玠 use 前 ideally

179.3.0.4 4⃣ Anaerobic Pulmonary Infection — Modern View

  • Originally taught as “anaerobic infection” of lung
  • Modern view: usually polymicrobial — aerobe + anaerobe
  • 䞍必 always cover anaerobe in CAP (IDSA / ATS 2019 — only if aspiration risk + 持续 fail / abscess)
  • Empyema + lung abscess: cover anaerobe firmly

179.3.0.5 5⃣ Lemierre’s — Pre-/Post-Antibiotic Era

  • Pre-antibiotic (1900-1940s) — common, often fatal
  • Antibiotic era — almost disappeared (90s)
  • Recent re-emergence — possibly antibiotic stewardship (less PCN for sore throats, atypical Fusobacterium)
  • Awareness in young adult + severe pharyngitis + new sepsis

179.3.0.6 6⃣ Anticoagulation in Lemierre’s

  • Controversial; no RCT
  • Indications consider: clot propagation, intracranial extension, slow resolution
  • Risk: bleeding (sepsis-related coagulopathy)
  • Many centers use 3-6 mo anticoagulation (LMWH → warfarin or DOAC)

179.3.0.7 7⃣ Source Control Critical

  • Anaerobic infections — source control trumps antibiotic choice
  • Abscess drainage > antibiotic alone
  • Necrotic tissue debridement
  • Foreign body removal
  • Antibiotic only — failure unless drainage

179.3.0.8 8⃣ 健保 / Taiwan

  • 健保 pip-tazo / mero / clindamycin / metro broad indication
  • Anaerobic culture standard in tertiary microbiology labs
  • B. fragilis AST + R surveillance program
  • Lemierre’s — case reports + alert