中华眼底病杂志

中华眼底病杂志

531例化脓性眼内炎患者的致病因素和病原学特征分析

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目的分析化脓性眼内炎的致病因素和病原学特征。方法2006年1月至2015年12月10年间在山东省眼科研究所青岛眼科医院住院诊疗的一组连续性化脓性眼内炎患者531例531只眼纳入研究。其中,男性410例410只眼(77.2%),女性121例121只眼(22.8%)。平均年龄(38.62±15.36)岁。详细收集患者的病史资料,分析其致病因素。在无菌条件下采集患眼前房水、玻璃体或眼内标本进行细菌和真菌培养及体外药物敏感试验。结果眼外伤是化脓性眼内炎的首位致病因素(60.1%),其他因素包括内眼手术相关性眼内炎(19.0%)、化脓性角膜炎相关性眼内炎(17.1%)和内源性眼内炎(3.8%)。内眼手术后相关性眼内炎中以白内障手术后眼内炎为主(12.6%)。共培养获得致病菌224株,其中以革兰阳性菌为主(54.0%),表皮葡萄球菌最为常见(25.0%);其他致病菌依次为真菌(29.5%)和革兰阴性菌(16.5%)。真菌中以曲霉菌属为主(10.7%),其次为镰刀菌属(9.8%)。革兰阳性菌对抗生素敏感性分别为万古霉素97.4%,加替沙星91.8%,夫西地酸77.9%,左氧氟沙星为54.6%;革兰阴性菌对抗生素敏感性分别为加替沙星85.7%,左氧氟沙星77.8%,妥布霉素71.4%,头孢他啶62.5%。真菌对伏立康唑和两性霉素B敏感性分别为88.2%、84.8%。结论眼外伤是化脓性眼内炎的主要致病因素,其次为内眼手术和化脓性角膜炎。革兰阳性菌是导致化脓性眼内炎的主要致病菌,以表皮葡萄球菌最为常见;其次为真菌,以曲霉菌和镰刀菌为主。

ObjectiveTo analyze pathogenic factors and etiological characteristics of suppurative endophthalmitis.MethodsA total of 531 consecutive patients (531 eyes) with suppurative endophthalmitis who were hospitalized in Qingdao Eye Hospital of Shandong Eye Institute from January 2006 to December 2015 were included in the study. Among them, 410 patients with 410 eyes were males (77.2%), 121 patients with 121 eyes were females (22.8%). The average age of the patients was 38.62±15.36 years. The relevant medical records were collected to analyze the pathogenic factors. Samples of aqueous humor, vitreous or other intraocular samples were taken under aseptic conditions for bacterial and fungal culture and in vitro drug sensitivity test.ResultsOcular trauma was the primary pathogenic factor of suppurative endophthalmitis (60.1%), other factors included postoperative endophthalmitis (19.0%), suppurative keratitis-related endophthalmitis (17.1%) and endogenous endophthalmitis (3.8%). Postoperative endophthalmitis mainly occured after cataract surgery. A total of 224 strains of organisms were isolated, among which the predominant organisms isolated were gram-positive bacteria (54.0%) and staphylococcus epidermidis was the most common (25.0%). The other pathogenic organisms were fungi (29.5%) and gram-negative bacteria (16.5%). Among the fungi, aspergillus (10.7%) was the dominant genus, followed by fusarium (9.8%). For gram-positive organisms, susceptibilities were vancomycin 97.4%, gatifloxacin 91.8%, fusidate acid 77.9% and levofloxacin 54.6%. For gram-negative organisms, susceptibilities were gatifloxacin 85.7%, levofloxacin 77.8%, tobramycin 71.4% and ceftazidime 62.5%. For fungal isolates, sensitivities were voriconazole 88.2% and amphotericin B 84.8%.ConclusionsOcular trauma is the main pathogenic factor of suppurative endophthalmitis, followed by postoperative endophthalmitis and suppurative keratitis-related endophthalmitis. Gram-positive bacteria are the major pathogenic organisms, especially staphylococcus epidermidis followed by fungal species, among which aspergillus and fusarium were the dominating pathogenic genus.

关键词: 眼内炎/流行病学; 眼内炎/病因学; 眼内炎/微生物学; 眼内炎/预防和控制

Key words: Endophthalmitis/epidemiology; Endophthalmitis/microbiology; Endophthalmitis/etiology; Endophthalmitis/prevention & control

引用本文: 万磊, 陈楠, 张静, 程钧, 刘芳, 谢立信. 531例化脓性眼内炎患者的致病因素和病原学特征分析. 中华眼底病杂志, 2019, 35(2): 181-186. doi: 10.3760/cma.j.issn.1005-1015.2019.02.014 复制

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