化脓性角膜炎的病原学特征及感染危险因素分析  

Analysis of pathogenic characteristic and infection risk factors of suppurative keratitis

作　　者：赵凌军 

机构地区：[1]新乡市第二人民医院眼科,河南省新乡市453003

出　　处：《眼科新进展》2014年第9期878-881,共4页Recent Advances in Ophthalmology

摘　　要：目的分析区域内化脓性角膜炎的病原学特征、耐药性变化和主要危险因素,为化脓性角膜炎的临床诊治提供依据。方法采用描述性研究方法,收集2009年1月至2014年1月住院治疗、临床资料完整的化脓性角膜炎患者277例(277眼),详细记录每例患者的基本信息资料、就诊信息、病原学检查结果,将所有资料进行整理分析。结果 277例患者中病原学检测检出率37.55%,其中细菌检出率35.47%,真菌检出率42.13%,各年份真菌检出率均高于细菌检出率,但差异均无统计学意义(均为P>0.05)。检出细菌株包括革兰阳性球菌56株(59.57%),革兰阴性杆菌28株(29.79%),革兰阳性杆菌10株(10.64%);真菌以曲霉菌(26株,34.67%)、白假丝酵母菌(13株,17.33%)为主。药物敏感试验结果显示,葡萄球菌属对哌拉西林、氨苄西林、红霉素等耐药比较高,而对庆大霉素和万古霉素敏感;革兰阴性杆菌属对红霉素、氨苄西林、环氧氟沙星的耐药比较高。不同菌属病原体对哌拉西林、红霉素和左氧氟沙星的耐药比差异均有统计学意义(均为P<0.05)。化脓性角膜炎的主要危险因素是角膜外伤,以植物外伤为主,其次是沙石异物和金属异物;其他危险因素还包括原有眼部疾病、全身疾病、眼部手术史和配戴角膜接触镜。结论化脓性角膜炎病原检出率偏低,真菌检出率超过细菌检出率,同时存在明显的抗生素耐药现象,角膜外伤仍是导致化脓性角膜炎的主要危险因素。应根据区域病原学特征及药敏试验结果,规范临床合理用药,改善治理效果,同时相关部门应开展针对性的宣传教育,使居民远离危险因素,降低角膜炎的发生率。Objective To explore the pathogenic characteristic, drug-resistance variation and major risk factors of regional suppurative keratitis （SK）, and provide the basis for SK clinical treatment. Methods A total of 277 SK patients were enrolled in this study from January 2009 to January 2014 by descriptive epidemiology, and detailed demographic information, hospital visiting information and pathogenic examination of each SK patients were collected and analyzed properly. Results The pathogenic detection rate of the 277 SK patients was 37.55% ,including a 35.47% of bacterium detec- tion rate and 42.13% of fungus detection rate, and the fungus detection rates were higher than bacterium detection rates in each year, but there was no statistical significance （P 〉 0.05）. Detected bacterium included 56 strains of Gram （ ＋ ） cocci （ 59.57% ）, 28 strains of Gram（ - ） bacilli （29.79%） ,and 10 strains of Gram （ ＋ ） cocci （ 10.54% ）, detected fungi were mainly aspergiUus（ 34. 67% ） and candida albicans（ 17.33% ）. Drug sensitivity experiment results indicated that, staphylococcus was resistant to piperacillin,ampicillin, erythromycin, but sensitive to gentamicin and vancomycin; while Gram （ - ） bacillus had relatively higher resistance rate in antibiotic of erythromycin,ampicillin, epoxy enrofloxacin. Drug resist- ant ratios between staphylococcus genus and Gram（ - ） bacillus genus toward piperacillin, erythromycin intment and levofloxacin were all statistically significant （P 〈 0.05 ）. Corneal trauma was the main cause of SK, and mainly to plant injury, followed by sand bodies and metal foreign body; Other risk factors of SK included the original ocular diseases, systemic dis- eases, eye operation history and wearing contact lenses. Conclusion SK pathogen detection rate is relative low, and the detection rate of fungi surpass the bacteria detection rate, meanwhile antibiotic resistance phenomenon is obviously, corneal injury is still the main risk factors. Region SK clini

关 键 词：化脓性角膜炎 病原学特征 感染危险因素 

分 类 号：R779.65[医药卫生—眼科]