内眼手术患者术前结膜囊细菌分布及药物敏感性分析  

Conjunctival flora and their antibiotic susceptibility in patients undergoing penetrating intraocular surgeries

作　　者：任春阳[1] 何静娜 王琳[3] 柳姗姗[2] 孙晶 曹咏[1] 王海林[2] 李若溪[2] 张绍丹 Ren Chunyang;He Jingna;Wang Lin;Liu Shanshan;Sun Jing;Cao Yong;Wang Hailin;Li Ruoxi;Zhang Shaodan(Department of Clinical Laboratory,the Forth People's Hospital of Shenyang,Shenyang 110031,China;Department of Ophthalmology,The Key Lab of Ophthalmology of Shenyang,the Forth People's Hospital of Shenyang,Shenyang 110031,China;Department of Pathogen Biology,China Medical University,Shenyang 110001,China;the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]沈阳市第四人民医院检验科,110031 [2]沈阳市第四人民医院眼科,沈阳市眼病中心重点实验室 [3]中国医科大学病原生物学教研室,沈阳110001 [4]温州医科大学附属眼视光医院,325000

出　　处：《中华实验眼科杂志》2018年第9期704-709,共6页Chinese Journal Of Experimental Ophthalmology

基　　金：辽宁省自然科学基金项目(2015020560);沈阳市重点科技研发计划项目(17-230-9-03);沈阳市重点实验室建设项目(F15-160-1-00)

摘　　要：目的探讨内眼手术患者术前结膜囊细菌分布情况以及药物敏感性,为临床预防性用药和术后眼内炎的治疗提供依据。方法采用前瞻性病例对照研究设计,连续收集2015年2—8月于沈阳市第四人民眼科住院拟行内眼手术的非感染性眼病患者,在术前预防性使用抗生素等处理前进行结膜囊标本采集并进行需氧菌和厌氧菌培养,观察结膜囊细菌培养阳性率和菌种分布情况。采用全自动微生物药物敏感试验分析系统对培养阳性的需氧菌进行眼科常用抗菌药物的敏感性试验。结果本研究共纳入患者192例192眼,其中男88例,占45.83%;平均年龄(58±15)岁。结膜囊标本需氧菌培养阳性81例,阳性率为42.19%。共分离需氧菌91株,主要为革兰阳性菌占91.21%;其中表皮葡萄球菌,占64.84%,其次为缓慢葡萄球菌和金黄色葡萄球菌,分别占7.69%和3.30%。革兰阴性菌包括克氏枸橼酸杆菌、摩根菌、变形杆菌和阴沟肠杆菌。凝固酶阴性的葡萄球菌(CNS)占所有阳性需氧菌的80.22%。厌氧菌培养阳性标本28例,占14.58%,主要为疮疱丙酸杆菌和大芬戈尔德菌,分别占71.43%和10.71%。药物敏感性试验结果显示,大多数CNS对庆大霉素和万古霉素敏感,耐药率小于10%,而普遍对红霉素和头孢他啶耐药,耐药率分别占69.86%和63.01%。对于眼科常用的左氧氟沙星、环丙沙星和莫西沙星,细菌耐药性分别是42.47%、39.73%和17.81%。对3种及以上抗生素同时耐药的CNS占38.36%。结论内眼手术患者结膜囊存在较高比例的需氧菌及厌氧菌生长。CNS是常见的分离菌种,且相当一部分对眼科常用的抗生素耐药。根据地区常见菌种和药物敏感试验结果调整预防性措施或治疗性用药对于提高手术安全性和治疗有效性具有重要意义。Objective To determine the spectrum of conjunctival flora and the antibiotic susceptibility profiles of patients scheduled for penetrating intraocular surgeries.Methods A prospective case control study was performed.A total of 192 patients(192 eyes)scheduled for penetrating intraocular surgeries at the Fourth People's Hospital of Shenyang from February to August 2015 were enrolled.Samples from the conjunctival sac were collected before instillation of any ophthalmic solutions for both aerobic and anaerobic culture.The positive rate and bacterial spectrum were observed.Bacterial isolates were tested for antibiotic susceptibility to 7 commonly used ophthalmic antibiotics using automated drug resistance analyzing system.The research was approved by the Ethics Committee of the Fourth People's Hospital of Shenyang.Results Totally 91 strains were collected from 81 conjunctival samples during aerobic culture,the positive rate was 42.19%.Staphylococcus epidermidis was the most common microorganism(64.84%),followed by Staphylococcus lentus(7.69%)and Staphylococcus aureus(3.30%).Coagulatase negtive Staphylococcus(CNS)accounted for 80.22%of the positively cultured aerobes.For anaerobic culture,a total of 28 strains were isolated from 28 conjunctival samples,the positive rate was 14.58%Propionibacterium acnes was the predominant species(71.43%),followed by Finegoldia magna(10.71%).Majority of the CNS were sensitive to gentamycin and vancomycin,with resistance rates lower than 10%,but their resistance rate to erythromycin and ceftazidime was 87.67%and 63.01%,respectively.Resistance rate of these CNS to levofloxacin,ciprofloxacin,and moxifloxacin was 42.47%,39.73%and 17.81%,respectively.Multidrug resistance to at least 3 antibiotic classes was present in 38.36%of the CNS.Conclusions Bacteria in the conjunctiva sac of preoperative patients are resistant to various ophthalmic antibiotics.To follow-up the bacterial distribution and antibiotic resistance is great meaningful in the prophylactic and treatment in ocular surgery-relat

关 键 词：内眼手术 结膜囊 细菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]