角膜移植手术患者术前结膜囊细菌培养菌群分布及影响因素研究  

Bacterial distribution and antibiotic susceptibility of conjunctival sac before keratoplasty

作　　者：李晨迪 冯云[1] 洪晶[1] Li Chendi;Feng Yun;Hong Jing(Department of Ophthalmology,Peking University 3rd Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院眼科,100191

出　　处：《眼科》2021年第2期131-135,共5页Ophthalmology in China

摘　　要：目的研究角膜移植手术术前结膜囊菌群分布及其影响因素。设计回顾性病例系列。研究对象2017年8月至2019年4月北京大学第三医院眼科572例角膜移植手术患者。排除现存眼部感染者。方法回顾患者术前结膜囊细菌培养及药物敏感性试验结果及病例资料,包括术后早期感染患者的随访资料。结膜囊细菌培养阳性者作为病例组,阴性者为对照组。主要指标患者临床信息,结膜囊细菌培养结果,药物敏感性结果。结果572例中23例(4%)患者结膜囊细菌培养阳性,以革兰阳性菌为主(78.2%)。首位检出菌为表皮葡萄球菌12例(52.2%)。病例组及对照组在性别、年龄、眼别、术式、眼部手术史、糖尿病史等因素无统计学差异(P均>0.05)。病例组及对照组术前局部抗生素用药天数(1、2、3天及以上)阳性率差异具有统计学意义(χ^(2)=5.807,P=0.046)。不同原发病结膜囊细菌培养阳性率差异具有统计学意义(P=0.001),以免疫性疾病阳性率最高(38.5%)。药敏结果显示革兰阳性菌对利福平(100%)及万古霉素(88.9%)敏感性高。术后1例Stevens-Johnson综合征患者出现早期感染,其培养结果为大肠埃希菌。结论角膜移植术术前抗生素用药天数的延长可降低细菌培养阳性率。免疫性疾病患者术前结膜囊细菌培养阳性率高,可能与术后感染有一定关系,需关注感染风险。Objective To investigate the distribution of conjunctival bacteria before different type of keratoplasty(include limbal stem cell transplantation)and the factors that affecting the positive rate as well as the antibiotic susceptibility.Design Retrospective case series.Participants 572 patients underwent keratoplasty in Peking University 3rd Hospital were included and patients with current infection were excluded.Method Bacterial culture of conjunctival sac,results of antibiotic susceptibility and clinic data were reviewed.Clinic data of acute infection after surgery was also collected.All cases were divided into case group(positive culture)and control group(negative culture)depending on the result of conjunctival culture.Main Outcome Measures Clinical information,conjunctival culture results and antibiotic susceptibilities.Results The positive rate of bacterial culture was 4%(23/572).The main detected bacteria were Staphylococcus epidermidis(78.2%).There was no significant difference in gender,age,left/right eyes,type of keratoplasty,history of eye surgery,diabetes mellitus(all P>0.05).The positive rate of local antibiotic time(1 day,2 days,3 days and more)before keratoplasty was statistically significant(χ^(2)=5.807,P=0.046).The positive rate was significantly different in different protopathy(P=0.001)and immune diseases was the highest(38.5%).Antibiotic susceptibility test suggest that gram positive bacteria was sensitive to rifampicin(100%)and vancomycin(88.9%).One patient with Stevens-Johnson syndrome had acute infection after keratoplasty,and his result of conjunctival culture was Escherichia coli.Conclusion The positive rate of conjunctival bacteria culture before keratoplasty would reduce by extend time of antibiotic.The patients with immune diseases should be concerned due to the high positive rate of bacteria culture.The positive result of preoperative conjunctival bacteria culture might have relation with acute infection after surgery.

关 键 词：角膜移植 结膜 细菌 药物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学] R779.6[医药卫生—临床医学]