眼前节不同部位分离出的耐药葡萄球菌对常用眼用抗生素的敏感性分析  

Susceptibility of drug-resistant staphylococci isolated from different parts of the ocular anterior segment to common ophthalmic antibiotics

作　　者：岳娟 王春梅 吕奇学 简守珺 牛月月 刘素素 孙声桃 韩雷 张红敏 Yue Juan;Wang Chunmei;Lyu Qixue;Jian Shoujun;Niu Yueyue;Liu Susu;Sun Shengtao;Han Lei;Zhang Hongmin(Department of Ophthalmology,Henan Provincial People′s Hospital of Ophthalmology,Henan Eye Hospital,Henan Eye Institute,School of Clinical Medicine,Ophthalmology Department of Henan University,People′s Hospital of Zhengzhou University,Henan Provincial Key Laboratory of Ophthalmology and Visual Science,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院眼科河南省立眼科医院河南省眼科研究所河南大学临床医学院郑州大学人民医院眼科河南省眼科学与视觉科学重点实验室,郑州450003

出　　处：《中华眼科杂志》2022年第8期598-605,共8页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(81770902);河南省立眼科医院基础研究重点专项(21JCZD003)。

摘　　要：目的探讨眼前节不同部位分离出的耐药葡萄球菌对左氧氟沙星、妥布霉素、头孢唑啉钠、夫西地酸、克林霉素的敏感性。方法横断面研究。收集2018年1月至2019年5月河南省立眼科医院微生物室从67例(67只眼)眼前节感染患者的结膜囊、角膜、睑缘及泪囊采集的标本中分离出的67株耐药葡萄球菌的资料进行研究。患者中男性37例,女性30例;年龄(35.18±24.69)岁;结膜炎33例、细菌性角膜炎6例、睑缘炎7例、新生儿泪囊炎9例、成人泪囊炎1例、其他感染性眼病11例。通过细菌测定系统随机体外诊断试剂板(DL-STAPH葡萄球菌)对菌株的耐药机制类型[耐甲氧西林(MRS)株和(或)产β内酰胺酶(β-Lac)]进行鉴定,依据美国临床和实验室标准化研究所的M100标准,对微量液基法测出的最小抑菌浓度进行敏感和耐药的判定。采用卡方或Fisher确切检验对数据进行统计学分析。结果67株耐药葡萄球菌中MRS株35株、产β-Lac株30株、产β-Lac MRS株2株。泪囊、角膜、睑缘和结膜囊的MRS株分别有3、9、4、19株,占各部位分离出总菌株数的3/4、9/12、4/8、19/43(44.2%);产β-Lac株分别有1、3、3、23株,占各部位分离出总菌株数的1/4、3/12、3/8和23/43(53.5%)。结膜囊分离出的产β-Lac株中来自诊断为结膜炎的患者有17株,占比最高(25.3%);角膜和泪囊分离出的MRS株中来自诊断为细菌性角膜炎和新生儿泪囊炎患者的分别为5(7.5%)和3株(4.5%);睑缘分离出的MRS株、产β-Lac株来自睑缘炎患者的均为3株(4.5%)。睑缘和结膜囊分离出的菌株中以耐药表皮葡萄球菌为主,泪囊和角膜分离出的菌株以耐药金黄色葡萄球菌为主。35株MRS株中,分别有25、24、12、12、11株对头孢唑啉钠、夫西地酸、左氧氟沙星、克啉霉素和妥布霉素敏感,敏感率分别为71.4%、68.6%、34.3%、34.3%和31.4%,差异有统计学意义(χ^(2)=22.756,P<0.01),且4个眼前节部位分离出的MRS株Objectie To investigate the susceptibility of drug-resistant staphylococci isolated from different parts of the anterior segment to levofloxacin,tobramycin,cefazolin sodium,fusidic acid and clindamycin.Methods Experimental Study.A total of 67 patients with anterior segment infection(33 cases of conjunctivitis,6 cases of bacterial keratitis,7 cases of blepharitis,9 cases of neonatal dacryocystitis,9 cases of neonatal dacryocystitis,1 case of adult dacryocystitis and 11 cases of other infectious eye diseases)were collected from the conjunctival sac,cornea,eyelid margin and lacrimal sac.Minimum inhibitory concentration(MIC)determination of methicillin-resistant Staphylococcus(MRS)strains andβ-lactamase-producing(β-Lac)strains by a micro-liquid-based method,according to the M100 standard of the American Institute for Clinical and Laboratory Standardization Susceptibility and resistance determinations were made.Data were statistically analyzed using Chi-square or Fisher′s exact test.Results Thirty-five MRS,30β-Lac and 2β-Lac MRS isolates were identified from 67 multidrug-resistant Staphylococcus.There were 3,9,4,and 19 MRS isolates isolated from the lacrimal sac,cornea,eyelid margin and conjunctival sac,accounting for 3/4,9/12,4/8,19/43(44.2%)of the isolated sites respectively.There were 1,3,3,and 23β-Lac isolates,accounting for 1/4,3/12,3/8 and 23/43(53.5%)of the isolated sites,respectively.The highest proportion ofβ-Lac isolates isolated from patients with a diagnosis of conjunctivitis was 17(25.3%)from the conjunctival sac.Among the MRS strains isolated from the cornea and lacrimal sac,5(7.5%)and 3(4.5%)were from patients diagnosed with bacterial keratitis and neonatal tear,respectively.The number of MRS strains andβ-Lac isolates isolated from patients with a diagnosis of blepharitis were both 3(4.5%)from the lid margin.Among the strains isolated from the eyelid margin and the conjunctival sac,drug-resistant Staphylococcus epidermidis was the main strain,the drug-resistant Staphylococcus aureus was the maj

关 键 词：眼前半段 眼感染 细菌性 葡萄球菌感染 抗菌药 抗药性 多种 细菌 微生物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]