56例链球菌性眼内炎患眼临床特征和预后分析  

Clinical features and prognosis of 56 cases with streptococcal endophthalmitis

作　　者：张琇雯 熊晓梅 李小霞 沈思琦 黄潘敏 Zhang Xiuwen;Xiong Xiaomei;Li Xiaoxia;Shen Siqi;Huang Taomin(Department of Pharmacy,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;School of Pharmacy,Shanghai University of Medicine and Health Sciences,Shanghai 201318,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院药剂科,上海200031 [2]上海健康医学院药学院,上海201318

出　　处：《中华眼底病杂志》2023年第9期735-740,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：上海市卫生健康委员会(202140069)。

摘　　要：目的观察链球菌性眼内炎患眼的临床特点、抗生素敏感性、治疗措施和治疗结局。方法回顾性、观察性病例系列研究。2012年1月至2022年12月于复旦大学附属眼耳鼻喉科医院检查确诊的链球菌性眼内炎患者56例56只眼纳入研究。治疗策略遵循相关指南共识的一般治疗原则,包括玻璃体切割手术(PPV)、玻璃体腔注射抗生素(IVI)以及全身应用抗生素等。随访时间(11.9±17.0)个月。详细收集患者的病史资料,分析其临床特点、病原学和药物敏感试验结果、治疗和视力结局。结果56例患者中,男性39例39只眼(69.6%,39/56),女性17例17只眼(30.4%,17/56);年龄(25.0±24.4)岁;均为单眼发病。左眼、右眼分别为26(46.4%,26/56)、30(53.6%,30/56)只眼。外伤性、眼科手术后、内源性眼内炎分别为41(73.2%,41/56)、13(23.2%,13/56)、2(3.6%,2/56)只眼。致病菌为草绿色链球菌、肺炎链球菌、β-溶血性链球菌分别为28(50.0%,28/56)、18(32.1%,18/56)、10(17.9%,10/56)只眼。对青霉素、头孢曲松、万古霉素、左氧氟沙星的敏感性分别为66.0%、57.1%、94.1%、92.4%。初始治疗为PPV+IVI、IVI者分别为49(87.5%,49/56)、7(12.5%,7/56)只眼。行玻璃体腔注射糖皮质激素者17只眼(30.4%,17/56);全身应用抗生素者52例(92.9%,52/56)。末次随访时,56只眼中,有视力记录者47只眼,其中最佳矫正视力≥0.05者20只眼(35.7%,20/56);BCVA<0.05者27只眼(48.2%,27/56),其中眼球摘除1只眼(1.8%,1/56)。不同感染原因、链球菌种类、初始治疗是否进行PPV、是否接受玻璃体腔注射糖皮质激素、是否全身应用抗生素均对患者视力结局无明显影响(P>0.05);出现症状至就诊时间≤3d对视力预后有显著影响(P=0.025)。结论眼外伤是链球菌性眼内炎的主要病因;草绿色链球菌是导致链球菌性眼内炎最常见致病菌;链球菌对万古霉素具有较高敏感性;链球菌性眼内炎患眼视力结局不佳。Objective To investigate the clinical settings,antibiotic susceptibilities,management and outcomes of streptococcal endophthalmitis.Methods A retrospective observational case series study.Fifty six eyes of 56 patients diagnosed with streptococcal endophthalmitis in Eye&ENT Hospital,Fudan University from 2012 to 2022 were collected.The treatment fllowed the general principles of relevant guidelines,including pars plana vitrectomy(PPV),vitreous injection of antibiotics(IVI),vitreous injection of glucocorticoids and systemie application of antibiotics.The follow-up time was(11.9±17.0)months.Patients'clinical characteristics,pathogenic distribution and antibiotic susceptibilties,treatment and outcomes in their medical records were retrospectively collected and analyzed.Results All 56 patients had monocular onset,including 39(69.6%,39/56)males and 17(30.4%,17/56)females,26(46.4%,26/56)with left eyes involved and 30(53.6%,30/56)with right eyes involved.Their average age was(25.0±24.4)years.Ocular trauma was the leading cause of streptococcal endophthalmitis(73.2%,41/56),followed by ophthalmic surgery(23.2%,13/56)and endogenous infeection(3.6%,2/56).The streptococcal species included Streptococcus viridans(50.0%,28/56),Streptococcus pneumoniac(18/56,32.1%)andβ-hemolytic Streptococcus(17.9%,10/56).The susceptibility rates of Streptococcus to penicillin,cefatriaxone,vancomycin and levofloxacin were 66.0%,57.1%,94.1%and 92.4%,respectively.Patients received PPV+IVI and IVI as initial treatment were 49 eyes(87.5%,49/56)and 7 eyes(12.5%,7/56),respectively.Vitreous injection of glucocorticoids were performed in 17 eyes(30.4%,17/56);and systemic antibiotics were applied in 52 cases(92.9%,52/56).At the final follow-up,47 cyes were recorded with visual acuity.Twenty(35.7%,20/56)had best corrected visual acuity(BCVA)≥0.05 and 27(48.2%,27/56)had BCVA<0.05,of which 1(1.8%,1/56)had an eyeball enucleation.The etiology of endophthalmitis,streptococcal species,initial treatment with PPV,vitreous injection of glucocorticoids,and sys

关 键 词：眼内炎 链球菌 视力结局 抗菌药物敏感性 

分 类 号：R771.3[医药卫生—眼科]