糖尿病患者内眼手术前结膜囊细菌及其耐药性  

Analysis of bacteria in the conjunctival sac and its drug resistance in diabetic patients before intraocular surgery

作　　者：郭磊 崔哲 张淑荣 GUO Lei;CUI Zhe;ZHANG Shu-rong(The Third Affiliated Hospital of Qiqihar Medical University,Qiqihar,Heilongjiang 161000,Chin)

机构地区：[1]齐齐哈尔医学院附属第三医院眼科,黑龙江齐齐哈尔161000

出　　处：《中华医院感染学杂志》2024年第20期3093-3097,共5页Chinese Journal of Nosocomiology

基　　金：齐齐哈尔市科学技术基金资助项目(SFGG-201946)。

摘　　要：目的分析糖尿病患者内眼手术前结膜囊细菌及其药物敏感性。方法选取2021年11月-2023年11月齐齐哈尔医学院附属第三医院糖尿病合并眼病拟行内眼手术患者120例(120眼)纳入糖尿病组,同期非糖尿病眼病拟行内眼手术患者120例(120眼)作为非糖尿病组,术前预防性使用抗菌药物处理前采集结膜囊标本,进行细菌培养并进行眼科常用抗菌药物药敏试验。结果糖尿病组120份结膜囊标本中,细菌培养阳性68例,阳性检出率为56.67%,非糖尿病组120份结膜囊标本中,细菌培养阳性35份,阳性检出率为29.17%;糖尿病组年龄>60岁、糖尿病病程>8年者内眼手术前结膜囊细菌培养阳性率分别为68.63%、78.79%,高于年龄≤60岁、糖尿病病程≤8年者(P<0.05);糖尿病组120份结膜囊标本中,共检出革兰阳性菌86株,以表皮葡萄球菌、棒状杆菌为主,革兰阴性菌32株,以鲁氏不动杆菌为主;28份标本检出多种病原菌;糖尿病组表皮葡萄球菌对诺氟沙星耐药率最高(47.83%),其次为红霉素(43.48%)、庆大霉素(39.13%),对万古霉素耐药率较低(4.35%);非糖尿病组表皮葡萄球菌对多数抗菌药物的耐药率相对较低,对万古霉素耐药率最低(3.57%);糖尿病组棒状杆菌对庆大霉素耐药率最高(50.00%),其次为红霉素(42.86%)、诺氟沙星(42.86%);非糖尿病组棒状杆菌则对大部分抗菌药物耐药率较低,尤其对头孢他啶、妥布霉素和万古霉素敏感。结论糖尿病患者内眼手术前结膜囊细菌阳性率高于非糖尿病患者,在老年和病程较长的患者中更为明显,细菌以革兰阳性菌为主,表皮葡萄球菌、棒状杆菌为主,革兰阴性菌则以鲁氏不动杆菌为主,且主要细菌均表现出多药耐药性。OBJECTIVE To analyze the bacteria in the conjunctival sac and its drug sensitivity in diabetic patients before intraocular surgery.METHODS Totally 120 diabetic patients(120 eyes)with eye diseases who were scheduled to receive intraocular surgery in the Third Affiliated Hospital of Qiqihar Medical University from November 2021 to November 2023 were enrolled in the diabetic group,and 120 patients with eye diseases but without diabetes(120 eyes)who planned to receive intraocular surgery during the same period were selected as the non-diabetic group.Conjunctival sac samples were collected prior to preoperative prophylactic antimicrobial drug treatment,and bacterial cultures,as well as drug sensitivity tests for commonly-used ophthalmic antibacterial drugs were performed.RESULTS Of the 120 conjunctival sac specimens in the diabetic group,68 cases were positive for bacterial culture,with a positive detection rate of 56.67%,and of the 120 conjunctival sac specimens in the non-diabetic group,35 cases were positive for bacterial culture,with a positive detection rate of 29.17%.In the diabetic group,the positive rates of conjunctival sacbacteria culture before intraocular surgery in patients with age>60 years old and duration of diabetes>8 years were 68.63%and 78.79%,which were significantly higher than those in patients with age<60 years old and diabetes duration≤8 years(P<0.05).In the diabetic group,of 120 conjunctival sac specimens,a total of 86 strains of gram-positive bacteria were detected,mainly Staphylococcus epidermidis and Corynebacterium,and 32 strains of gramnegative bacteria were detected,mainly Acinetobacter lwoffi.Multiple infections were detected in 28 specimens.The drug resistance rate of Staphylococcus epidermidis to norfloxacin in the diabetic group was the highest(47.83%),followed by erythromycin(43.48%)and gentamicin(39.13%),and the drug resistance rate to vancomycin was lower(4.35%).The drug resistance rates of Staphylococcus epidermidis to most antibacterial drugs in the non-diabetic group were rel

关 键 词：糖尿病 内眼手术 结膜囊 病原菌 耐药性 

分 类 号：R781.64[医药卫生—口腔医学]