感染性眼内炎患者病原学检测结果分析

Etiological profiles and pathogen detection of infectious endophthalmitis

目的 探讨不同病原学检测方法的阳性率,为感染性眼内炎的临床诊断和治疗提供支持依据.方法 回顾分析2000年1月至2010年12月间山东省眼科研究所住院治疗的临床诊断为感染性眼内炎的患者319例,对普通肉汤增菌和双相血培养瓶两种细菌分离培养方法的阳性率进行比较,统计细菌对抗生素的敏感性和真菌对抗真菌药物的敏感性.结果 319例感染性眼内炎患者中,眼外伤（230例,72.10％）是最主要的致病因素.从手术中采集的眼内标本中培养出的细菌占43.57％（139/319）,真菌占18.22％（49/269）.2000-2002年间使用普通营养增菌肉汤培养细菌,阳性率为29.00％ （29/100）；2003-2010年间使用双相血培养瓶培养细菌,阳性率为50.23％（110/219）.两种培养方法阳性率比较,差异有统计学意义（x2=12.58,P＜0.01）.细菌对左氧氟沙星的敏感性为81.82％；真菌对两性霉素B、伊曲康唑、氟康唑和酮康唑的最小抑菌浓度分别为1.05、35.07、3.00和2.42 μg/ml.结论 眼内炎的主要致病因素是眼外伤,细菌是导致眼内炎的主要病原体,采用双相血培养瓶可以提高细菌培养阳性率.细菌对左氧氟沙星的敏感性高,真菌对两性霉素B的敏感性高.

Objective To retrospectively analyze the etiological characteristics of infectious endophthalmitis so as to improve the positive detection rate of its pathogens in laboratory test. Methods The epidemiological features and laboratory findings of 319 inpatients （319 eyes） diagnosed with infectious endophthalmitis at our institute from January 2000 to December 2010 were retrospectively reviewed and analyzed. Results Ocular trauma （n =230,72.10%） was a major risk factor for infectious endophthalmitis.Bacteria and fungi were isolated from intraocualr specimens with the positive rates of 43.57% （ 139/319） and 18.22% （49/269）respectively.The positive rates of bacteria culture were 29.00%for nutrient broth medium and 50.23% for blood enrichment medium respectively. And the difference was statistically significant （ x2 =12.58,P 〈 0.01 ）.The sensitivity of isolated bacteria to levofloxacin was 81.82%. The geometric mean of minimal inhibitory concentrations of amphotericin B, fluconazole,ketoconazole and itraconazole against fungi were 1.05, 5.07,3.00 and 2.42 μg/ml respectively.Conclusion The major cause of infectious endophthalmitis is ocular trauma and the dominant pathogen is bacteria. The use of blood enrichment medium may improve the positive rate of bacteria culture.Levofloxacin and amphotericin B are indicated for the treatment of bacterial and fungal endophthalmitis.