山西地区感染性眼内炎临床特点和病原学分析的临床研究

Clinical characteristics and etiology of infectious endophthalmitis in Shanxi Province

目的探讨感染性眼内炎的致病因素、病原体分布及其耐药性。方法收集2011年1月至2020年12月就诊于山西省眼科医院检验科疑似感染性眼内炎1364例(1364只眼)患者的临床资料。其中,男性1159例(1159只眼),女性205例(205只眼);年龄1-83岁,平均年龄(47.3±13.5)岁。抽取患者的房水和玻璃体液进行病原体培养实验,鉴定感染菌种类别和药物敏感性试验,采用WHONET5.6软件分析眼内炎患者的临床特点、病原菌分布以及主要病原菌的耐药性情况。感染性眼内炎病原菌分布和致病因素分布采用例数和百分比进行描述。结果在1364例(1364只眼)全部疑似患者中,有341例(341只眼)患者最终确诊为感染性眼内炎,致病年龄段以15-65岁男性为主;外源性眼内炎者339例(339只眼),内源性眼内炎者2例(2只眼),主要致病因素为眼外伤,其次为内眼手术。玻璃体液中含有病原菌者257例(257只眼),房水中含有病原菌者84例(84只眼)。病原菌中革兰氏阳性菌271株,占79.5%,以表皮葡萄球菌和链球菌为主。其中,表皮葡萄球菌为131株,占48.3%;链球菌53株,占19.6%;耐甲氧西林的表皮葡萄球菌92株,占70.2%。按照最低抑菌浓度(MIC)90为界定标准,表皮葡萄球菌对青霉素和氨苄西林的耐药率均超过90%,表皮葡萄球菌对红霉素、左氧氟沙星及复方新诺明的耐药性均超过50%,未发现表皮葡萄球菌对万古霉素和利奈唑胺耐药。10年中夏季为多发季节。结论感染性眼内炎中外源性眼内炎发生率高,病原菌以表皮葡萄球菌为主;高龄、外伤及内眼手术为发生感染性眼内炎的危险因素,其中白内障术后感染性眼内炎发生率较高;万古霉素和利奈唑胺对其有较高的敏感性。

Objective The aim of this study was to investigate the pathogenic factors,pathogen distribution and drug resistance of infectious endophthalmitis.Methods The clinical data of 1364 patients(1364 eyes)checked in Shanxi Eye Hospital from January 2011 to December 2020 who may be infected by infectious endophthalmitis were retrospectively analyzed.Among of them,1159 cases(1159 eyes)were male and 205 cases(205 eyes)were female.The patients were 1 to 83 years-old with an average age of(47.3±13.5)years-old.The anterior aqueous humor and vitreous fluid were extracted for pathogen culture,identification and drug sensitivity test.The clinical characteristics of endophthalmitis patients,and the distribution of pathogens and the drug resistance of main pathogens were analyzed by WHONET5.6 software.The distribution of pathogenic bacteria and pathogenic factors of infectious endophthalmitis were described by the number and percentage.Results After pathogenic bacteria examination,341 patients(341 eyes)were diagnosed as infectious endophthalmitis.Among of 341 cases(341 eyes)of infective endophthalmitis,males aged 15 to 65 years-old were the main pathogenic age group.There were 339 cases(339 eyes)of exogenous endophthalmitis,and 2 cases(2 eyes)of endogenous endophthalmitis.The main pathogenic factor was ocular trauma,followed by internal eye surgery.There were 257 cases(257 eyes)of vitreous fluid and 84 cases(84 eyes)of aqueous humor.Among of the pathogenic bacteria,there were 271 strains of Gram-positive bacteria(79.5%),mainly Staphylococcus epidermidis and Streptococcus,of which 131 strains(131 eyes)of Staphylococcus epidermidis accounting for 48.3%,53 strains(53 eyes)of Streptococcus accounting for 19.6%.There were 92 strains(92 eyes)of methicillin-resistant Staphylococcus epidermidis,accounting for 70.2%.According to minimum inhibitory concentration(90%),the strains were highly resistant to penicillin and ampicillin(more than 90%);the resistant to erythromycin,levofloxacin and cotrimoxazole for strains were more than 50%;no Staphylococcus epidermidis resistant to vancomycin and linezolid was found.More frequent seanson that affected by endophthalmitis was in summer during the period of ten years.Conclusions The incidence of exogenous endophthalmitis of infectious endophthalmitis was higher than others.Age,trauma and intraocular surgery were risk factors for infectious endophthalmitis.The incidence of infectious endophthalmitis after cataract surgery was higher.Vancomycin and linezolid were highly sensitive to vancomycin.