快速生长型分枝杆菌性角膜炎的暴发与控制

Outbreaks and control of rapidly growing mycobacterium keratitis

目的 探讨角膜异物伤后快速生长型分枝杆菌性角膜炎（RGMK）暴发的原因与控制措施.方法 回顾性系列病例研究.调查2007年7月1日至8月5日南通一基层医院在角膜异物剔除术后暴发的11例（11眼）RGMK,了解患者的发病和初诊情况,以及当地医院、接诊医生和患者的工作场所,并采集标本做细菌培养.控制措施包括重视无菌操作,剔除角膜异物时摒弃戊二醛浸泡的角膜异物针,首选一次性针头,选用高压蒸汽法消毒替代戊二醛消毒液消毒等;治疗方法有局部和全身应用抗生素,5%碘酊烧灼清创病灶甚至角膜移植.结果 RGMK暴发感染的原因为异物本身带菌或使用的戊二醛难以杀灭快速生长型分枝杆菌,导致异物针带菌污染角膜造成感染.9例患者经局部和全身应用多种抗生素及5%碘酊烧灼清创病灶后治愈,2例以药物治疗无明显疗效,经角膜移植后治愈.结论 RGMK可在角膜异物剔除术后暴发流行,其对药物治疗反应慢,顽固性病例可经角膜移植而治愈.加强劳动防护,重视无菌操作,提高消毒灭菌质量,异物剔除术毕使用多种抗生素,术后密切随访观察等有利于预防和减少RGMK的发生.

Objective To study the cause and control of outbreaks of rapidly growing mycobacterium keratitis （RGMK）. Methods This was a retrospective case series study. Eleven eyes of 11 patients with RGMK following corneal foreign body trauma were participants in a study at the local hospital. Case histories were taken at the local hospital and patient＇s workplaces were investigated, and environmental cultures were taken to identify potential contaminants in the new outpatient offices, examination rooms and the patient＇s workplaces. The control measures stressed the importance of aseptic technique, foreign body removal with disposable needles as opposed to a foreign-body spud soaked in 2% glutaral. The patients received local and systemic antibiotic therapy,lesion cleaning followed by cauterization with tincture of iodine （5%） and even keratoplasty. Results The outbreaks of RGMK were traced to nonsterile foreign bodies or foreign-body spuds treated with frustrane glutaral. Infections in 9 cases were successfully treated with a regimen that included a combination of antimicrobial agents and local lesion cleaning followed by cauterization with 5%tincture of iodine. Two cases that had a poor response to 6 months of antibiotic therapy were successfully treated by keratoplasty. Conclusion RGMK can occur in an epidemic fashion following corneal foreign body trauma. RGMK has a long response period to medical management and the recalcitrant infections can be resolved by keratoplasty. Enhanced workplace protection, attaching importance to aseptic techniques, improved sterilization, multiple antibiotic therapy and close follow-up after removal will help to prevent outbreaks of RGMK.