准分子激光原位角膜磨镶术中使用的角膜刀片及吸血棉签细菌培养结果分析

The investigation of microbial culturing of microkeratome blades and sponges used in laser in situ keratomileusis

目的探讨准分子激光原位角膜磨镶术（LASIK）中使用的角膜板层刀片及吸血棉签细菌对手术后感染的风险影响。方法前瞻性研究。2009年3月至4月，河南省眼科研究所准分子激光治疗中心106例近视眼患者行LASIK手术者，对手术中使用的板层角膜刀片（106个）及棉签（212个）进行细菌培养，阳性者进一步进行药物敏感试验，对其结果进行分析。两侧眼间棉签阳性率及刀片与棉签阳性率的差异采用Pearson Chi—square检验，不同性别刀片阳性率及不同药物敏感性的差异采用Fisher精确检验。结果106个刀片8个有细菌生长，阳性率为7．55％，均为表皮葡萄球菌，其中男女各4个，差异无统计学意义（P=1．000）；212个棉签23个培养阳性，阳性率为10．38％，均为表皮葡萄球菌，其中右眼12个，左眼11个，左右眼阳性率差异无统计学意义（P=0．825）。31个培养阳性菌株对加替沙星、妥布霉素、左氧氟沙星、氧氟沙星、环丙沙星敏感性百分比依次为：100．00％（31／31）、96．77％（30／31）、93．55％（29／31）、90．32％（28／31）和74．20％（23／31）。所有患者手术后6个月均无感染。结论常规LASIK术中角膜刀片及术中使用的棉签可培养出细菌，主要为表皮葡萄球菌，其对三、四代喹诺酮类抗生素（加替沙星）以及妥布霉素滴眼液敏感，手术前后合理使用抗生素滴眼液对预防手术后感染有重要作用。

Objective The microbial culturing results were analysed from samples of the microkeratome blade and sponges in laser in situ keratomileusis （LASIK） procedures as for chossing the rational antiotic eye drops for preventing infectious keratitis. Method In this prospective study, 106 microkeratome blades and 212 sponges were cultured in routine LASIK procedure, at Excimer laser center in Henan Eye Institute During March to April 2009. Positive cultures were then sent for routine sensitivities and the results were analysed. Results 8 of the 106 blades were culturing positive, the positive rate was 7.55%. Each four positive cultures were in male and female patients. There was no statistical difference with gender（P = 1. 000）. 23 of the 212 sponges cultures were positive. The positive rate was 10. 38%. All positive cultures grew Staphylococcus epidermidis. Twelve sponge positive cultures were in right eye and 11 were in left eye. There was no statistical difference between the right eye and left eye （ P = 0. 825 ）. All of the 31 positive cultures were sensitive to gatifloxacin. The sensitivity of gatifloxacin, tobramycin, levofioxacin, ofloxacin, and ciprofloxacin were 100.00% , 96. 77% （ 30/31 ） , 93.55% （ 29/31 ） , 90. 32% （28/31） and 74. 20% （23/31） respectively. All the patients have no infectious keratitis followed-up more then 6 monthes. Conclusion There could be positive cultures from samples of the microkeratome blade and sponges in routine LASIK procedures but no patients with positive cultures developed postoperative infectious keratitis. The main positive bacteria was Staphylococcus epidermidise. They are sensitive to third and the fourth-generation fluoroquinolones and tobomycin antibiotics. Pre and post-operative supply of sensitive antibiotics can prevent post-operative infection.