眼科手术后感染的病原学分布及其药物敏感性分析

Etiological analysis of infection after eye surgery and the investigation of drug sensitivity

背景 目前临床工作和研究发现,细菌耐药现象日益严重.感染性疾病的盲目用药势必加重病原菌的耐药性,因此充分了解眼科手术后感染性致病菌的分布特点及其对抗菌药物的敏感性有利于药物的选择. 目的 分析眼部手术后发生感染的病原菌分布特点及药物敏感性,为临床合理选择抗生素提供参考. 方法 对2009年1月至2011年12月进行微生物学检查取得分离培养阳性的病原菌进行针对常规抗生素的药物敏感性试验,对诊断为眼科术后感染患者的眼科标本共65例进行回顾性分析. 结果 65例眼科标本中革兰阳性菌35株,占53.8％；革兰阴性菌15株,占23.1％；真菌15株,占23.1％.其中表皮葡萄球菌占革兰阳性菌的42.9％,铜绿假单胞菌占革兰阴性菌的33.3％,曲霉菌属占真菌的60.0％.8株金黄色葡萄球菌中有3株为耐甲氧西林金黄色葡萄球菌（MRSA）,未发现耐万古霉素肠球菌（VRE）和耐万古霉素葡萄球菌（VRS）.体外药物敏感性试验发现,革兰阳性菌以表皮葡萄球菌、金黄色葡萄球菌为主,对利奈唑胺、万古霉素、左氧氟沙星、环丙沙星等药物的敏感率均＞50.0％,而对青霉素、红霉素等的敏感率均≤30.0％；革兰阴性菌以铜绿假单胞菌为主,对妥布霉素、阿米卡星、头孢他啶、头孢吡肟、头孢哌酮/舒巴坦钠、哌拉西林/他唑巴坦、亚胺培南、美罗培南的敏感率≥80.0％.结论 表皮葡萄球菌、金黄色葡萄球菌、铜绿假单胞菌、曲霉菌属是眼科手术后感染的主要病原菌,对眼科常用抗生素,如青霉素、红霉素、左氧氟沙星、头孢噻肟均呈现较高的耐药性,及时、合理选用敏感的抗生素是预防、控制和治疗眼科术后感染的关键.

Background Clinical researches showed that antimicrobial-resistance of bacterium is gradually serious.It is very important to master pathogen distribution and antimicrobial susceptibility after eye surgery.Objective This study was to investigate the distribution and drug sensitivity of pathogenic bacteria from ocular operative infection in 3-year duration to provide a reference for reasonable selection of antibiotics.Methods Sixtyfive positive specimens were obtained from 65 patients due to postoperative infection in Department of Ophthalmology of Shenzhou Hospital and Shengjing Hospital from 2009 January through 2011 December.The pathogenic bacteria were isolated and then the drug sensitivity test of conventional antibiotics was performed.Results Among the 65 ophthalmic specimens,35 strains of Gram-positive bacteria were isolated with the constituent ratio 53.8%,and 15 strains of Gram-negative bacteria accounted for 23.1%.Fungus was found in 15 cases with the constituent ratio 23.1%.Staphylococcus epidermidis accounted for 42.9% in Gram-positive bacteria,and Pseudomonas aeruginosa accounted for 33.3% in Gram-negative bacteria.Aspergillus was the main component of fungus,which accounted for 60.0% of the proportion 3 strains of methicillin-resistant Staphylococcus aureus （MRSA） in 8 strains of Staphylococcus aureus,but no vancomycin-resistant Enterococcus （VRE） and vancomycin-resistant Staphylococcus （VRS） were seen.The in vitro drug sensitivity test showed that the main Gram-positive bacteria,Staphylococcus epidermidis and Staphylococcus aureus,were sensitive to linezolid,vancomycin,levofloxacin and ciprofloxacin with the sensitive rates 〉50.0%,and these bacteria were lowly sensitive to penicillin and erythromycin with the sensitive rates ≤30.0%.Pseudomonas aeruginosa appeared to be the main Gram-negative bacteria,showing a sensitive rate ≥ 80.0% to tobramycin,amikacin,ceftazidime,cefepime,cefoperazone/sulbactam,piperacillin/tazobactam,imipenem and meropenem.Conclusions Staphylococcus epidermidis,Staphylococcus aureus,Pseudomonas aeruginosa and Aspergillus are primary pathogens in ocular infection after operation.Antibiotics such as penicillin,erythromycin,levofloxacin,cefotaxime seem to be relatively high resistant to eye infection.To choose sensitive antibiotics timely and reasonably is a key to the prevention and control of ocular infection after operation.