眼表烧伤患者结膜囊带菌分析

Study on bacteria status in conjunctival sac with ocular surface burn

目的了解烧伤状态下结膜囊的带菌情况，为其预防性使用抗感染药品提供依据。方法对2011年6月至2013年3月在重庆医大第一医院眼科就治的眼表烧伤患者（26只烧伤眼）及自愿者（25只正常眼）的结膜囊进行细菌培养和药物敏感试验，并对其结果进行分析。结果眼表烧伤患者患眼结膜囊细菌阳性率为53．85％（14／26），对照组正常结膜囊细菌阳性率为56．00％（14／25），2组比较差异无统计学意义（Х^2=0．024，P=0．877）。烧伤眼（26只眼）与正常眼（25只眼）均培养出2个菌种，5个菌株。正常眼所检出的14例阳性菌株中，革兰阳球菌占92．86％（13／14），其次为革兰阳性杆菌，占7．14％（1／14）。阳性菌株中表皮葡萄球菌为64．29％（9／14），头状葡萄球菌14．29％（2／14）。烧伤眼结膜囊检出的14例阳性菌株，主要由革兰阳球菌构成为92．86％（13／14），其次为革兰阳性杆菌占7．14％（1／14）。阳性菌株中表皮葡萄球菌42．86％（6／14），溶血葡萄球菌35．74％（5／14）。2组结膜囊优势菌种均以表皮葡萄球菌为主。烧伤眼表皮葡萄球菌占总检出阳性菌株的42．86％（6／14），较正常组的64．29％（9／14）低，差异无统计学意义（P=0．449，P〉0．05）；烧伤眼溶血性葡萄球菌阳性检出率明显高于正常眼，2组差异有统计学意义（P=0．041，P〈0．05）。结论烧伤眼与正常眼结膜囊内的细菌为常居菌。2组细菌阳性检出率、菌种数、革兰分类的构成比相似。但较于正常眼，烧伤眼结膜囊溶血葡萄球菌阳性率明显增高。其高检出率提示烧伤眼结膜囊的微环境可能已发生改变。故烧伤患者治疗过程中，应常规进行结膜囊细菌培养，并根据其结果选择敏感抗生素防止感染。

Objective To understand the bacteria status in the conjunctival sac with ocular surface burns, for the treatment of infection and aseptic preparation before operation. Methods A total of 26 eyes with ocular surface burns in our hospital were examined, and another 25 normal eyes in the same crowd were analyzed as the control group. Then, the results of bacterial culture results and drug sensitivity test were analyzed. Results The positive rate of the cultivation was 53.85% （14/26） in ocu- lar surface bums eyes, and 56% （14/25） in normal eyes. There was no statistical difference between two groups （Х^2=0.024, P =0.877）. In two groups of conjunctival sac, 5 species bacteria were cultivated, Gram-positive bacteria in 13 eyes （92.86%）, Gram-negative bacteria in 1 eye （7.14%）. There were 9 Staphylococcus epidermidis strains （64.29%） and Staphylococcus capitis 2 strains （14.29%） in bum eyes group. In control group, there were 6 Staphylococcus epidermidis strains （42.86%）, 5 strains of Staphy- lococcus haemolyticus （35.74%）. Two groups of conjunctival sac advantage strains were mainly Staphy- lococcus epidermidis. The positive rate of bum eyes of Staphylococcus epidermidis was 42.86%. It was lower than the normal group （64.29%）. There was no statistical difference of positive rate between two groups （P =0.449）. The positive rate of bum eyes of Staphylococcus haemolyticus was significant- ly higher than that in normal eyes. There was statistical difference of positive rate between two groups （P =0.041）. Conjunctival bacteria （coagulase negative Staphylococcus） in bum eyes group resisted to the commonly used in clinical drug, such as penicillin, ciprofloxacin, erythromycin; sensitive to moxi- floxacin, gentamicin. Conclusions There is no infuence whether or not with ocular surface bums in bacterial positive rate, the number of bacterial species, the constituent ratio of Gram classification and dominant strain. Compared with the normal eyes, the positive rate of bum of conjunctival sac hemolyt- ic Staphylococcus is increased. The bacterial culture of conjunctiva sac is necessary for treatment of oc- ular surface burns patients. And sensitive antibiotics shall be used to prevent eye infections.