化脓性角膜溃疡常见致病菌的变迁

The variance of pathogenic organisms of purulent ulcerative keratitis

目的 探讨化脓性角膜溃疡的致病菌谱变迁 ,为临床治疗选择药物提供依据。方法对 1 995～ 2 0 0 0年 1 4 30例化脓性角膜溃疡病原菌培养标本的结果进行回顾性分析 ,并复习文献进行比较。结果 在 1 4 30例检测标本中 ,2 58例细菌培养阳性 (1 8 0 % ) ,498例真菌培养阳性 (34 8% ) ,34例棘阿米巴培养阳性 (2 4% ) ;640例 (44 8% )培养阴性。阳性病菌中 ,金黄色葡萄球菌 (1 6例 ,6 2 % )和绿脓杆菌 (56例 ,2 1 7% )均有所下降 ,而条件致病菌如表皮葡萄球菌 (71例 ,2 7 5 % )则明显增加。真菌致病菌中 ,主要致病菌为镰刀菌属 (32 1例 ,64 5 % )。药物敏感试验 :细菌对氟喹诺酮类抗生素的耐药性有逐渐上升趋势 ,近半数的绿脓杆菌对庆大霉素耐药 ,而对妥布霉素等敏感 ,镰刀菌属对常用抗真菌药物的耐药性明显升高。

Objective To identify the variance of pathogens of purulent keratitis and their resistance patterns to antibiotics Methods From January 1995 to October 2000, all patients with suspected infectious corneal ulcer were examined by bacterial, fungal and Acanthameoba culture The results of microorganism culture were compared with those in literature Results Of the specimens in 1 430 cases, there were 790 cases (55 2%) with positive culture including bacterial isolates in 258 cases (18 0%), fungal isolates in 498 cases (34 8%) and parasites in 34 cases (2 4%) The Staphylococcus aureous and Pseudomonas aeruginosa that had markedly declined since 1980s represented 6 2% and 21 7% of bacterial isolates respectively However, the opportunity organism such as Staphylococcus epidermidis represented 27 5%, a tendency of gradual increase The most common fungal pathogen was fusarium spp that represented 64 5% of all positive fungal cultures, and Aspergillus spp (13 6%) occupied the second place The resistance of the ocular bacteria to fluoroquinolones gradually increased Although the Pseudomonas aeruginosa was resistant to gentamycin in 36 2%, it was almost no resistance to tobramycin (3 4%) The fusarium spp was shown to be resistant to a number of the anti fungal agents, but it is sensitive to natamycin Conclusion The survey of pathogens in purulent ulcerative keratitis and their resistance patterns to antibiotics helps in clinical treatment