白内障PHACO术后感染性眼内炎的病原菌分布特征及耐药性分析

The pathogenic bacteria distribution and drug resistance of infectious endophthalmitis after PHACO operation

目的探讨白内障超声乳化手术（PHACO）术后感染性眼内炎的病原菌分布特征及耐药性分析。方法选择2006年11月至2013年12月来青田县人民医院就诊住院实施白内障PHACO术的患者共4 132例（6 734眼）,其中9例（9眼）患者术后发生眼内炎。对其进行细菌、真菌及阿米巴等的培养与鉴定,病原菌的种类分布及体外药敏试验。结果 PHACO术后眼内炎的发生率为0.13%（9/6 734）,其中有8眼细菌培养阳性（房水培养2眼,玻璃体培养6眼）,阳性率为88.9%：表皮葡萄球菌4眼,粪肠球菌2眼,金黄色葡萄球菌1眼,醋酸不动杆菌1眼。所有标本均未发现真菌感染。8眼细菌培养阳性的标本行药敏试验,表皮葡萄球菌及粪肠球菌等均对万古霉素、利福平、利奈唑胺敏感,对其他抗生素耐药情况则不同。进行术后6个月随访,9例患者术后1-6个月最佳矫正视（BCVA）与术前比较,差异均有统计学意义（P〈0.05）,提示患者术后的BCVA较术前有提高,6个月较1个月有提高。所有患者末次随访时炎症均得到有效控制,无复发眼内炎。结论白内障PHACO术后的感染性眼内炎以表皮葡萄球菌及粪肠球菌为主的条件致病菌为主要致病的菌株,其中万古霉素对这两种菌属以及其他菌属均有良好的药敏性,可以作为临床眼科预防和治疗的参考用药。

Objective To study the distribution and drug resistance of pathogens in infective endophthalmitis after PHACO surgery.Methods 4132patients（6734eyes）who accepted phacoemulsification（PHACO）procedure in our hospital during November 2006 and December 2013 were selected,including 9cases（9eyes）of postoperative endophthalmitis.The pathogens（bacteria,fungi and amoebas）were cultured and identified;their drug susceptibility was detected in vitro.Results The incidence rate of postoperative endophthalmitis was 0.13%（9/6734）,among which 8eyes（88.9%）were germiculture positive（2cases of aqueous humor and 6cases of vitreous）.Staphylococcus epidermidis was detected in 4eyes,Enterococcus faecalis in 2eyes,Staphylococcus aureus in 1eye,and Acinetobacter acetate in 1eye.No fungi were detected.The Staphylococcus epidermis and Enterococcus caecalis were susceptible to vancomycin,rifampicin and linezolid,while resistant to other antibiotics in different extents.6 months of postoperative follow-up showed that 9patients gained better BCVA（P〈0.05）after the surgery,which was further improved at Month 6.The inflammation of all patients was effectively controlled at the last follow-up with no reccurence cases.Conclusion The main pathogens causing infectious endophthalmitis after PHACO are conditional pathogenic bacteria such as Staphylococcus epidermis and Enterococcus caecalis,which can be controlled effectively with vancomycin.