2006至2015年我国北方地区细菌性角膜炎病原学及药物敏感性分析

Etiological analysis and in vitro drug sensitivity of bacterial keratitis in northern China in the period of 2006-2015

目的探讨细菌性角膜炎的病原学、药物敏感性特点及其变迁。方法回顾性系列病例研究。收集2006至2015年北京同仁眼科中心拟诊角膜细菌感染的细菌培养标本6220份，总结分析患者一般资料、病原学及药物敏感性试验结果。计数资料的组间差异应用卡方检验，阳性率及构成比的年度变化趋势应用Spearman相关分析。结果共收集送检角膜细菌培养标本6220份，阳性标本1133份，阳性率为18．2％，其中来自男性患者673份，女性460份，年龄11d至94岁，平均年龄（45．3±22．1）岁。培养阳性的细菌中，革兰阳性球菌741株，占62．0％，阴性杆菌303株，占25．2％。表皮葡萄球菌最常见，共321株，占细菌总数的26．9％，铜绿假单胞菌次之，共131株，占11．0％。细菌对11种抗菌药体外药物敏感试验结果表明，加替沙星敏感率为最高，妥布霉素和头孢他啶敏感率低于其他药物。多重耐药菌占总细菌的29．2％。结论近10年来，导致角膜感染的细菌种类在发生变化，表皮葡萄球菌为最常见细菌。角膜细菌对以加替沙星为代表的第4代氟喹诺酮类抗菌药的敏感率为最高。

Objective To analyze the etiology and drug sensitivity of bacterial keratitis and their changes, and to provide evidence for treatment and drug selection of bacterial keratitis. Methods Retrospective case series study. From January 2006 to December 2015, corneal specimens suspected of bacterial infection were collected and cultured in Beijing Tongren Eye Center. General information of patients, etiological results and drug sensitivity test results were summarized and analyzed. The Chi-square test and Spearman correlation analysis were performed using SPSS 20.0 software. Results A total of 6 220 6orneal specimens were collected, and 1 133 of them were positive. The positive rate was 18.2%. Among the positive specimens, 673 were from males and 460 were from females, aged from 11 days to 94 years old, with an average age of （45.3 ± 22.1） years old. Among all isolated bacteria, 741 strains of Gram-positive cocci accounted for 62.0%, and 303 strains of Gram-negative bacilli accounted for 25.2%. Three hundred and twenty-one strains of Staphylococcus epidermidis was the most common isolates, accounting for 26.9% of all bacteria isolated, which was followed by 131 Strains of Pseudomonas aeruginosa （11.0%）. In vitro drug sensitivity test results of 11 antibiotics showed that the sensitivity rate of gatifloxacin was highest, while the sensitivity rate of tobramycin and ceftazidime was lower than the other drugs. Multi-drug resistant bacteria accounted for 29.2% of all bacteria isolated. Conclusion Bacterial species causing corneal infection are changing over time in northern China within recent 10 years. Staphylococcus epidermidis is the most common bacteria isolated. The sensitivity rate of corneal bacteria to the fourth generation of fluoroquinolone antibiotics represented by gatifloxacin is highest. （Chin J Ophthalmol, 2017, 53： 662-667）