393例眼内炎病原菌药敏结果及临床用药分析

Analysis of drug sensitivity of pathogenic bacteria and medication selection in 393 cases of endophthalmitis

目的:探讨眼内炎病原菌药物敏感性及临床用药选择情况,为临床合理用药提供依据。方法:对2012年1月至2016年12月北京同仁医院393例诊断为感染性眼内炎的病例资料进行回顾性分析。结果:393例眼内炎中外源性眼内炎占78.1%(307/393)、内源性眼内炎16.8%(66/393),其他5.1%(20/393),249例给予房水/玻璃体标本病原菌培养,培养阳性66例,阳性率26.5%,病原菌中革兰阳性球菌、革兰阴性杆菌、革兰阳性杆菌、厌氧菌和真菌分别占51.5%、28.7%、4.6%、4.6%和10.6%,其中革兰阳性球菌以表皮葡萄球菌为主(19.7%),革兰阴性杆菌以肺炎克雷伯菌为主(12.1%),革兰阳性球菌对万古霉素、利奈唑胺敏感率最高,均为100.0%,革兰阴性杆菌对亚胺培南、哌拉西林/三唑巴坦敏感率较高,分别为94.7%、89.5%。用药选择中全身用药前5位的分别为头孢曲松(34.1%)、左氧氟沙星(27.2%)、头孢呋辛(20.9%)、万古霉素(14.2%)和头孢克洛(10.9%),局部滴眼前3位分别为妥布霉素(77.3%)、左氧氟沙星(18.8%)和加替沙星(10.4%),局部注射前3位分别为妥布霉素(23.7%)、万古霉素(8.6%)和两性霉素B(2.5%),治疗后视力大于0.05占12.5%。结论:感染性眼内炎以外源性为主,其致病菌谱较广,应及早检测致病菌菌种及药物敏感性,对于病原菌不明确的细菌性眼内炎,提倡早期联合用药。

Objective：To investigate the drug sensitivity of pathogenic bacteria and drug treatment of endophthalmitis,thus to provide scientific basis for clinical rational use of antibiotics.Methods：The medical records of patients with infectious endophthalmitis in Beijing Tongren Hospital from January 2012 to December 2016 were analyzed retrospectively.Results：Of the 393 endophthalmitis cases,78.1% （307/393） were exogenous,16.8% （66/393） were endogenous,and 5.1% （20/393） were resulted by other causes.Pathogenic bacteria culture of aqueous/vitreous samples was performed for 249 patients,among whom 66 had a positive result,with a positive rate of 26.5%.Among the isolated pathogens,51.5%,28.7%,4.6%,4.6% and 10.6% were Gram-positive cocci,Gram-negative bacilli,Gram-positive bacilli,anaerobes and fungi,respectively.The most common Gram-positive bacterial pathogen was staphylococcus epidermidis （19.7%）.The most common Gram-negative bacterium was Klebsiella pneumonia （12.1%）.The susceptibility ratios of Gram-positive cocci to vancomycin and linezolid were both 100%.For Gram-negative bacilli,the susceptibility ratios to imipenem and piperacillin/tazobactam were 94.7% and 89.5%,respectively.The top 5 drugs for systemic administration were ceftriaxone （34.1%）,levofloxacin （27.2%）,cefuroxime （20.9%）,vancomycin （14.2%）,and cefaclor （10.9%）,the top 3 eye drops were tobramycin （77.3%）,levofloxacin （18.8%）,and gatifloxacin （10.4%）,and the top 3 intraocular injections were tobramycin （23.7%）,vancomycin （8.6%）,and amphotericin B （2.5%）.There were 12.5% patients who had a post-therapeutic visual acuity of more than 0.05.Conclusion：Most endophthalmitis cases are exogenous and caused by a variety of pathogens.Pathogenic bacteria culture and drug susceptibility should be conducted as early as possible.Combination drug therapy is preferred for patients with bacterial endophthalmitis with unknown pathogenic bacteria.