眼科术前结膜囊细菌培养

Conjunctival bacterial flora culture before eye surgery

目的:回顾性分析眼科手术前结膜囊细菌培养的阳性菌构成及药物敏感性。方法:选取2016年1月至2018年1月在武汉大学人民医院眼科中心住院的3 205例患者,按照入院疾病不同,分为3组行眼分泌物细菌培养,对阳性菌株和药敏结果进行统计分析。结果:3 205例患者眼分泌物培养的阳性率为8.33%。其中白内障患者1 435例,阳性率为9.13%。青光眼、孔源性视网膜脱离患者总数分别为870,900例,阳性率分别为10.11%,5.33%。孔源性视网膜脱离组与白内障组(P=0.0008)、青光眼组(P=0.0002)相比,差异均有统计学意义(均P<0.05)。白内障与青光眼组相比,差异无统计学意义(P>0.05)。细菌菌种的阳性株以革兰阳性细菌为多,占77.90%,其中表皮葡萄球菌最多,占革兰阳性菌的66.83%。药敏检查结果示绝大多数菌株都对红霉素耐药,对万古霉素、庆大霉素、阿米卡星敏感;对妥布霉素及环丙沙星的敏感性稍低。结论:术前常规结膜囊无菌化极为重要,尤其是眼前节手术(如青光眼、白内障)术前。

Objective： To analyze the conjunctival bacterial flora and antibiotic resistance pattern in the patients undergoing surgery. Methods： From January 2016 to 2018, 3 205 patients hospitalized in the Eye Center of People＇s Hospital of Wuhan University were divided into three groups according to the diseases. The preoperative conjunctival cultures and antibiotic susceptibility tests of 3 205 eyes were studied retrospectively. Results： Of 3 205 eyes, 267（8.33%） had positive cultures. The number of cases of cataract, glaucoma and retinal detachment was 1 435, 870 and 900, respectively and the positive rate was 9.13%, 10.11%, 5.33%. Statistical significance was observed in the retinal detachment patients compared with their counterparts with cataract and glaucoma（both P〈0.05）. There was no statistically significant difference between the cataract and glaucoma groups（P〈0.05）. Grampositive bacterium（G＋）（77.90%） was the most common bacterial isolate, mainly staphylococcus epidermidis（66.83%）. Most of the strains were resistant to erythromycin, sensitive to vancomycin, gentamicin and amikacin. The sensitivity of tobramycin and ciprofloxacin was slightly lower. Conclusion： It is of significance to make preoperative conjunctival preparation, especially glaucoma and cataract patients.