细菌性角膜炎的病原学分析及预防对策

Analysis of pathogenic characteristics and preventive measures of bacterial keratitis

目的探讨细菌性角膜炎患者病原学特征及其预防对策,为临床治疗提供参考依据。方法选取2015年1月-2016年1月河北省眼科医院收治的52例细菌性角膜炎患者为研究对象,收集该组患者的临床资料进行回顾性分析,分析病原菌分布及耐药性情况并提出相应的预防对策。结果 52例细菌性角膜炎患者中共分离出21株病原菌,其中革兰阳性球菌11株(52.38%),革兰阴性杆菌7株(29.41%),革兰阳性杆菌2株(9.52%),革兰阴性球菌1株(4.76%)。革兰阳性球菌中,金黄色葡萄球菌对青霉素G、亚胺培南的耐药率分别为100.00%、80.00%;表皮葡萄球菌对青霉素G、氨苄西林及亚胺培南的耐药率分别为100.00%、66.67%及66.67%;肺炎链球菌对青霉素G、氨苄西林的耐药率均为100.00%,对亚胺培南、头孢他啶的耐药率均为50.00%。革兰阴性杆菌中,铜绿假单胞菌对头孢曲松、头孢呋辛及头孢唑林的耐药率均为66.67%,对氨苄西林的耐药率则达到100.00%,大肠埃希菌对头孢曲松、头孢呋辛及氨苄西林的耐药率均为100.00%,肺炎克雷伯菌对环丙沙星、头孢唑林的耐药率均为0.00%。结论细菌性角膜炎患者病原菌类型较多,以革兰阳性球菌和革兰阴性杆菌为主。临床治疗时应进一步加强病原菌动态监测,正确分析病原菌分布及其变化趋势,结合药敏试验结果及时调整抗菌药物,合理使用抗菌药物进行治疗,进一步提升治疗效果。

Objective To investigate the pathogenic characteristics and preventive measures of bacterial keratitis patients,so as to provide reference for clinical treatment.Methods A total of 52 patients with bacterial keratitis in Hebei Eye Hospital from January 2015 to January 2016 were selected as objects of study.The clinical data were collected.The distribution and drug resistance of pathogenic bacteria were analyzed and the corresponding preventive measures were made.Results From the 52 patients with bacterial keratitis,21 pathogenic strains were isolated,including 11 strains of Gram-positive cocci accounting for 52.38%,7 strains of Gram-negative bacilli accounting for 29.41%,2 strains of Gram-positive bacilli accounting for 9.52%,and 1 strain of Gram-negative cocci accounting for 4.76%.In the Gram-positive cocci,the resistance rates of Staphylococcus aureus to Penicillin G and Imipenem were 100.00%and 80.00%respectively;the drug resistance rates of Staphylococcus epidermidis to Penicillin G,Ampicillin and Imipenem were 100.00%,66.67%and 66.67%respectively;the resistance rtaes of Streptococcus pneumoniae to Penicillin G and Ampicillin were 100.00%,the resistance rates to Imipenem to Ceftriaxone,Cefuroxime and Cefazolin were 66.67%,and Ampicillin resistance rate reached 100.00%;the resistance rates of Escherichia coli were not less than 50.00%,its resistance rates to Ceftriaxone,Cefuroxime and Ampicillin were 100.00%;the resistance rates of Klebsiella pneumoniae to Ciprofloxacin and Cefazolin were 0.00%.Conclusions There are many types of pathogenic bacteria in the patients with bacterial keratitis.Grampositive cocci and Gram-negative bacilli are the main pathogens.During clinical treatment the dynamic monitoring of pathogens should be further strengthened,pathogen distribution and change trend should be correctly analyzed,antibacterial drugs should be timely adjusted and rationally used according the results of drug sensitive test to further improve the therapeutic effect.