白内障围术期局部使用左氧氟沙星和加替沙星对结膜囊细菌变化的影响

Perioperative topical use of levofloxacin versus gatifloxacin on bacterial changes in conjunctival sac in cataract surgery

目的对比白内障患者围术期局部使用左氧氟沙星和加替沙星后结膜囊细菌的变化。方法选取2018年1-6月于我中心接受白内障手术的患者共80例(80眼),随机分为两组,A组(40例)使用0.3%左氧氟沙星滴眼液,B组(40例)使用0.3%加替沙星滴眼液,两组患者均于术前3 d～术后7 d连续使用眼药,4次/d。在3个时间点收集结膜囊标本并进行细菌培养及鉴定:入院未使用任何眼药时(T_1)、术前使用眼药3 d后(T_2)、术后使用眼药7 d后(T_3)。结果未用药前(T_1),两组结膜囊细菌构成基本相同,其中表皮葡萄球菌等G^+球菌是结膜囊中最常见的细菌。用药后,在T_2时间点,两组细菌培养阴性率均升高,但B组的抗菌效果开始显著高于A组(P <0.05);与A组相比,B组的表皮葡萄球菌检出率有所降低。在T_3时间点两组细菌培养阴性率持续升高,而B组的抗菌效果仍然显著高于A组(P <0.05)。此外,经时间趋势分析:两组的细菌培养阴性率均呈线性下降趋势(P <0.05)。结论加替沙星滴眼液不论在白内障术前还是术后对结膜囊细菌的抗菌效果均优于左氧氟沙星滴眼液,在白内障围术期局部抗菌药的选择上可优先考虑加替沙星。

Objective To compare the bacterial changes in conjunctival sac by perioperative use of levooxacin versus gatioxacin in cataract surgery.Methods A total of 80 patients(80 eyes)who underwent cataract surgery in the rst medical center of Chinese PLA General Hospital from January to June in 2018 were selected and randomly divided into two groups:patients in group A(40 cases)were treated with 0.3%levooxacin eye drop and patients in group B(40 cases)were treated with 0.3%gatioxacin eye drop.All patients used eye drops 4 times a day from 3 days before surgery through 7 days after surgery continuously.Conjunctival swabs were collected at 3 time points for bacterial culture and identication:before the preoperative application of topical antimicrobial agents(T1);3 days after eye drop use before surgery(T2);7 days after surgery(T3).Results Before the use of eye drops(T1),there was no signicant difference in the constitution of bacteria isolates in conjunctival sac between two groups,and the most common isolate was coagulase-negative staphylococci(CNS).After the use of eye drops(T2),the negative rate of bacteria culture increased in two groups,however,group B began to show better antibacterial effects than group A(P<0.05);The detection rate of CNS was lower in group B as compared with group A.At 7 days after surgery(T3),the negative rate of bacteria culture in two groups increased continuously,and the antibacterial effect in group B was still significantly higher in comparison with group A(P<0.05).In addition,the negative rate of bacteria culture in two groups showed a linear decline trend over time(P<0.05)exmined by Cochran Armitage trend test.Conclusion Perioperative administration of gatifloxacin is better than levofloxacin in reducing bacterial contamination risk in cataract surgery,which suggests that it should be given priority in selection of topical antimicrobial agents.