细菌性角膜炎951例病原学及药物敏感性分析

Pathogenicity and drug sensitivity analysis of 951 patients of bacterial keratitis

目的探讨并分析细菌性角膜炎病原学特征、药物敏感性特点及其变迁。方法回顾性病例研究。收集2011年6月至2018年6月浙江大学附属第二医院眼科中心拟诊感染性角膜炎的培养标本951份,总结并分析患者的一般资料、细菌病原学及药物敏感性试验结果。结果共收集送检角膜培养标本951份,细菌培养阳性标本105份,占11.0%,其中来自男性患者70份,女性患者35份,男女比例为2:1,年龄13~82 (54.3±17.2)岁。培养阳性的细菌中,革兰阳性球菌59株,占56.2%,革兰阴性杆菌32株,占30.5%。肺炎链球菌(29.5%)最常见,铜绿假单胞菌(19.0%)次之。细菌对10种抗菌药体外药物敏感性试验结果显示,万古霉素、左旋氧氟沙星敏感率高,头孢曲松敏感率低于其他药物。多重耐药菌占总细菌的13.3%,其中葡萄球菌属(43.5%)中多重耐药菌显著高于假单胞菌属(5.0%)(χ~2=8.320,P=0.004)及链球菌属(2.8%)(χ~2=15.327,P=0.000)。结论近年来,引起角膜感染的细菌种类在发生变化,肺炎链球菌为最常见细菌。角膜细菌对左旋氧氟沙星的敏感率最高,多重耐药菌主要发现于葡萄球菌属中。

Objective To explore the pathogenic characteristics,drug sensitivity characteristics and its changes in bacterial keratitis.Methods Retrospective case study.Totally 951 samples diagnosed as infectious keratitis were collected from the Eye Center of the Second Affiliated Hospital of Zhejiang University from June 2011 to June 2018,following the summary analysis of patient general information,bacterial pathogens and drug susceptibility test results.Results A total of 951 corneal culture specimens were collected,of which 105 specimens were positive for bacterial culture,accounting for 11.0%,including 70 male patients and 35 female patients,the male to female ratio was 2:1,aged 13-82(54.3±17.2) years.Among the culture-positive bacteria,fifty-nine were Gram-positive cocci,accounting for 56.2%,and 32 were Gram-negative bacilli,accounting for 30.5%.Streptococcus pneumoniae(29.5%) was the most common,followed by Pseudomonas aeruginosa(19.0%).The in vitro drug susceptibility test of bacteria against 10 antibacterial drugs showed that vancomycin and levofloxacin had high sensitivity rate,and the sensitivity of ceftriaxone was lower than that of other drugs.Multi-drug resistant bacteria accounted for 13.3% of total bacteria,and multi-drug resistant bacteria(43.5%) in Staphylococcus were significantly higher than Pseudomonas(5.0%)(χ~2=8.320,P=0.004) and Streptococcus(2.8%)(χ~2=15.327,P=0.000).Conclusion In recent years,the types of bacteria that cause corneal infections are changing,and Streptococcus pneumoniae is the most common bacteria.Corneal bacteria have the highest sensitivity to levofloxacin,and multi-drug resistant bacteria are mainly found in Staphylococcus.