角膜溃疡刮片细菌检测及耐药性分析

Resistance surveillance of cornea bacteria

目的分析近5年的角膜溃疡组织培养阳性的病原菌及药敏情况,为细菌感染性角膜炎的诊治提供依据。方法对山东省眼科研究所自2013年1月至2017年12月收集的2774份角膜溃疡刮片进行细菌培养鉴定及药敏。细菌及药敏数据利用whonet 5.6软件进行统计分析。结果检出病原菌457株,总体阳性率16.5%。其中葡萄球菌属250株,占54.7%。检出前3位的是表皮葡萄球菌(191株)、铜绿假单胞菌(33株)、金黄色葡萄球菌(29株);金黄色葡萄球菌对眼科常用喹诺酮类的耐药率在15%以下,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为31%;表皮葡萄球菌对左氧氟沙星耐药率超60%,耐甲氧西林表皮葡萄球菌(MRSE)检出率为72%。铜绿假单胞菌对常用喹诺酮类耐药率也不足15%。喹诺酮类药物表皮葡萄球菌的耐药率明显高于金黄色葡萄球菌、铜绿假单胞菌及其他细菌,差异具有统计学意义(P<0.01)。结论表皮葡萄球菌、铜绿假单胞菌及金黄色葡萄球菌是本院细菌性角膜炎的主要病原菌,其对常用眼科喹诺酮类耐药率差异明显,临床上应依据感染病菌情况合理选用抗菌药物。

Objective To provide the basis for the diagnosis and treatment of bacterial infectious keratitis,the pathogenic bacteria and drug sensitivity of comeal ulcer were analyzed in the five years.Methods The bacteria culture,bacterial identification and drug susceptibility of 2,774 comeal ulcer slices were carried out.The data of bacteria and drug sensitivity were analyzed by whonet 5.6.Results Total 457 strains of pathogenic bacteria were detected,the total positive rate was 16.5%.Among them,250(54.7%)were Staphylococcus.The top 3 were Staphylococcus epidermidis(191 cases),Pseudomonas aeruginosa(33 cases),Staphylococcus aureus(29 cases).The resistance rate of staphylococcus aureus and Pseudomonas aeruginosa to quinolones was below 15%,and the resistance rate of Staphylococcus epidermidis to levofloxacin was over 60%.The detection rate of methicillin-resistant staphylococcus aureus(MRSA)and methicillin resistant Staphylococcus epidermidis(MRSE)were 31% and 72% respectively.The resistance rate of Staphylococcus epidermidis to quinolones were definitely higher than that of other bacteria(P<0.01).Conclusions Staphylococcus epidermidis,Pseudomonas aeruginosa and Staphylococcus aureus are the main pathogens of bacterial keratitis in our hospital,the rate of resistance to quinolones is different.