灌注液中庆大霉素对白内障患者结膜囊细菌的作用

Effect of gentamicin in irrigating solutions on bacteria in conjunctival sac of cataract patient

目的:分析白内障手术灌注液中庆大霉素对白内障患者结膜囊细菌的作用,为制定围手术期眼内炎预防措施提供依据。方法:采集200例白内障患者结膜囊拭子标本,进行细菌培养鉴定和药物敏感试验,观察检出细菌对20μg/mL、40μg/mL、80μg/mL庆大霉素和2μg/mL左氧氟沙星敏感率。结果:结膜囊细菌培养阳性检出率为62%,其中以表皮葡萄球菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为3.22%,耐甲氧西林表皮葡萄球菌(MRSE)检出率为28.2%;全部检出细菌对20μg/mL、40μg/mL、80μg/mL庆大霉素和2μg/mL左氧氟沙星敏感率分别为79.84%、95.16%、97.58%、78.23%,中高浓度庆大霉素和左氧氟沙星比较,差异有统计学意义(均P<0.05);MRSA和MRSE对20μg/mL、40μg/mL、80μg/mL庆大霉素和2μg/mL左氧氟沙星敏感率分别为69.23%、94.87%、100%、41.03%,各浓度庆大霉素和左氧氟沙星比较,差异有统计学意义(均P<0.05)。结论:白内障患者结膜囊细菌对灌注液中庆大霉素具有较高的敏感度,灌注液中加入适宜浓度庆大霉素,作为白内障围手术期眼内炎预防的措施应继续加以推广。

Objective:To analyze the effect of gentamicin in cataract irrigating solutions on bacteria in conjunctival sac of cataract patient and to provide the evidence for endophthalmitis precaution in cataract perioperative period.Methods:Bacterial culture and drug sensitive test were performed for 200 samples from cataract patients’conjunctival sac.Susceptibility rates of detected pathogens against 20μg/mL,40μg/mL,80μg/mL gentamicin and 2μg/mL levofloxacin were observed.Results:Cultural positive rate of conjunctival sac was 62%(mainly Staphylococcus epidermidis,among them MRSA 3.22%,MRSE 28.2%).The sensitivity rates of all detected bacteria to 20μg/mL,40μg/mL,80μg/mL gentamicin and 2μg/mL levofloxacin were 79.84%,95.16%,97.58%,78.23%,respectively.The difference between high and medium concentrations of gentamicin and levofloxacin was statistically significant(all P<0.05).The sensitivity rates of MRSA and MRSE to 20μg/mL,40μg/mL,80μg/mL gentamicin and 2μg/mL levofloxacin were 69.23%,94.87%,100%,41.03%,respectively.The difference between gentamicin in each concentration and levofloxacin was statistically significant(all P<0.05).Conclusion:The bacteria in the conjunctival sac of patients with cataract have a high sensitivity to gentamicin in irrigating solutions.Gentamycin at appropriate concentration in irrigating solutions is a good measure for perioperative endophthalmitis prevention during cataract surgery.