四川地区细菌性角膜炎病因与致病菌特征分析

Analysis of etiological factors and characteristics of pathogenic bacteria resulting in bacterial keratitis in Sichuan Province

目的分析四川地区细菌性角膜炎患者的病因及致病菌特征,为本地区细菌性角膜炎的防控提供参考。方法回顾性分析2015年1月至2019年12月我院拟诊为细菌性角膜炎的346份病历(均为单眼),分析总结患者病因、细菌培养结果、致病菌分布及其耐药情况。结果346名拟诊患者中,最常见的病因为佩戴角膜接触镜(39.9%)、眼表疾病(19.9%)和眼外伤(10.4%)。共有183份细菌培养阳性标本,阳性率52.9%,其中革兰阳性菌57.9%(106/183),阴性菌42.1%(77/183)。两类细菌中分离率位居前三位的分别为表皮葡萄球菌(24.6%)、肺炎链球菌(13.7%)和金黄色葡萄球菌(10.9%)以及铜绿假单胞菌(21.3%)、大肠埃希菌(7.7%)和肺炎克雷伯杆菌(6.0%)。革兰阳性菌对万古霉素、利奈唑胺、复方新诺明、利福平和左氧氟沙星有较好的敏感性,革兰阴性菌对亚胺培南、哌拉西林和三代头孢有较好的敏感性。结论佩戴角膜接触镜是四川地区细菌性角膜炎最主要的病因,本地区致病菌的流行病学调查有助于临床医生在治疗细菌性角膜炎时选择合理的治疗方案。

Objective To analyze etiological factors and characteristics of pathogenic bacteria resulting in bacterial keratitis in Sichuan Province.The results could be helpful for prevention and control of bacterial keratitis.Methods We retrospectively collected 346 cases(346 monocular eyes)that were diagnosed as bacterial keratitis in our hospital.Etiological factors,results of bacterial culture,distribution and antimicrobial resistance of pathogenic bacteria were analyzed.Results Among the 346 cases diagnosed as bacterial keratitis,the most common etiological factors included wearing corneal contact lens(39.9%),ocular surface diseases(19.9%)and ocular trauma(10.4%).Positive bacterial culture results were acquired in 183 patients,with a positive rate of 52.9%.Among the detected bacteria,57.9%(106/183)gram-positive and 42.1%(77/183)gram-negative bacteria were found.The most common gram-positive bacteria were Staphylococcus epidermidis(24.6%),Streptococcus pneumonia(13.7%)and Staphylococcus aureus(10.9%).Pseudomonas aeruginosa(21.3%),Escherichia coli(7.7%)and Klebsiella pneumonia(6.0%)were most commonly detected among gram-negative bacteria.While gram-positive bacteria presented relatively high susceptibility to vancomycin,linezolid,sulfamethoxazole,rifampicin and levofloxacin,gram-negative bacteria presented relatively high susceptibility to imipenem,piperacillin and third-generation cephalosporins.Conclusion Wearing corneal contact lens is the most common etiological factor resulting in bacterial keratitis in Sichuan province.Epidemiological investigation in the local district could be helpful for choosing better therapeutic strategies against bacterial keratitis.