婴幼儿泪囊炎泪囊冲洗液微生物学培养及药物敏感性分析

Microbiological Culture and Drug Sensitivity Analysis of Lacrimal Sac Flushing Fluid of Infantile Dacryocystitis

目的调查婴幼儿泪囊炎的微生物检出率和感染谱,为临床合理使用抗生素提供参考。方法纳入华中科技大学同济医学院附属同济医院2018年10月—2019年12月婴幼儿泪囊炎患儿198例(其中双眼患儿32例),男115例,女83例,男女比为1.39:1。所有患儿均行鼻泪管探通治疗,收集患儿泪囊冲洗液标本,进行细菌培养及药物敏感性试验。根据药敏试验结果,分析致病菌药敏和耐药情况。结果婴幼儿泪囊炎的致病菌平均检出率为69.2%(137/198),各年龄段致病菌的检出率无明显差异,有15例患儿同时检测出2种或2种以上致病菌。婴幼儿泪囊炎致病菌菌种种类多,革兰阳性球菌构成婴幼儿泪囊炎的主要致病菌,包括肺炎链球菌(眼睛43只,28.9%)、金黄色葡萄球菌(眼睛15只,10.1%)、缓症链球菌(眼睛13只,8.7%)等。革兰阴性致病菌主要包括:卡它(黏膜炎)摩拉菌(眼睛12只,8.1%)、流感嗜血杆菌(眼睛7只,4.7%)、嗜麦芽窄食单胞菌(眼睛7只,4.7%)等。还包含少见的致病菌,其中真菌包括:近平滑念珠菌(眼睛9只,6.0%)和黄曲霉(眼睛1只,0.7%)。药敏试验结果发现,大多数致病菌对左氧氟沙星、头孢曲松和万古霉素敏感。结论革兰阳性球菌仍为婴幼儿泪囊炎的主要致病菌,左氧氟沙星滴眼液可作为首选眼部抗感染用药,能有效控制致病菌感染。

Objective To investigate the microbial detection rate and microbial spectrum of infantile dacryocystitis,and to provide references for rational use of antibiotics in clinic.Methods A total of 198 infants(32 of whom were binocular)with dacryocystitis were included in this study from October 2018 to December 2019 in Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology.There were 115 males and 83 females with a male-to-female ratio of 1.39:1.All the patients were treated with nasolacrimal duct probing,and samples of lacrimal sac flushing fluid were collected for bacterial culture and drug sensitivity test.According to the results,the drug sensitivity and resistance of pathogenic bacteria were analyzed.Results The average detection rate of pathogenic bacteria in infantile dacryocystitis was 69.2%(137/198).There was no significant difference in the detection rate of pathogenic bacteria in all ages.There were 15 cases of children with two or more kinds of pathogenic bacteria detected at the same time.There were various kinds of pathogenic bacteria in infantile dacryocystitis,and Gram-positive coccus constituted the main pathogenic bacteria in infantile dacryocystitis,including Streptococcus pneumoniae(43 eyes,28.9%),Staphylococcus aureus(15 eyes,10.1%),Streptococcus mitis(13 eyes,8.7%),etc.The Gram-negative pathogens mainly included:Moraxella catarrhalis(12 eyes,8.1%),Haemophilus influenzae(7 eyes,4.7%),stenotrophomonas maltophilia(7 eyes,4.7%),etc.It also contains rare pathogenic bacteria,among which fungi include:Candida albicans(9 eyes,6.0%)and Aspergillus flavus(1 eyes,0.7%).The results of drug sensitivity test showed that most pathogenic bacteria were sensitive to levofloxacin,ceftriaxone,and vancomycin.Conclusion Gram-positive cocci are still the main pathogenic bacteria of infantile dacryocystitis.Levofloxacin eye drops can be the first choice for the anti-infective use in the patients with infantile dacryocystitis,which can effectively control the most of the pathogenic bacteria infection.