近40年我国细菌性角膜炎病原学及药物敏感性变化Meta分析

Etiology and drug sensitivity of bacterial keratitis in recent 40 years in China:a Meta-analysis

目的评价我国近40年细菌性角膜炎患者病原菌分布及药物敏感性变化规律。方法采用Meta分析方法,检索PubMed、ScienceDirect、Embase、中国知网和万方数据知识服务平台5个数据库。研究现场限定为以医院为基础,人群不限,文献发表时间为1980—2020年,文献研究设计类型为横断面研究,文献中英文不限。2名研究人员遵循纳入标准和排除标准完成文献检索、数据提取及参考针对“率”的方法学评分系统对文献进行质量评估。采用Q检验和I 2检验评估纳入文献的异质性,并依据异质性决定采用固定效应模型或随机效应模型计算合并后的率指标完成Meta分析。结果最终纳入27篇原始研究文献,共计50046例细菌性角膜炎患者入组。随机效应模型Meta分析结果显示,细菌性角膜炎细菌培养阳性率为28%(95%CI:0.24~0.32)。培养阳性细菌中革兰阳性球菌和革兰阴性杆菌占比分别为57%(95%CI:0.52~0.62)和32%(95%CI:0.28~0.37),革兰阳性杆菌和革兰阴性球菌占比分别为8%(95%CI:0.06~0.10)和1%(95%CI:0.01~0.02)。近40年间,我国细菌性角膜炎中分离的革兰阳性球菌比例呈上升趋势,革兰阴性杆菌比例逐渐下降。其中,凝固酶阴性葡萄球菌比例最高,占23%(95%CI:0.17~0.30),其次为铜绿假单胞菌占18%(95%CI:0.14~0.23)、肺炎链球菌占8%(95%CI:0.06~0.12)、金黄色葡萄球菌占6%(95%CI:0.04~0.08)、棒状杆菌占4%(95%CI:0.03~0.07)以及大肠杆菌占4%(95%CI:0.02~0.06)。药物敏感性试验结果显示,革兰阳性球菌对万古霉素、莫西沙星、左氧氟沙星、氧氟沙星高度敏感;铜绿假单胞菌对妥布霉素最敏感,大肠杆菌对氧氟沙星最敏感。结论近40年间我国细菌性角膜炎中分离的革兰阳性球菌比例呈上升趋势,革兰阴性杆菌比例逐渐下降。目前凝固酶阴性葡萄球菌和铜绿假单胞菌为我国细菌性角膜炎感染常见的致病菌,各种菌属对常用抗生素的敏感性均有下降趋势,应根据药物敏感性结果正确选择敏感抗菌药物治疗。

Objective To evaluate the distribution and drug sensitivity of pathogenic bacteria in patients with bacterial keratitis in recent 40 years in China.Methods A Meta-analysis was conducted.Five databases including PubMed,ScienceDirect,Embase,CNKI and Wanfang Data Knowledge Service Platform were searched.The research was limited to the hospital-based cross-sectional studies published in Chinese and English between 1980 and 2020,without limitations of subject.Two researchers followed the inclusion and exclusion criteria to complete literature retrieval,data extraction and methodological quality evaluation.The literature quality was assessed with reference to a methodological scoring system for rates.Q test and I 2 test were used to quantify the degree of heterogeneity of the included literature.According to the heterogeneity,the fixed effects model or random-effects model was used to calculate the combined rates indicators to perform the Meta-analysis.Results Twenty-seven original studies were incorporated,including 50046 cases of bacterial keratitis.A random-effects model for the Meta-analysis showed that the positive rate of bacterial culture in bacterial keratitis was 28%(95%CI:0.24-0.32).Among the culture-positive bacteria,the percentages of gram-positive cocci and gram-negative bacilli were 57%(95%CI:0.52-0.62)and 32%(95%CI:0.28-0.37),respectively.The percentages of gram-positive bacilli and gram-negative cocci were 8%(95%CI:0.06-0.10)and 1%(95%CI:0.01-0.02),respectively.In the recent 40 years,the proportion of gram-positive cocci isolated from corneas in China was on the rise,and the proportion of gram-negative bacilli was on the decline.Among them,coagulase-negative Staphylococcus accounted for 23%(95%CI:0.17-0.30),followed by Pseudomonas aeruginosa 18%(95%CI:0.14-0.23),Streptococcus pneumoniae 8%(95%CI:0.06-0.12),Staphylococcus aureus 6%(95%CI:0.04-0.08),Corynebacterium 4%(95%CI:0.03-0.07),and Escherichia coli 4%(95%CI:0.02-0.06).The results of the drug sensitivity test showed that gram-positive cocci were highly sensitive to vancomycin,moxifloxacin,levofloxacin and ofloxacin.Pseudomonas aeruginosa was most sensitive to tobramycin,and Escherichia coli was most sensitive to ofloxacin.Conclusions This Meta-analysis indicates that the proportion of gram-positive cocci isolated from corneas in China has been on the rise,while the proportion of gram-negative bacilli was on the decline during the recent 40 years.Coagulase-negative Staphylococcu s and Pseudomonas aeruginosa have become the most common pathogens of bacterial keratitis in China.The sensitivity of various bacteria to commonly used antibiotics shows a downward trend.The sensitive antibiotics should be selected correctly according to the drug sensitivity results.