老年外伤性感染性眼内炎患者病原菌和耐药性及炎症因子水平变化和意义

Changes and significance of pathogenic bacteria,drug resistance and inflammatory factor levels in elderly patients with traumatic infectious endophthalmitis

目的探讨老年外伤性感染性眼内炎患者病原菌和耐药性特征,分析年龄、炎症因子水平变化与病原菌感染类型的关系。方法将四川大学华西医院2018年1月—2020年7月收治的72例老年外伤性感染性眼内炎患者(病例组)作为研究对象,根据患者年龄分为60~75岁组和>75岁组。病例组均进行病原菌检测和耐药性分析,并选择同期收治的36例单纯性老年白内障患者作为对照组,采集2组玻璃体液或前房液标本,测定白介素(IL)-1β、IL-6与肿瘤坏死因子(TNF)-α含量。结果72例老年外伤性感染性眼内炎患者共检出53株病原菌,其中革兰阳性菌43株,革兰阴性菌7株,真菌3株。革兰阳性菌中,以表皮葡萄球菌对青霉素和庆大霉素的耐药性最高,腐生葡萄球菌对青霉素和红霉素的耐药性最高。革兰阴性菌中,铜绿假单胞菌对阿米卡星和氨苄西林耐药性最高,肺炎克雷伯菌对氨苄西林耐药性最高。病例组中,>75岁组的真菌检出率高于60~75岁组(P<0.05)。病例组眼内液IL-1β、IL-6和TNF-α水平均高于对照组(P<0.05),病例组中,革兰阳性菌感染的患者眼内液IL-1β、IL-6和TNF-α水平与革兰阴性菌感染的患者比较,差异无统计学意义(P>0.05)。结论老年外伤性感染性眼内炎患者的病原菌分布和耐药性具有一定特征性,年龄可能会影响老年感染性眼内炎患者病原菌的分布;患者眼内液L-1β、IL-6和TNF-α等炎症因子水平升高较明显,但不同病原菌感染类型患者的眼内液炎症因子水平无明显差异。

Objective To explore the characteristics of pathogenic bacteria and drug resistance in elderly patients with traumatic infective endophthalmitis,and analyze the relationship among age,levels of inflammatory factors and the type of pathogenic bacteria infection.Methods 72elderly patients with traumatic infectious endophthalmitis(case group)admitted to West China Hospital Affiliated to Sichuan University from January2018to July2020were selected as the research subjects.They were divided into60-75years old group and>75years old group according to their age.All patients in the case group underwent pathogen detection and drug resistance analysis.Meanwhile,36patients with simple senile cataract treated in the same period were selected as the control group.The samples of vitreous humor or anterior chamber fluid of the patients were collected to detect the levels of interleukin(IL)-1β,IL-6and tumor necrosis factor(TNF)-α.Results A total of53strains of pathogenic bacteria were detected in72elderly patients with traumatic infectious endophthalmitis,including43strains of Gram-positive bacteria,7ones of Gram-negative bacteria and3ones of fungi.Among the Gram-positive bacteria,Staphylococcus epidermidis had the highest resistance to penicillin and gentamicin,and Staphylococcus saprophyticus had the highest resistance to penicillin and erythromycin.Among Gram-negative bacteria,Pseudomonas aeruginosa had the highest resistance to amikacin and ampicillin,and Klebsiella pneumoniae had the highest resistance to ampicillin.In the case group,the fungal detection rate in the>75-year-old group was higher than that in the60-75-year-old group(P<0.05).The levels of IL-1β,IL-6and TNF-αin the intraocular fluid of the case group were higher than those of the control group(P<0.05).In the case group,there was no significant difference in the levels of IL-1β,IL-6and TNF-αin the intraocular fluid between the patients infected by Gram-positive bacteria and those infected by Gram-negative bacteria(P>0.05).Conclusion The distribution and drug resistance of pathogens in elderly patients with traumatic endophthalmitis have certain characteristics,and age may affect the distribution of pathogens in these patients.The levels of inflammatory factors such as L-1β,IL-6 and TNF-αin the intraocular fluid of the patients were significantly increased,but there was no significant difference in the levels of inflammatory factors in the intraocular fluid of the patients with different types of pathogenic bacteria infection.