感染性角膜炎临床特征与病原菌及其耐药性

Clinical characteristics of infectious keratitis patients distribution and drug resistance of pathogens

目的 分析2018-2022年华中科技大学医院感染性角膜炎患者的临床特点与病原菌特征及耐药性。方法 回顾性收集2018年1月-2022年8月华中科技大学医院眼耳鼻喉科收治的108例感染性角膜炎患者临床资料,根据患者感染病原菌种类将其分为细菌组(82例)和真菌组(26例),统计感染性角膜炎患者特征及感染病原菌特征,分析主要感染病原菌耐药情况。结果 真菌组病程长于细菌组,溃疡深度深基质层患者占比高于细菌组,溃疡面积大于细菌组(P<0.05);革兰阴性菌主要感染病原菌种类为铜绿假单胞菌、大肠埃希菌;革兰阳性菌主要感染病原菌种类为表皮葡萄球菌、金黄色葡萄球菌;真菌主要感染病原菌种类为曲霉菌、镰刀菌;铜绿假单胞菌对氨苄西林、妥布霉素耐药性较高;大肠埃希菌对氨苄西林、庆大霉素、妥布霉素耐药性较高;表皮葡萄球菌对青霉素、庆大霉素、妥布霉素耐药性较高;金黄色葡萄球菌对青霉素、亚胺培南耐药性较高;曲霉菌对酮康唑、伏立康唑耐药性较高;镰刀菌对特比萘芬、那他霉素耐药性较高。结论 与细菌感染患者相比,真菌感染性角膜炎患者具有病程长、溃疡深度高、溃疡面积大的特点,主要感染病原菌包括铜绿假单胞菌、大肠埃希菌、表皮葡萄球菌、金黄色葡萄球菌、曲霉菌、镰刀菌,不同病原菌耐药性不同。

OBJECTIVE To analyze the clinical characteristics,pathogenic bacteria distribution and drug resistance in patients with infectious keratitis in Huazhong University of Science and Technology Hospital from 2018 to 2022.METHODS Clinical data of 108 patients with infectious keratitis admitted to the department of eye and otolaryngology of Huazhong University of Science and Technology Hospital from Jan 2018 to Aug 2022 were retrospectively collected.According to the types of pathogenic bacteria infected,the patients were divided into the bacterial group(82 cases)and fungal group(26 cases).The characteristics of patients with infectious keratitis and pathogenic bacteria were analyzed.The drug resistance of main pathogenic bacteria was analyzed.RESULTS The disease course in the fungal group was longer than that in the bacterial group.The proportion of ulcer in deep stromal layer in the fungal group was higher than that in the bacterial group,and the area of ulcer was higher than that in the bacterial group(P<o.05).The main pathogens of gram-negative bacteria were Pseudomonas aeruginosa and Escherichia coli.The main pathogens of gram-positive bacteria were Staphylococcus epidermidis and Staphylococcus aureus.The main fungal pathogens were Aspergillus and Fusarium.P.aeruginosa had high resistance to ampicillin and tobramycin.E.coli had high resistance to ampicillin,gentamicin and tobramycin;S.epidermidis had high resistance to penicillin,gentamicin and tobramycin;S.aureus had high resistance to penicillin and imipenem;Aspergillus had high resistance to ketoconazole and voriconazole and Fusarium has high resistance to terbinafine and natamycin.CONCLUSION Compared with bacterial keratitis patients,patients with fungal keratitis have long course of disease,high depth and large area of ulcer.The main pathogens of infection include P.aeruginosa,E.coli,S.epidermidis,S.aureus,Aspergillus and Fusarium,which showed different drug resistance.