玻璃体腔注射药物前结膜囊培养结果分析

Evaluation of conjunctival sac culture findings prior to intravitreal injection

目的观察玻璃体腔注射(IVI)前不同方式预防感染后结膜囊微生物培养阳性率的变化差异。方法前瞻性病例对照研究。2021年7月至2023年12月于天津医科大学眼科医院IVI中心接受IVI药物治疗的眼底疾病患者1200例纳入研究。按照IVI前3、1 d抗生素眼液点眼(前3 d、前1 d)、治疗前不使用抗生素眼液(前0)和IVI前3 min、30 s聚维酮碘(PVI)眼局部消毒将患者随机分为6组:前3 d抗生素+3 min PVI组、前1 d抗生素+3 min PVI组、前0+3 min PVI组、前3 d抗生素+30 s PVI组、前1 d抗生素+30 s PVI组、前0+30 s PVI组,每组均为200例。IVI前进行结膜囊微生物采样培养,比较各组阳性率差异。多组间比较采用单因素方差分析;计数资料比较采用χ2检验。结果1200例患者中,男性566例,女性634例;年龄(62.59±13.44)岁。糖尿病、高血压分别为397、482例。IVI次数(2.35±2.34)次。IVI前结膜囊培养阳性64例。各组患者年龄(F=1.468)、性别构成比(χ^(2)=2.876)、糖尿病例数(χ^(2)=10.002)、高血压例数(χ^(2)=6.019)、IVI次数(χ^(2)=4.507)、结膜囊细菌培养阳性率(χ^(2)=6.272)比较,差异均无统计学意义(P>0.05)。以IVI前抗生素应用时长为分层因素,不同IVI前抗生素应用时长组结膜囊培养阳性率比较,差异无统计学意义[χ^(2)=0.414,P=0.520,合并比值比(OR)=0.819,95%可信区间(CI)0.493~1.360]。以PVI应用时长为分层因素,不同PVI消毒时间组结膜囊培养阳性率比较,差异无统计学意义(χ^(2)=0.000,P=1.000,合并OR=1.000,95%CI 0.503~1.988)。结论IVI前0.5%PVI作用30 s可达到抑制结膜囊微生物菌落生长的作用;IVI前眼局部抗生素眼液的应用不能降低结膜囊细菌阳性率。

Objective To observe the differences in the positive rate of conjunctival sac microbial culture after different methods of preventing infection before intravitreal injection(IVI).Methods A prospective case-control study.A total of 1200 participants with fundus diseases who received IVI injection at Tianjin Medical University Eye Hospital from July 2021 to December 2023 were included.Patients were randomly divided into 6 groups according to eye spot with antibiotic solution 3,1 and 0 days before IVI and local eye disinfection with povidone-iodine(PVI)3 min and 30 s before IVI:the first 3 days of antibiotics+3 min PVI group,the first 1 day of antibiotics+3 min PVI group,the first 0 days of antibiotics+3 min PVI group,the first 3 days of antibiotics+30 s PVI group,the first 1 day of antibiotics+30 s PVI group,the first 0 days of antibiotics+30 s PVI group,there were 200 cases in each group.Microbial sampling and cultivation of conjunctival sac were conducted before IVI to compare the differences in positive rates among different groups.Multiple group comparisons were conducted using one-way analysis of variance.The comparison of count data is conducted usingχ2 test.Results Among the 1200 patients,there were 566 males and 634 females.Age(62.59±13.44)years old.There were 397 cases of diabetes and 482 cases of hypertension.IVI frequency(2.35±2.34).64 cases were positive for conjunctival sac culture before IVI.The age(F=1.468),sex composition ratio(χ^(2)=2.876),diabetes(χ^(2)=10.002),hypertension(χ^(2)=6.019),times of IVI(χ^(2)=4.507),and positive rate of conjunctival sac bacterial culture(χ^(2)=6.272)of patients in each group had no statistical significance(P>0.05).Using the duration of antibiotic application before IVI as a stratified factor,there was no statistically significant difference in the positive rate of conjunctival sac culture between groups with different durations of antibiotic application before IVI[χ^(2)=0.414,P=0.52,combined odds ratio(OR)=0.819,95%confidence interval(CI)0.493-1.360].Using the duration of PVI application as a stratified factor,there was no statistically significant difference in the positive rate of conjunctival sac culture between different PVI disinfection times[χ^(2)=0.000,P=1.000,combined OR=1.00,95%CI 0.503-1.988].Conclusions Pre IVI treatment with 0.5%PVI for 30 s can inhibit the growth of microbial colonies in the conjunctival sac.The application of local antibiotic eye fluid in the anterior eye of IVI cannot reduce the positive rate of conjunctival sac bacteria.