糖尿病视网膜病变患者结膜囊菌群分布及耐药性

Distribution and drug resistance of conjunctival sac flora in patients with diabetic retinopathy

目的探讨糖尿病视网膜病变患者结膜囊菌群分布及其耐药特点,为术后感染的防范提供临床指导。方法回顾性分析2015年1月至2017年10月长兴县中医院156例糖尿病视网膜病变患者术前结膜囊细菌培养及药敏试验结果。结果 211份样本共检出112株细菌,检出率为53.08%,其中革兰阳性菌检出93株,占83.04%;革兰阴性菌检出19株,占16.96%。全部菌株中表皮葡萄球菌检出率最高,为55.36%,其次为棒状杆菌9.82%。表皮葡萄球菌对红霉素(67.74%)、妥布霉素(46.77%)耐药较为严重,对万古霉素(100.0%)、左氧氟沙星(91.94%)、头孢他啶(90.32%)敏感。棒状杆菌对红霉素(45.45%)耐药较为严重,对万古霉素(100.00%)、妥布霉素(90.91%)、头孢他啶(100.00%)敏感。不动杆菌对红霉素(50.00%)耐药较为严重,对万古霉素(100.00%)、左氧氟沙星(100.00%)敏感。年龄>60岁、居住地农村、病程>8年为糖尿病视网膜病变的独立危险因素。结论糖尿病视网膜病变患者细菌培养及药敏试验为术前结膜囊无菌化合理用药的关键,对术后眼内炎症的预防至关重要。

Objective To investigate the distribution and drug resistance of conjunctival sac flora in patients with diabetic retinopathy,and provide clinical guidance for the prevention of postoperative infection.Methods 156 cases of diabetic retinopathy from January 2015 to October 2017 in our hospital were enrolled.The results of bacterial culture of conjunctival sac and drug sensitivity test were retrospectively analyzed.Results A total of 112 strains of bacteria were detected from 211 samples with a detection rate of 53.08%,including 93strains(83.04%)of Gram positive bacteria and 19strains(16.96%)of Gram negative bacteria.The detection rate of Staphylococcus epidermidis was the highest,55.36%,followed by Corynebacterium spp.9.82%.The Staphylococcus epidermidis was resistant to Erythromycin(67.74%)and Tobramycin(46.77%)while sensitive to Vancomycin(100.00%),Levofloxacin(91.94%)and Ceftazidime(90.32%).The Corynebacterium strains were resistant to Erythromycin(45.45%)while sensitive to Vancomycin(100.00%),Tobramycin(90.91%)and Ceftazidime(100.00%).The Acinetobacters were resistant to Erythromycin(50.00%)while sensitive to Vancomycin(100.00%)and Levofloxacin(100.00%).Age>60,rural environment and disease course>8years were the independent risk factors of diabetic retinopathy.Conclusion The identification and drug sensitivity of bacteria in conjunctival sac are the keys to the rational use of drugs in patients with diabetic retinopathy before operation,and are very important for the prevention of postoperative endophthalmitis.