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一家大型县医院微生物性角膜炎的危险因素和抗生素敏感模式演变 Evolving risk factors and antibiotic sensitivity patterns for microbial keratitis at a large county hospital

Jin, H., Parker, W.T., Law, N.W., et al.

期刊名称:The British journal of ophthalmology

卷期:2017年第101卷第11期

摘要

摘要:目的:旨在明确得克萨斯州休斯敦一家大型县级医院的微生物角膜炎的危险因素,致病微生物,药物敏感性及预后。设计:病例系列。方法:设置:德克萨斯州休斯敦一家大型县级医院。研究人群:20111月至20155月间已知的微生物角膜炎患者。观察过程:回顾性总结。主要预后:微生物性角膜炎的流行病学,危险因素,预后和抗生素易感性。结果:最常见的危险因素是隐形眼镜使用(34.4%),眼外伤(26.3%),糖尿病(16.7%),眼外科手术(13.5%),眼表疾病(11.5%),既往角膜炎(10.4%),青光眼(6.3%),可卡因使用5.2%)和艾滋病毒阳性(4.2%)。与培养阴性眼(38.5%)相比,阳性培养眼(61.5%)的视觉预后较差(p = 0.019)和随访次数较多(p = 0.007)。角膜穿孔是最常见的并发症(11.5%)。革兰氏阴性菌(21.9%)均对头孢他啶,妥布霉素和氟喹诺酮类药物敏感。革兰氏阳性菌(33.3%)的预后比革兰氏阴性菌(21.9%)更差,表现出广谱抗生素耐药性,但都对万古霉素敏感。 27%的凝固酶阴性葡萄球菌对氟喹诺酮类药物具有耐药性。结论:本研究确定了得克萨斯州休斯敦县医院微生物性角膜炎的最近危险因素和抗生素耐药模式的改变。在我们的患者人群中,氟喹诺酮单药治疗不建议用于严重的角膜溃疡。根据这些结果,万古霉素和妥布霉素应该用于经验治疗,直到微生物确认和敏感性结果可用时为止。

Purpose: To identify the risk factors, causative organisms, antimicrobial susceptibility and outcomes of microbial keratitis in a large county hospital in Houston, Texas.Design: Case series.METHODS:Setting: A large county hospital in Houston, Texas.STUDY POPULATION:Patients with known diagnosis of microbial keratitis from January 2011 to May 2015.OBSERVATION PROCEDURE:Retrospective chart review.MAIN OUTCOMES:Epidemiology, risk factors, outcomes and antibiotic susceptibility of microbial keratitis.RESULTS:The most commonly identified risk factors were contact lens use (34.4%), ocular trauma (26.3%), diabetes mellitus (16.7%), ocular surgery (13.5%), ocular surface diseases (11.5%), previous keratitis (10.4%), glaucoma (6.3%), cocaine use (5.2%) and HIV-positive status (4.2%). Eyes with positive cultures (61.5%) were associated with worse visual outcomes (p=0.019) and a higher number of follow-up visits (p=0.007) than eyes with negative cultures (38.5%). Corneal perforation was the most common complication (11.5%). Gram-negative organisms (21.9%) were all susceptible to ceftazidime, tobramycin and fluoroquinolones. Gram-positive organisms (33.3%) had worse outcomes than Gram-negative organisms (21.9%) and exhibited a wide spectrum of antibiotic resistance, but all were susceptible to vancomycin. Twenty-seven per cent of the coagulase-negative Staphylococci were resistant to fluoroquinolones.CONCLUSION:This study identified a recent shift in risk factors and antibiotic resistance patterns in microbial keratitis at a County Hospital in Houston, Texas. In our patient population, fluoroquinolone monotherapy is not recommended for severe corneal ulcers. On the basis of these results, vancomycin and tobramycin should be used for empirical therapy until microbial identity and sensitivity results are available.


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