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小儿感染性角膜炎:一家三级转诊中心的107例儿童病例系列 Paediatric infectious keratitis: a case series of 107 children presenting to a tertiary referral centre

Rossetto, J.D., Cavuoto, K.M., Osigian, C.J., 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:背景/目的:角膜溃疡会导致儿童严重的视力损害。美国儿科微生物溃疡性角膜炎的最新趋势仍是未知。本研究旨在报告南佛罗里达州儿童微生物性角膜炎的危险因素,微生物学特征和治疗预后。方法:1992 - 2015年间,一所大学三级眼科治疗中心的回顾性病例系列。对107例微生物性溃疡性角膜炎儿科患者(<18岁)进行了分析。收集患者的人口统计资料,文化数据,微生物易感性,治疗趋势和患者预后。结果:患者平均年龄13±4.6岁(0.2-17岁)。最常见的相关危险因素是隐形眼镜磨损(77.6%),其次是眼外伤(8.4%)。 4.7%的病例存在系统性因素。培养物来自89例患者。 52份角膜切片分离了74种微生物,阳性率为58.4%。确定了17种微生物,以绿脓杆菌为主(46.2%),其次为嗜麦芽窄食单胞菌(19.2%)和镰刀菌(13.5%)。联合强化抗生素是最常见的治疗方法(51.4%)。平均随访时间为40.6±91.6周(范围:0.3-480周)。平均视力从20/160提高到20/50p <0.0001)。结论:本研究中,隐形眼镜佩戴是儿童感染性角膜炎最常见的危险因素。铜绿假单胞菌是我们现在最常见的微生物。大部分病例对药物治疗反应良好。

 

BACKGROUND/AIMS:Corneal ulcers can result in severe visual impairment in children. The recent trends of paediatric microbial ulcerative keratitis in the USA are unknown. The purpose of this study is to report the risk factors, microbiological profile and treatment outcomes of paediatric microbial keratitis in South Florida.METHODS:A university-based tertiary eye care centre retrospective case series between 1992 and 2015. Medical records of 107 paediatric patients (age <18 years) with the diagnosis of microbial ulcerative keratitis were analysed. Patient demographics, culture data, microbial susceptibility, management trends and patient outcomes were collected.RESULTS:Mean age of patients was 13±4.6 years (range 0.2-17 years). The most common associated risk factor was contact lens wear (77.6%), followed by ocular trauma (8.4%). Systemic factors were present in 4.7% of cases. Cultures were taken from 89 patients. A total of 74 organisms were isolated from the 52 corneal scrapings with growth, yielding a 58.4% positivity rate. Seventeen microbial species were identified, with a predominance of Pseudomonas aeruginosa (46.2%), followed by Stenotrophomonas maltophilia (19.2%) and Fusarium (13.5%). Combined fortified antibiotics were the most common treatment (51.4%). Mean follow-up time was 40.6±91.6 weeks (range: 0.3-480 weeks). The mean visual acuity improved from 20/160 to 20/50 (p<0.0001). No therapeutic penetrating keratoplasty was needed.CONCLUSIONS:In this study, contact lens wear was the most frequent risk factor in infectious keratitis in children. P. aeruginosa was the most common microorganism present in our setting. The majority of the cases responded well to medical management.


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