化脓性角膜炎的病原学特征及感染危险因素分析

发布时间：2019-05-19 06:41

【摘要】：目的分析区域内化脓性角膜炎的病原学特征、耐药性变化和主要危险因素,为化脓性角膜炎的临床诊治提供依据。方法采用描述性研究方法,收集2009年1月至2014年1月住院治疗、临床资料完整的化脓性角膜炎患者277例(277眼),详细记录每例患者的基本信息资料、就诊信息、病原学检查结果,将所有资料进行整理分析。结果 277例患者中病原学检测检出率37.55%,其中细菌检出率35.47%,真菌检出率42.13%,各年份真菌检出率均高于细菌检出率,但差异均无统计学意义(均为P0.05)。检出细菌株包括革兰阳性球菌56株(59.57%),革兰阴性杆菌28株(29.79%),革兰阳性杆菌10株(10.64%);真菌以曲霉菌(26株,34.67%)、白假丝酵母菌(13株,17.33%)为主。药物敏感试验结果显示,葡萄球菌属对哌拉西林、氨苄西林、红霉素等耐药比较高,而对庆大霉素和万古霉素敏感;革兰阴性杆菌属对红霉素、氨苄西林、环氧氟沙星的耐药比较高。不同菌属病原体对哌拉西林、红霉素和左氧氟沙星的耐药比差异均有统计学意义(均为P0.05)。化脓性角膜炎的主要危险因素是角膜外伤,以植物外伤为主,其次是沙石异物和金属异物;其他危险因素还包括原有眼部疾病、全身疾病、眼部手术史和配戴角膜接触镜。结论化脓性角膜炎病原检出率偏低,真菌检出率超过细菌检出率,同时存在明显的抗生素耐药现象,角膜外伤仍是导致化脓性角膜炎的主要危险因素。应根据区域病原学特征及药敏试验结果,规范临床合理用药,改善治理效果,同时相关部门应开展针对性的宣传教育,使居民远离危险因素,降低角膜炎的发生率。
[Abstract]:Objective to analyze the etiological characteristics, drug resistance and main risk factors of suppurative keratitis in the region, and to provide evidence for clinical diagnosis and treatment of suppurative keratitis. Methods A descriptive study was used to collect 277patients (277eyes) with complete clinical data of suppurative keratitis from January 2009 to January 2014. The basic information and medical information of each patient were recorded in detail. The results of etiological examination were analyzed and all the data were sorted out and analyzed. Results the detection rate of pathogen was 37.55%, including 35.47% of bacteria and 42.13% of fungi. The detection rate of fungi was higher than that of bacteria in each year, but the difference was not statistically significant (P 0.05). The bacterial strains included 56 strains of Gram-positive cocci (59.57%), 28 strains of Gram-negative bacteria (29.79%) and 10 strains of Gram-positive bacteria (10.64%). Aspergillus (26 strains, 34.67%) and Pseudomonas albicans (13 strains, 17.33%) were the main fungi. The results of drug sensitivity test showed that Staphylococcus was highly resistant to piperacillin, ampicillin and erythromycin, but sensitive to gentamicin and vancomycin. Gram-negative bacilli are highly resistant to erythromycin, ampicillin and ofloxacin. The resistance ratios of different pathogens to piperacillin, erythromycin and levofloxacin were significantly different (P 0.05). The main risk factors of suppurative keratitis are corneal trauma, mainly plant trauma, followed by sand and stone foreign bodies and metal foreign bodies, and other risk factors include original eye diseases, systemic diseases, history of eye surgery and wearing corneal contact lenses. Conclusion the pathogen detection rate of suppurative keratitis is low, the detection rate of fungi is higher than that of bacteria, and there is obvious antibiotic resistance. Corneal trauma is still the main risk factor of suppurative keratitis. According to the regional etiological characteristics and the results of drug sensitivity test, we should standardize the rational clinical use of drugs and improve the treatment effect. At the same time, the relevant departments should carry out targeted publicity and education to keep residents away from risk factors and reduce the incidence of keratitis.
【作者单位】：新乡市第二人民医院眼科;
【分类号】：R772.21

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