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目的分析病原学诊断为细菌性角膜炎患者的临床特征、病原菌分布、药物敏感性及疾病转归。设计回顾性病例系列。研究对象2010年1月至2015年4月北京同仁医院细菌培养阳性的角膜炎患者146例。方法对患者的临床病历资料统计分析临床特征、病原菌分布以及药物敏感试验结果等。主要指标患者一般情况、临床特征、治疗及转归,以及细菌培养和药敏试验结果。结果 146例均为单眼患病。平均年龄(46.7±18.97)岁,女性64例(43.84%)。眼外伤病史46例(31.5%)。76例(52.1%)就诊前使用过局部抗菌素类药物,19例(13.0%)使用过局部糖皮质激素类药物,15例(10.3%)联合使用了抗生素和糖皮质激素类药物;病原菌82例(56.2%)为革兰阳性菌、64例(43.8%)为革兰阴性菌。假单胞菌(34.9%)最常见,其次为葡萄球菌(24.0%)。病原菌对加替沙星、阿米卡星和左氧氟沙星类药物具有较高敏感性。139眼(95.2%)局部用药治疗病情好转或治愈;7眼(4.8%)行手术治疗。结论眼外伤是细菌性角膜炎最常见的危险因素;革兰阳性菌为较常见的病原菌类型,病原菌对加替沙星、阿米卡星和左氧氟沙星具较高敏感性,药物控制不良时需积极采取手术治疗。
Objective To analyze the clinical features, pathogens distribution, drug sensitivity and disease outcome of patients with bacterial keratitis diagnosed by etiology. Design retrospective case series. Participants 146 patients with positive bacterial keratitis from Beijing Tongren Hospital from January 2010 to April 2015. Methods Clinical data of patients were statistically analyzed clinical characteristics, distribution of pathogens and drug sensitivity test results. The main indicators of patients in general, clinical features, treatment and prognosis, as well as bacterial culture and susceptibility test results. Results 146 cases were monocular disease. The average age (46.7 ± 18.97) years old, 64 females (43.84%). Eye injury history of 46 cases (31.5%). 76 cases (52.1%) used topical antibiotics before treatment, 19 (13.0%) used topical glucocorticoid drugs and 15 (10.3%) combined antibiotics and glucocorticoid drugs; 82 pathogens (56.2%) were Gram-positive bacteria and 64 (43.8%) were Gram-negative bacteria. Pseudomonas (34.9%) was the most common, followed by Staphylococcus aureus (24.0%). Pathogenic bacteria have higher sensitivity to gatifloxacin, amikacin and levofloxacin. In 139 eyes (95.2%), local treatment was improved or cured; in 7 eyes (4.8%), surgical treatment was performed. Conclusions Ocular trauma is the most common risk factor for bacterial keratitis. Gram-positive bacteria are the most common pathogen types. Pathogenic bacteria are highly sensitive to gatifloxacin, amikacin and levofloxacin. Active drug control Take surgical treatment.