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目的分析化脓性角膜炎病原学的变迁特征。方法回顾性分析1989年至2006年间在北京同仁医院眼科拟诊为真菌性、细菌性及棘阿米巴性角膜炎患者11302例微生物实验室检查资料。结果培养鉴定出病原微生物2896份,其中真菌1602份、细菌1161份、棘阿米巴原虫133份,总阳性率为25.62%.真菌培养阳性率为33.83%,夏秋季为高发季节,常见的致病真菌为镰刀菌属(62.23%)和曲霉菌素(14.61%);对2000年至2006年间培养的895株真菌进行体外药敏实验,结果显示那他霉素、特比萘酚、伊曲康唑和氟康唑的药物敏感性分别为88.83%、55·75%、28·60%和11·84%;镰刀菌属对那他霉素最敏感,曲霉菌素对特比萘酚敏感性高。常见细菌培养阳性率为18.78%(1126/5995),以G+球菌和G-杆菌为主,占检出细菌的85·52%;主要致病菌属为铜绿假单胞菌,其所占比例近年来有所下降,而金黄色葡萄球菌、凝固酶阴性葡萄球菌和微球菌属所占比例有明显增高;对2000年至2006年间培养的430株细菌行体外药敏实验,结果显示左氧氟沙星、氧氟沙星、妥布霉素和环丙沙星药物敏感性分别为82.09%、75.81%、66.98%和62.33%;假单胞菌属对4种抗菌药物敏感性无显著性差异。棘阿米巴检查(培养+刮片)阳性率为23.25%(133/572),其检出例数逐年升高。放线菌、非结核分枝杆菌和厌氧菌为少见病原体,非结核分枝杆菌多分离自屈光手术后的角膜感染。结论真菌和细菌为化脓性角膜炎的主要病原体,棘阿米巴角膜炎病例数逐年升高,放线菌及非结核分枝杆菌引起的角膜感染应引起重视。
Objective To analyze the etiological features of pyogenic keratitis. Methods A retrospective analysis was conducted on 11,302 laboratory samples of microorganisms in patients undergoing ophthalmology examination in Beijing Tongren Hospital from 1989 to 2006 as fungal, bacterial and Acanthamoeba keratitis. Results 2896 strains of pathogenic microorganisms were identified, of which 1,602 were fungi, 1,161 were bacteria and 133 were Acanthamoeba, the total positive rate was 25.62%. The positive rate of fungi culture was 33.83%. The summer and autumn were the high season, The pathogenic fungi were Fusarium (62.23%) and streptomycin (14.61%). In vitro susceptibility tests were carried out on 895 fungi cultured from 2000 to 2006. The results showed that natamycin, terbinafine, The drug sensitivity of conazole and fluconazole were 88.83%, 55.75%, 28.60% and 11.84%, respectively. Fusarium was the most sensitive to natamycin, and the fungistatin was sensitive to terbinafine High sex. The positive rate of common bacterial culture was 18.78% (1126/5995), mainly G + cocci and G-bacilli, accounting for 85.52% of the detected bacteria; the main pathogen was Pseudomonas aeruginosa, the proportion of which In recent years, there has been a decline, while Staphylococcus aureus, coagulase-negative Staphylococcus aureus and Micrococci share was significantly increased; from 2000 to 2006 430 strains of bacteria cultured in vitro susceptibility testing showed that levofloxacin, oxygen The susceptibilities of fluconazole, tobramycin and ciprofloxacin were 82.09%, 75.81%, 66.98% and 62.33%, respectively. There was no significant difference in the susceptibility of Pseudomonas to the four antibiotics. Acanthamoeba check (culture + blade) positive rate was 23.25% (133/572), the number of cases detected increased year by year. Actinomyces, non-tuberculosis and anaerobic bacteria are rare pathogens, non-tuberculous mycobacterial multifocal corneal infection after refractive surgery. Conclusion Fungi and bacteria are the main causative agents of purulent keratitis. The number of acanthamoeba keratitis patients is increasing year by year. Corneal infections caused by actinomycetes and non-tuberculous mycobacteria should be emphasized.