146例细菌性角膜炎临床分析

doi:10.13281/j.cnki.issn.1004-4469.2017.03.005

眼科

146例细菌性角膜炎临床分析

高敏张阳肖扬王智群孙旭光

100043 首都医科大学附属北京朝阳医院眼科（高敏、肖扬）；100005首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所眼科学与视觉科学北京市重点实验室（张阳、王智群、孙旭光）

收稿日期:2016-10-08 出版日期:2017-05-25 发布日期:2017-06-02
通讯作者: 孙旭光，Email：sunxg1955@163.com E-mail:sunxg1955@163.com

Clinical profiles of bacterial keratitis: a retrospective study on 146 cases

GAO Min¹, ZHANG Yang², XIAO Yang¹, WANG Zhi-qun², SUN Xu-guang²

1. Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China; 2. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China

Received:2016-10-08 Online:2017-05-25 Published:2017-06-02
Contact: SUN Xu-guang, Email：sunxg1955@163.com E-mail:sunxg1955@163.com

摘要/Abstract

摘要：

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。

关键词: 细菌性角膜炎, 抗生素敏感性, 角膜感染, 角膜溃疡, 流行病学, 危险因素

Abstract:

Objective To elucidate the epidemiological characteristics, clinical signs, laboratory findings, and outcomes in bacterial keratitis. Design Retrospective case series. Participants 146 inpatients (146 eyes) with bacterial keratitis from January 2010 through April 2015 in Beijing Tongren Hospital. Methods The medical records of 146 inpatients (146 eyes) with bacterial keratitis were reviewed retrospectively for clinical features, pathogenic bacterium distribution and drugs sensitivity patterns. Main Outcome Measures Demographic information, clinical findings, treatment, outcomes, laboratory findings and the result of drug-susceptibility test. Results All 146 cases of bacterial keratitis were single eye-affected. The average age was 46.7 ±18.97 years. Out of which, 82 cases (56.16%) were male. Ocular trauma was the most common cause of bacterial keratitis accounting for 31.5%. Majority of the patients (76 cases, 52.1%) presented after topical antibiotics administration. 19 patients(13.0%) utilized topical steroid and 15 cases (10.3%) used both topical antibiotic and steroid at presentation. 82 cases (56.2%) showed Gram-positive bacterium, and 64 cases (43.8%) showed Gram-negative bacterium. Pseudomonas was identified to be the most common isolate (34.9%), followed by Staphylococcus species (24.0%). As a whole, isolates were most sensitive to gatifloxacin, amikacin and levofloxacin. Most cases(139 cases, 95.2%) resolved with topical administration. Surgical therapies were adopted in 7 cases(4.8%). Conclusion Trauma was the most common risk factor of bacterial keratitis. The most common bacteria isolated were Gram-positives and most of the bacteria isolated were susceptive to gatifloxacin, amikacin and levofloxacin. Therapeutic penetrating keratoplasty (PKP) is the most frequently performed surgery to save the eye and preserve vision in severe infective keratitis.

Key words: bacterial keratitis, antibiotic sensitivity, corneal infection, corneal ulcer；epidemiology, risk factor

高敏张阳肖扬王智群孙旭光. 146例细菌性角膜炎临床分析[J]. 眼科, doi: 10.13281/j.cnki.issn.1004-4469.2017.03.005.

GAO Min1, ZHANG Yang2, XIAO Yang1, WANG Zhi-qun2, SUN Xu-guang2. Clinical profiles of bacterial keratitis: a retrospective study on 146 cases[J]. Ophthalmology in China, doi: 10.13281/j.cnki.issn.1004-4469.2017.03.005.

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146例细菌性角膜炎临床分析

Clinical profiles of bacterial keratitis: a retrospective study on 146 cases

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