Anand A R, Therese K L, Madhavan H N
Vision Research Foundation, Chennai, India.
Indian J Ophthalmol. 2000 Jun;48(2):123-8.
To determine the spectrum of infectious agents of postoperative endophthalmitis, the relationship with the time of onset of symptoms after surgery and the antibiotic susceptibilities of the aerobic bacterial isolates.
A retrospective review of microbiological records from January 1995 to December 1998 yielded 173 isolates from intraocular specimen of 170 patients with culture-proven postoperative endophthalmitis. Antibiotic susceptibility of these isolates was determined for various ocular antibiotics using the Kirby-Bauer disk-diffusion test. Based on the time of onset of illness, clinical presentation was classified into acute, delayed and chronic.
Among 170 cases, 71 (41.7%) were attributable to gram-negative, 64 (37.6%) to gram-positive bacteria, and 37 (21.8%) to fungi. Gram-negative bacteria included P. aeruginosa (29;17.1%), other Pseudomonas spp (15;8.8%), non-fermenters (18;10.6%) and others (10;5.8%). Among these, 40 of 72 (55.5%) were sensitive to gentamicin, 47 of 72 (65.2%) to cefotaxime, 47 of 69 (68.1%) to amikacin, 52 of 71 (73.2%) to ciprofloxacin, and 25 of 40 (62.5%) to ceftazidime. The gram-positive bacteria included S. epidermidis (22;12.9%), S. aureus (13;7.6%), P. acnes (10;5.9%), Enterococcus spp (4;2.3%), Streptococcus spp (7;4.1%) and others (8;4.8%). Among these, 41 of 53 (77.3%) were sensitive to gentamicin, 47 of 53 (88.6%) to cefotaxime, 46 of 52 (88.4%) to ciprofloxacin, 38 of 41 (92.6%) to cefazolin and 27 of 37 (72.9%) to ceftazidime. All gram-positive bacteria were sensitive to vancomycin.
In this large series of postoperative endophthalmitis, gram-negative bacilli followed by fungi accounted for the largest number of cases. A high degree of resistance of gram-negative bacilli to gentamicin, cefotaxime, amikacin and ceftazidime was recorded.
确定术后眼内炎的感染病原体谱、与术后症状发作时间的关系以及需氧菌分离株的抗生素敏感性。
回顾性分析1995年1月至1998年12月的微生物学记录，从170例经培养证实患有术后眼内炎患者的眼内标本中分离出173株菌株。采用 Kirby-Bauer 纸片扩散法测定这些分离株对多种眼科抗生素的敏感性。根据疾病发作时间，临床表现分为急性、延迟性和慢性。
在170例病例中，71例（41.7%）归因于革兰氏阴性菌，64例（37.6%）归因于革兰氏阳性菌，37例（21.8%）归因于真菌。革兰氏阴性菌包括铜绿假单胞菌（29株；17.1%）、其他假单胞菌属（15株；8.8%）、非发酵菌（18株；10.6%）和其他（10株；5.8%）。其中，72株中的40株（55.5%）对庆大霉素敏感，72株中的47株（65.2%）对头孢噻肟敏感，69株中的47株（68.1%）对阿米卡星敏感，71株中的52株（73.2%）对环丙沙星敏感，40株中的25株（62.5%）对头孢他啶敏感。革兰氏阳性菌包括表皮葡萄球菌（22株；12.9%）、金黄色葡萄球菌（13株；7.6%）、痤疮丙酸杆菌（10株；5.9%）、肠球菌属（4株；2.3%）、链球菌属（7株；4.1%）和其他（8株；4.8%）。其中，53株中的41株（77.3%）对庆大霉素敏感，53株中的47株（88.6%）对头孢噻肟敏感，52株中的46株（88.4%）对环丙沙星敏感，41株中的38株（92.6%）对头孢唑林敏感，37株中的27株（72.9%）对头孢他啶敏感。所有革兰氏阳性菌对万古霉素敏感。
在这一大组术后眼内炎病例中，革兰氏阴性杆菌其次是真菌占病例数最多。记录到革兰氏阴性杆菌对庆大霉素、头孢噻肟、阿米卡星和头孢他啶具有高度耐药性。
