Sridhar M S, Sharma S, Garg P, Rao G N
Cornea Service, L.V. Prasad Eye Institute, Hyderabad, India.
Cornea. 2001 Jul;20(5):458-62. doi: 10.1097/00003226-200107000-00003.
To report our experience in treatment and outcome ofNocardia keratitis.
Medical and microbiology records of seven cases of culture-provenNocardia keratitis seen between January 1997 and March 1999 were reviewed retrospectively. In all patients, corneal scrapings were obtained for direct microscopic evaluation and culture. Drug sensitivity was determined by the Kirby-Bauer disk-diffusion method. The minimum inhibitory concentration of ciprofloxacin and amikacin for these isolates was determined by agar dilution method. Response to medical therapy and the end result were analyzed.
By the in vitro Kirby-Bauer disk-diffusion techniques, all isolates were sensitive to amikacin; six of these isolates were sensitive to gentamicin and four were sensitive to ciprofloxacin. The minimum inhibitory concentration (MIC) of amikacin for all isolates by the agar-dilution technique was well below the MIC breakpoint forNocardia resistance, whereas the MIC of ciprofloxacin was above the MIC breakpoint forNocardia resistance. All patients responded to medical therapy. The corneal infection resolved in three patients after treatment with ciprofloxacin, in one patient after fortified gentamicin, and in three patients after fortified amikacin. Outcome details were available for six patients. There was good visual recovery in four patients, with visual acuity of 20/25 or better in three. The cornea of two patients developed nonvascularized scars, and in four patients in whom the infiltrates were peripheral, vascularization was seen.
Although patients ofNocardia keratitis may respond to other antibiotics, amikacin appears to be a drug of choice. In this small series, when appropriate therapy was initiated,Nocardia keratitis resolved promptly with good visual recovery.
报告我们治疗诺卡菌性角膜炎的经验及治疗结果。
回顾性分析1997年1月至1999年3月间7例经培养证实的诺卡菌性角膜炎患者的医学和微生物学记录。所有患者均取角膜刮片进行直接显微镜检查和培养。采用 Kirby-Bauer 纸片扩散法测定药敏。通过琼脂稀释法测定环丙沙星和阿米卡星对这些分离株的最低抑菌浓度。分析药物治疗反应及最终结果。
通过体外 Kirby-Bauer 纸片扩散技术，所有分离株对阿米卡星敏感；其中6株对庆大霉素敏感，4株对环丙沙星敏感。采用琼脂稀释技术，阿米卡星对所有分离株的最低抑菌浓度远低于诺卡菌耐药的最低抑菌浓度断点，而环丙沙星的最低抑菌浓度高于诺卡菌耐药的最低抑菌浓度断点。所有患者对药物治疗均有反应。3例患者经环丙沙星治疗后角膜感染消退，1例患者经强化庆大霉素治疗后消退，3例患者经强化阿米卡星治疗后消退。6例患者有详细的治疗结果。4例患者视力恢复良好，其中3例视力达到20/25或更好。2例患者角膜形成无血管瘢痕，4例浸润位于周边的患者出现角膜血管化。
尽管诺卡菌性角膜炎患者可能对其他抗生素有反应，但阿米卡星似乎是首选药物。在这个小系列研究中，当开始适当治疗时，诺卡菌性角膜炎迅速消退，视力恢复良好。
