Di Bartolomeo S, Mirta D H, Janer M, Rodríguez Fermepin M R, Sauka D, Magariños F, de Torres R A
Microbiology Laboratory, National Hospital Professor A. Posadas, Ministery of Public Health, Buenos Aires, Argentina.
Int J Infect Dis. 2001;5(3):139-43. doi: 10.1016/s1201-9712(01)90088-8.
Ocular infection in neonatology is a permanent and important health problem. To improve primary attention, prevention, and control, the study of the potential bacterial etiology of all consecutive cases of conjunctivitis was incorporated as a regular procedure in primary care from July 1995 to December 1998.
Prof. A. Posadas Hospital (Great Buenos Aires) has an average of 4294 births per year. This report analyzes the results obtained in 332 infants (age range, 0-30 d) with conjunctivitis. Clinical conjunctivitis was diagnosed in inpatients and outpatients by the same specialized staff. Isolation and characterization of bacteria were done by conventional microbiologic methods, including specific search for Neisseria gonorrhoeae and Chlamydia trachomatis. Chlamydia trachomatis was studied by antigen immunodetection and polymerase chain reaction, and genotyped by restriction fragment length polymorphism.
Conjunctivitis had an incidence (cases per 1000 live births) of 39.6 in 1995, 25.3 in 1996, 15.4 in 1997, and 15.2 in 1998. Microbial growth was detected in 167 (50.3%) of 332 cases. Ocular C. trachomatis infection was detected in 26 cases (7.83%). Five of seven isolates in tissue cultures belonged to type E and two to type G. Bacteria from respiratory ecology were the main isolates: Haemophilus influenzae (16.9%), Streptococcus pneumoniae (12.3%), and Staphylococcus aureus (8.7%). Haemophilus influenzae isolates were not serotyped and 17.2% of them were b-lactamase producers. In 15 cases both H. influenzae and S. pneumoniae were isolated together. Of S. pneumoniae, 4.9% were oxacillin resistant.
There has been a decline in the total number of cases of neonatal conjunctivitis, but the disease is still an important health problem. Chlamydia trachomatis also shows a decreasing profile with an incidence of (cases per 1000 live births) 4.39 in 1995, 1.85 in 1996, 1.01 in 1997, and 0.78 in 1998, and a tendency to show more incidence in spring-summer and significant accumulation of cases in babies between 7 and 9 days of age. Haemophilus influenzae alone (12.3%) or associated with S. pneumoniae (4.5%) appears as a prevalent potential bacterial pathogen. A significant accumulation of H. influenzae and S. pneumoniae cases occurs in winter. In 47.6% of cases, there was no bacterial growth. No significant seasonal differences in percentage of negative cultures or among the three-day age groups were detected. Neisseria gonorrhoeae was not found associated with ophthalmia neonatorum in this series.
新生儿眼部感染是一个长期存在的重要健康问题。为了加强初级护理、预防和控制工作，1995年7月至1998年12月期间，对所有连续性结膜炎病例的潜在细菌病因研究被纳入初级护理的常规程序。
A. 波萨达斯教授医院（大布宜诺斯艾利斯）每年平均有4294例分娩。本报告分析了332例结膜炎婴儿（年龄范围0至30天）的研究结果。住院患者和门诊患者的临床结膜炎均由同一专业人员诊断。细菌的分离和鉴定采用常规微生物学方法，包括对淋病奈瑟菌和沙眼衣原体的特异性检测。沙眼衣原体采用抗原免疫检测和聚合酶链反应进行研究，并通过限制性片段长度多态性进行基因分型。
1995年结膜炎发病率（每1000例活产病例数）为39.6，1996年为25.3，1997年为15.4，1998年为15.2。332例病例中有167例（50.3%）检测到微生物生长。检测到26例（7.83%）眼部沙眼衣原体感染。组织培养中的7株分离株有5株属于E型，2株属于G型。呼吸道常见细菌是主要分离菌：流感嗜血杆菌（16.9%）、肺炎链球菌（12.3%）和金黄色葡萄球菌（8.7%）。流感嗜血杆菌分离株未进行血清分型，其中17.2%为β-内酰胺酶产生菌。15例同时分离出流感嗜血杆菌和肺炎链球菌。肺炎链球菌中，4.9%对苯唑西林耐药。
新生儿结膜炎病例总数有所下降，但该疾病仍是一个重要的健康问题。沙眼衣原体发病率也呈下降趋势，1995年为每1000例活产病例4.39例，1996年为1.85例，1997年为1.01例，1998年为0.78例，且有春夏季发病率较高、7至9日龄婴儿病例显著积聚的趋势。单独的流感嗜血杆菌（12.3%）或与肺炎链球菌相关的流感嗜血杆菌（4.5%）似乎是主要的潜在细菌病原体。流感嗜血杆菌和肺炎链球菌病例在冬季显著积聚。47.6%的病例未检测到细菌生长。阴性培养物百分比在不同三日龄组间未检测到显著的季节差异。本系列研究中未发现淋病奈瑟菌与新生儿眼炎相关。
