Miño de Kaspar Herminia, Shriver Erin M, Nguyen Eddy V, Egbert Peter R, Singh Kuldev, Blumenkranz Mark S, Ta Christopher N
Department of Ophthalmology, Stanford University School of Medicine, 300 Pasteur Dr, Room A-157, Stanford, California 94305, USA.
Graefes Arch Clin Exp Ophthalmol. 2003 Sep;241(9):730-3. doi: 10.1007/s00417-003-0742-5. Epub 2003 Aug 20.
The purpose of this study was to determine if patients with certain risk factors are more likely to harbor conjunctival bacterial flora resistant to multiple antibiotics.
In this prospective study, detailed medical history and slit-lamp examination were performed on all patients prior to intraocular surgery. Patients with local risk factors were defined as those with chronic blepharitis, conjunctivitis or discharge. Those with systemic risk factors were patients with diabetes, autoimmune, immunodeficient or skin disorders, asthma and those taking immunosuppressant medications. Conjunctival cultures were obtained prior to preoperative antibiotics and povidone-iodine. Bacteria isolated were identified and antibiotic susceptibility was determined. Bacteria resistant to five or more antibiotics were defined as multi-resistant (MR).
Among the 207 patients enrolled in the study, 73 patients had local risk factors. Of these patients, 32 patients (44%) carried MR organisms, compared to 32 of the 134 patients (24%) without local risk factors (P=0.0049). Thirty-two of 71 patients (45%) with systemic risk factors harbored MR organisms, compared to 32 of 136 patients (24%) without systemic risk factors (P=0.0025). Seventeen of 93 patients (18%) who had neither local nor systemic risk factors had MR organisms on their conjunctiva. In contrast, 17 of the 30 patients (57%) with both local and systemic risk factors (57%) carried MR bacteria (P=0.0001).
Patients with local and/or systemic risk factors are more likely to harbor MR organisms. This may be one mechanism for the reported increased risk of postoperative endophthalmitis in this group of patients.
本研究的目的是确定具有某些危险因素的患者是否更有可能携带对多种抗生素耐药的结膜细菌菌群。
在这项前瞻性研究中，对所有接受眼内手术的患者在术前进行了详细的病史询问和裂隙灯检查。具有局部危险因素的患者定义为患有慢性睑缘炎、结膜炎或有分泌物的患者。具有全身危险因素的患者包括患有糖尿病、自身免疫性疾病、免疫缺陷或皮肤病、哮喘的患者以及正在服用免疫抑制药物的患者。在术前使用抗生素和聚维酮碘之前获取结膜培养物。对分离出的细菌进行鉴定并确定其抗生素敏感性。对五种或更多种抗生素耐药的细菌被定义为多重耐药（MR）菌。
在纳入研究的207例患者中，73例有局部危险因素。在这些患者中，32例（44%）携带多重耐药菌，而在没有局部危险因素的134例患者中有32例（24%）携带（P = 0.0049）。在有全身危险因素的71例患者中有32例（45%）携带多重耐药菌，相比之下，在没有全身危险因素的136例患者中有32例（24%）携带（P = 0.0025）。在既无局部也无全身危险因素的93例患者中，有17例（18%）结膜上有多重耐药菌。相比之下，在同时具有局部和全身危险因素的30例患者中有17例（57%）携带多重耐药菌（P = 0.0001）。
具有局部和/或全身危险因素的患者更有可能携带多重耐药菌。这可能是据报道该组患者术后眼内炎风险增加的一种机制。
