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[软性角膜接触镜佩戴者的医院内铜绿假单胞菌相关性角膜炎]

[Nosocomial pseudomonas aeruginosa-associated keratitis in soft contact lens wearer].

作者信息

Grünauer-Kloevekorn Claudia, Wilhelm Frank, Duncker Gernot I W, Hammer Thomas

机构信息

Klinik und Poliklinik für Augenheilkunde der Martin-Luther-Universität Halle-Wittenberg.

出版信息

Klin Monbl Augenheilkd. 2004 Jan;221(1):52-5. doi: 10.1055/s-2003-812639.

Abstract

BACKGROUND

Pseudomonas aeruginosa is the most common cause of bacterial-associated keratitis in soft contact lens wearers, due to wrong use of soft contact lenses. Problems are often severe corneal ulcers and even corneal perforations. We report on a soft contact lens wearer with credibly correct use of soft contact lenses and nosocomial Pseudomonas aeruginosa-associated keratitis.

CASE REPORT

A 33-year old woman suffered from corneal ulcer and corneal infiltration with beginning endophthalmitis 2 days after having used of new soft contact lenses. After systemic and local antibiosis and penetrating keratoplasty we could stop endophthalmitis before reaching the vitreous and retina.

RESULTS

Histological and microbiological examinations showed a corneal ulcer with severe corneal infection due to Pseudomonas aeruginosa with resistance to mezlocillin and intermediale resistance to gentamicin. After therapy a stable situation with visual acuity of 20/60 was attained.

CONCLUSIONS

Previous reports on Pseudomonas aeruginosa-associated keratitis in soft contact lens wearers demonstrate corneal problems due to extended or overnight wear or unsuccessful contact lens cleaning. We present a case of nosocomial corneal infection after soft contact lens wearing and nosocomial infection because of contact with a partner working in an intensive-care unit. Hygienic rules should be strictly followed by patients and staff using soft or hard contact lenses for visual correction or for therapeutic reasons.

摘要

背景

由于软性隐形眼镜使用不当,铜绿假单胞菌是软性隐形眼镜佩戴者细菌性角膜炎最常见的病因。问题通常是严重的角膜溃疡甚至角膜穿孔。我们报告一例软性隐形眼镜佩戴者,其正确使用软性隐形眼镜却发生了医院内感染的铜绿假单胞菌相关性角膜炎。

病例报告

一名33岁女性在使用新的软性隐形眼镜2天后出现角膜溃疡、角膜浸润并伴有早期眼内炎。经过全身及局部抗感染治疗和穿透性角膜移植术后,我们成功在眼内炎累及玻璃体和视网膜之前控制住了病情。

结果

组织学和微生物学检查显示角膜溃疡伴有严重的铜绿假单胞菌角膜感染,该菌对美洛西林耐药,对庆大霉素中度耐药。治疗后病情稳定,视力达到20/60。

结论

既往关于软性隐形眼镜佩戴者铜绿假单胞菌相关性角膜炎的报道表明,角膜问题是由于长时间或过夜佩戴隐形眼镜,或隐形眼镜清洁不当所致。我们报告了一例软性隐形眼镜佩戴后发生医院内角膜感染的病例,感染是由于与一名在重症监护病房工作的伴侣接触所致。使用软性或硬性隐形眼镜进行视力矫正或治疗的患者和工作人员应严格遵守卫生规则。

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