术前正常结膜细菌对氟喹诺酮类药物的敏感性比较。

Susceptibility comparisons of normal preoperative conjunctival bacteria to fluoroquinolones.

作者信息

Hori Yuichi, Nakazawa Toru, Maeda Naoyuki, Sakamoto Masako, Yokokura Syunji, Kubota Akira, Inoue Tomoyuki, Nishida Kohji, Tano Yasuo

机构信息

Department of Ophthalmology, Osaka University Medical School, Suita, Japan.

出版信息

J Cataract Refract Surg. 2009 Mar;35(3):475-9. doi: 10.1016/j.jcrs.2008.11.049.

DOI:10.1016/j.jcrs.2008.11.049

PMID:19251140

Abstract

PURPOSE

To compare the susceptibility and efficacy of 3 fluoroquinolones, (levofloxacin, gatifloxacin, and moxifloxacin) in treating conjunctival bacteria in patients having ocular surgery.

SETTING

Osaka University Hospital, Osaka, and Tohoku University Hospital, Miyagi, Japan.

METHODS

Eyes of patients were examined preoperatively. Aerobic and anaerobic cultures were obtained from conjunctival swabs. The minimum inhibitory concentrations (MICs) of levofloxacin, gatifloxacin, and moxifloxacin for isolated strains were determined. Using the MIC values, descriptive statistics (median, MIC(50), MIC(90), mode, and range), susceptibility, and efficacy of each fluoroquinolone were calculated for the bacteria isolated, and the data were analyzed statistically.

RESULTS

Of the 200 eyes sampled, 163 (81.5%) had positive bacterial growth. From the 163 eyes, 235 bacterial strains were isolated: 116 (49.4%) Propionibacterium acnes; 58 (24.7%) coagulase-negative Staphylococcus (CNS), including 36 methicillin-sensitive CNS (MS-CNS) and 22 methicillin-resistant CNS (MR-CNS); 10 (4.3%) Staphylococcus aureus, including 6 methicillin-sensitive S aureus and 4 methicillin-resistant S aureus (MRSA); and 29 (12.3%) Corynebacterium. Approximately 40% of Staphylococci (22/58 CNS, 37.9%; 4/10 S aureus, 40.0%) were methicillin-resistant. Furthermore, 18 (81.8%) of MR-CNS and all 4 MRSA were fluoroquinolone resistant. The MICs of moxifloxacin and gatifloxacin were statistically significantly lower than those of levofloxacin for CNS and P acnes (P<.05, Kruskal-Wallis test). However, there was no statistically significant difference in the susceptibility patterns of the fluoroquinolones for these strains (P>.05, McNemar test).

CONCLUSION

Because many methicillin-resistant and fluoroquinolone-resistant strains were isolated from the conjunctiva preoperatively, clinicians should be mindful of endophthalmitis or ocular infections associated with these strains.

摘要

目的

比较3种氟喹诺酮类药物（左氧氟沙星、加替沙星和莫西沙星）对接受眼科手术患者结膜细菌的敏感性和疗效。

地点

日本大阪的大阪大学医院和宫城的东北大学医院。

方法

对患者的眼睛进行术前检查。从结膜拭子中进行需氧和厌氧培养。测定左氧氟沙星、加替沙星和莫西沙星对分离菌株的最低抑菌浓度（MIC）。利用MIC值，计算分离出的细菌中每种氟喹诺酮类药物的描述性统计量（中位数、MIC50、MIC90、众数和范围）、敏感性和疗效，并对数据进行统计学分析。

结果

在采样的200只眼中，163只（81.5%）有细菌生长阳性。从这163只眼中分离出235株细菌：痤疮丙酸杆菌116株（49.4%）；凝固酶阴性葡萄球菌（CNS）58株（24.7%），其中包括36株甲氧西林敏感CNS（MS-CNS）和22株甲氧西林耐药CNS（MR-CNS）；金黄色葡萄球菌10株（4.3%），其中包括6株甲氧西林敏感金黄色葡萄球菌和4株甲氧西林耐药金黄色葡萄球菌（MRSA）；棒状杆菌29株（12.3%）。约40%的葡萄球菌（22/58 CNS，37.9%；4/10金黄色葡萄球菌，40.0%）为甲氧西林耐药。此外，18株（81.8%）MR-CNS和所有4株MRSA对氟喹诺酮耐药。对于CNS和痤疮丙酸杆菌，莫西沙星和加替沙星的MIC在统计学上显著低于左氧氟沙星（P<0.05，Kruskal-Wallis检验）。然而，这些菌株对氟喹诺酮类药物的敏感性模式没有统计学上的显著差异（P>0.05，McNemar检验）。