Jiang Ying, Jacobs Michael, Bajaksouzian Saralee, Foster Altreisha N, Debanne Sara M, Bielefeld Roger, Garvey Matt, Raghupathy Sangeetha, Kern Jami, Szczotka-Flynn Loretta B
Departments of Epidemiology & Biostatistics (Y.J., S.M.D.), Pathology (M.J., S.B., A.N.F.), Division of Information Technology Services (R.B., M.G.), Case Western Reserve University, Cleveland, OH; Department of Ophthalmology & Visual Sciences (S.R., L.B.S.-F.) and University Hospitals Eye Institute, University Hospitals Case Medical Center, Cleveland, OH; and Alcon Research Ltd. (J.K.), Fort Worth, TX.
Eye Contact Lens. 2014 May;40(3):148-56. doi: 10.1097/ICL.0000000000000026.
To assess risk factors associated with substantial microbial bioburden of lids, conjunctivae, contact lenses, and storage cases during daily wear of silicone hydrogel contact lenses.
Two hundred eighteen patients were fit to lotrafilcon A lenses, randomized to use either a multipurpose solution or a hydrogen peroxide care system, and followed up for 1 year. Lenses, lens transport saline, lids, conjunctivae, and storage cases were cultured and considered to have substantial microbial bioburden when they harbored high levels of commensal or pathogenic organisms. Univariate and multivariate logistic regression analyses were conducted to examine which demographic covariates were associated with significant bioburden at each location while controlling for solution use.
In multivariate analyses, smoking trended toward an association with lens bioburden (odds ratio [OR]=2.15, 95% confidence interval [CI]: 0.95-4.88). Clerical occupations were found to be associated with more frequent overall storage case contamination (OR=3.51, 95% CI: 1.15-10.70) and, specifically, higher gram-positive storage case contamination (OR=5.57, 95% CI: 1.82-17.06). The peroxide system was associated with more frequent storage case contamination (OR=7.6, 95% CI: 3.79-15.19). Coagulase-negative staphylococci (CNS) were the most frequently cultured organisms within storage cases, and in multivariate analyses, CNS were more frequently found in storage cases of peroxide users (OR=6.12, 95% CI: 2.91-13.09).
Clerical occupations were associated with increased microbial bioburden of storage cases during daily wear of silicone hydrogel lenses. Smoking may increase the risk of lens contamination. Storage cases are most frequently contaminated with normal skin flora, and peroxide cases were associated with more frequent contamination. However, the solution type was not associated with lid or lens contamination nor with corneal infiltrative events in this study.
评估在日常佩戴硅水凝胶隐形眼镜过程中，与眼睑、结膜、隐形眼镜及储存盒中大量微生物生物负荷相关的危险因素。
218例患者佩戴lotrafilcon A镜片，随机分为使用多功能护理液或过氧化氢护理系统两组，并随访1年。对镜片、镜片运输用生理盐水、眼睑、结膜及储存盒进行培养，当其中存在高水平的共生菌或致病菌时，则认为其具有大量微生物生物负荷。进行单因素和多因素逻辑回归分析，以检查在控制护理液使用的情况下，哪些人口统计学协变量与每个部位的显著生物负荷相关。
在多因素分析中，吸烟与镜片生物负荷呈趋势性关联（比值比[OR]=2.15，95%置信区间[CI]：0.95-4.88）。发现文职工作与更频繁的储存盒整体污染相关（OR=3.51，95%CI：1.15-10.70），具体而言，与更高的革兰氏阳性菌储存盒污染相关（OR=5.57，95%CI：1.82-17.06）。过氧化氢护理系统与更频繁的储存盒污染相关（OR=7.6，95%CI：3.79-15.19）。凝固酶阴性葡萄球菌（CNS）是储存盒中最常培养出的微生物，在多因素分析中，CNS在使用过氧化氢护理液者的储存盒中更常见（OR=6.12，95%CI：2.91-13.09）。
文职工作与日常佩戴硅水凝胶镜片期间储存盒中微生物生物负荷增加相关。吸烟可能增加镜片污染风险。储存盒最常被正常皮肤菌群污染，使用过氧化氢护理液的储存盒污染更频繁。然而，在本研究中，护理液类型与眼睑或镜片污染以及角膜浸润事件无关。
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