铜绿假单胞菌基因型与感染性中央角膜炎抗生素敏感性及临床特征的相关性

Correlation of Pseudomonas aeruginosa genotype with antibiotic susceptibility and clinical features of induced central keratitis.

作者信息

Shen Elizabeth P, Hsieh Yi-Ting, Chu Hsiao-Sang, Chang Shan-Chwen, Hu Fung-Rong

机构信息

Department of Ophthalmology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Taipei, Taiwan Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, Taipei, Taiwan.

Department of Ophthalmology, National Taiwan University Hospital, Medical College, National Taiwan University, Taipei, Taiwan.

出版信息

Invest Ophthalmol Vis Sci. 2014 Dec 23;56(1):365-71. doi: 10.1167/iovs.14-15241.

DOI:10.1167/iovs.14-15241

PMID:25537202

Abstract

PURPOSE

To determine the association of type III secretion system (T3SS) genotype with antibiotic susceptibility, serotypes, and clinical manifestation of centrally located Pseudomonas aeruginosa keratitis.

METHODS

Clinical characteristics of P. aeruginosa keratitis cases from 2001 to 2011 were analyzed. Each strain was serotyped and genotyped for T3SS exotoxin genes. Antibiotic sensitivity and minimum inhibitory concentrations were determined with agar dilution method. Prognostic factors affecting final visual outcomes and time to re-epithelialization were analyzed using linear and Cox regression models.

RESULTS

Forty-four invasive and 28 cytotoxic strains were identified. Invasive strains occurred mostly in males (P = 0.03) with older age (P = 0.009) and ocular surgery or trauma history (P = 0.006), poor presenting (P = 0.04) and final (P < 0.0001) best spectacle-corrected visual acuity (BSCVA), and larger infiltration size (P = 0.03). Cytotoxic strains were associated with contact lens wear (P < 0.0001). Poor prognostic factors for final BCVA after adjusting for sex, age, and contact lens wear included invasive strains (P = 0.02), larger infiltration area (P = 0.02), deeper infiltrations (P = 0.02), and presence of hypopyon (P = 0.09). Factors affecting complete re-epithelialization time included invasive strains (P = 0.02), infiltration area (P = 0.01), depth (P = 0.02), and hypopyon (P = 0.03) after adjusting for age and sex. Serotypes 2, 6, and 11 were more commonly found among all isolates. A trend to increased fluroquinolone resistance is noted for invasive strains, although not reaching statistically significant difference.

CONCLUSIONS

Cytotoxic strains are associated with contact lens wear while invasive strains are related to poor prognosis and increased resistance to fluoroquinolones. Clinicians should be aware of the two different genotypes of P. aeruginosa affecting prognosis.

摘要

目的

确定Ⅲ型分泌系统（T3SS）基因型与中心性铜绿假单胞菌角膜炎的抗生素敏感性、血清型及临床表现之间的关联。

方法

分析2001年至2011年铜绿假单胞菌角膜炎病例的临床特征。对每株菌株进行血清分型及T3SS外毒素基因的基因分型。采用琼脂稀释法测定抗生素敏感性及最低抑菌浓度。使用线性回归模型和Cox回归模型分析影响最终视力结果及上皮再形成时间的预后因素。

结果

鉴定出44株侵袭性菌株和28株细胞毒性菌株。侵袭性菌株多见于男性（P = 0.03）、年龄较大者（P = 0.009）且有眼部手术或外伤史（P = 0.006），初诊时（P = 0.04）及最终（P < 0.0001）最佳矫正视力（BSCVA）较差，浸润面积较大（P = 0.03）。细胞毒性菌株与佩戴隐形眼镜有关（P < 0.0001）。在调整性别、年龄和隐形眼镜佩戴因素后，最终BCVA的不良预后因素包括侵袭性菌株（P = 0.02）、浸润面积较大（P = 0.02）、浸润较深（P = 0.02）及前房积脓（P = 0.09）。在调整年龄和性别因素后，影响上皮完全再形成时间的因素包括侵袭性菌株（P = 0.02）、浸润面积（P = 0.01）、深度（P = 0.02）及前房积脓（P = 0.03）。血清型2、6和11在所有分离株中更为常见。侵袭性菌株对氟喹诺酮类药物的耐药性有增加趋势，尽管未达到统计学显著差异。