Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
Department of Ophthalmology, University Hospital Essen, Essen, Germany.
Eur J Clin Microbiol Infect Dis. 2018 May;37(5):889-895. doi: 10.1007/s10096-017-3182-6. Epub 2018 Jan 9.
The purpose of this investigation was to evaluate the performance of blood culture bottles in comparison to conventional microbiological culture techniques in detecting causative microorganisms of endophthalmitis and to determine their anti-infective susceptibility profiles. All consecutive cases with clinically suspected endophthalmitis in a university-based ophthalmology department between January 2009 and December 2016 were analysed in this retrospective comparative case series. Samples from 247 patients with suspected endophthalmitis underwent microbiological diagnostic work-up. All three culture methods were performed from 140 vitreous specimens. Vitreous fluid specimens were inoculated in blood culture bottles, aerobic and anaerobic broth solutions, and on solid media. Anti-infective susceptibility profiles were evaluated by semi-automated methods and/or gradient diffusion methods. Microorganisms were grown in 82 of 140 specimens for which all methods were performed (59%). Microorganisms were more frequently grown from blood culture bottles (55%) compared to broth solution (45%, p = 0.007) and solid media (33%, p < 0.0001). Considerable differences in the performance among culture media were detected for fungal pathogens. All grown fungi were detected by blood culture bottles (11 of 11, 100%). Broth solution recovered 64% and solid media 46% of grown fungi. No Gram-positive bacterium was resistant to vancomycin and all Gram-negative pathogens except for one isolate were susceptible to third-generation cephalosporins. In suspected endophthalmitis patients, blood culture bottles have a higher overall pathogen detection rate from vitreous fluid compared to conventional microbiological media, especially for fungi. The initial intravitreal antibiotic therapy with vancomycin plus third-generation cephalosporins appears to be an appropriate treatment approach for bacterial endophthalmitis.
本研究旨在评估血培养瓶与传统微生物培养技术在检测眼内炎病原体方面的性能，并确定其抗感染药敏谱。本回顾性对比病例系列研究纳入了 2009 年 1 月至 2016 年 12 月在一所大学附属医院眼科就诊的、临床疑似眼内炎的连续病例。对 247 例疑似眼内炎患者的样本进行了微生物学诊断。所有三种培养方法均对 140 例玻璃体标本进行了检测。将玻璃体标本接种于血培养瓶、需氧和厌氧肉汤溶液以及固体培养基中。通过半自动方法和/或梯度扩散方法评估抗感染药敏谱。在进行了所有三种方法检测的 140 例标本中的 82 例（59%）中培养出了微生物。从血培养瓶（55%）中培养出微生物的频率高于从肉汤溶液（45%，p=0.007）和固体培养基（33%，p<0.0001）。对于真菌病原体，不同培养介质的性能存在显著差异。通过血培养瓶检测到所有培养出的真菌（11 例中的 11 例，100%）。肉汤溶液恢复了 64%，固体培养基恢复了 46%。没有革兰氏阳性菌对万古霉素耐药，除了一个分离株外，所有革兰氏阴性病原体均对第三代头孢菌素敏感。在疑似眼内炎患者中，与传统微生物培养基相比，血培养瓶从玻璃体液中检测出病原体的总体阳性率更高，尤其是真菌。对于细菌性眼内炎，初始玻璃体内给予万古霉素联合第三代头孢菌素的抗生素治疗可能是一种合适的治疗方法。
