Bristol Eye Hospital, Cornea and Refractive Surgery, Bristol, United Kingdom.
University Hospitals Bristol and Public Health England Microbiology Laboratory Services Bristol, Bristol, United Kingdom.
Eye (Lond). 2019 Oct;33(10):1619-1625. doi: 10.1038/s41433-019-0463-6. Epub 2019 May 9.
The aims of this study were to identify the organisms responsible for microbial keratitis, as identified by corneal scrape using brain-heart infusion broth, trends over time and antimicrobial sensitivities, over an 11-year period at two eye units in the South West of England; Bristol Eye Hospital and Royal United Hospital, Bath.
All corneal scrapes performed and sent for microbiological analysis between 4th April 2006 and 31st October 2017 at the two eye units were retrospectively reviewed. First-line treatment was monotherapy with levofloxacin 0.5% and second-line treatment was a combination of cefuroxime 5% and gentamicin 1.5%. Both direct and enrichment cultures were used.
In total, 2614 corneal scrapes from 2116 patients (1082 female, mean age 47.7 ± 21.2 years) were identified. 38.1% (n = 996) were culture positive and 1195 organisms were cultured. In all, 91.6% were bacteria (69.4% were gram-positive, 30.6% gram-negative). Coagulase-negative Staphylococci (CoNS) were the most commonly cultured organism (n = 430). Pseudomonas aeruginosa was the most commonly identified gram-negative organism (n = 189). In total, 6.9% (n = 83) of organisms cultured were fungi. In all, 1.4% (n = 17) were acanthamoeba. There was no statistically significant trend in the organisms observed over the study period. Sensitivity testing confirmed reasonable sensitivity to the empiric antibiotics used in clinical practice.
This is the first report on microbial keratitis trends in the South West of England. Virulent organisms were likely to be detected on direct culture, whereas low virulent organisms such as CoNS were more likely to be detected on enrichment alone. Antibiotic sensitivity testing confirmed fluoroquinolone monotherapy as appropriate first-line treatment.
本研究的目的是确定在英格兰西南部的两个眼科单位（布里斯托尔眼科医院和皇家联合医院巴斯）的 11 年期间，通过脑心浸液肉汤进行角膜刮片确定微生物角膜炎的病原体，以及随时间的趋势和抗生素敏感性。
回顾性分析了 2006 年 4 月 4 日至 2017 年 10 月 31 日期间在这两个眼科单位进行的所有角膜刮片，并将其进行微生物分析。一线治疗是左氧氟沙星 0.5%单药治疗，二线治疗是头孢呋辛 5%和庆大霉素 1.5%联合治疗。均采用直接和富集培养。
共确定了 2116 例患者的 2614 例角膜刮片（1082 例女性，平均年龄 47.7±21.2 岁），其中 38.1%（n=996）为培养阳性，共培养出 1195 种病原体。所有病原体中 91.6%为细菌（69.4%为革兰阳性菌，30.6%为革兰阴性菌）。凝固酶阴性葡萄球菌（CoNS）是最常见的培养病原体（n=430）。铜绿假单胞菌是最常见的革兰阴性菌（n=189）。共培养出 6.9%（n=83）的真菌病原体。所有病原体中 1.4%（n=17）为棘阿米巴。在研究期间，观察到的病原体没有明显的趋势。药敏试验证实了在临床实践中使用的经验性抗生素具有合理的敏感性。
这是英格兰西南部微生物角膜炎趋势的第一份报告。直接培养可能会检测到毒力较强的病原体，而单独富集培养更有可能检测到毒力较弱的病原体，如 CoNS。抗生素药敏试验证实氟喹诺酮类单药治疗是合适的一线治疗。
