Davis J L, Koidou-Tsiligianni A, Pflugfelder S C, Miller D, Flynn H W, Forster R K
Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute.
Ophthalmology. 1988 Oct;95(10):1404-10. doi: 10.1016/s0161-6420(88)32990-8.
The predicted sensitivities of common organisms guide initial antibiotic therapy in endophthalmitis. The authors suspected a change in the expected sensitivity of coagulase-negative staphylococci when three cases of endophthalmitis due to multiply resistant organisms failed to respond to intravitreal cefazolin and gentamicin. The authors reviewed 48 cases from 1982 to 1986, compared these with 28 cases from 1973 to 1981, they found increased resistance to gentamicin (35 versus 0%, P less than 0.05) and increased resistance to methicillin (27 versus 19%). Eight cases were resistant to both antibiotics, including the three clinical failures. Final vision was unrelated to antimicrobial resistance. Since cephalosporins may be ineffective clinically against methicillin-resistant staphylococci, concomitant gentamicin resistance may render intravitreal cefazolin and gentamicin inadequate for their treatment. No isolates were resistant to vancomycin. Vancomycin and aminoglycoside, used intravitreally in the initial management of endophthalmitis, would be anticipated to provide better coverage than cefazolin and aminoglycoside for endophthalmitis due to the staphylococci, as well as for infections due to streptococcal and bacillus species.
常见病原体的预测敏感性指导眼内炎的初始抗生素治疗。当3例由多重耐药病原体引起的眼内炎病例对玻璃体内注射头孢唑林和庆大霉素无反应时，作者怀疑凝固酶阴性葡萄球菌的预期敏感性发生了变化。作者回顾了1982年至1986年的48例病例，并与1973年至1981年的28例病例进行比较，发现对庆大霉素的耐药性增加（35%对0%，P<0.05），对甲氧西林的耐药性增加（27%对19%）。8例对两种抗生素均耐药，包括3例临床治疗失败病例。最终视力与抗菌药物耐药性无关。由于头孢菌素在临床上可能对耐甲氧西林葡萄球菌无效，同时存在的庆大霉素耐药性可能使玻璃体内注射头孢唑林和庆大霉素不足以治疗此类感染。没有分离株对万古霉素耐药。在眼内炎的初始治疗中玻璃体内使用万古霉素和氨基糖苷类药物，预计比头孢唑林和氨基糖苷类药物能更好地覆盖由葡萄球菌引起的眼内炎，以及由链球菌和芽孢杆菌属引起的感染。
