泰国北部一家三级眼科护理机构的真菌性角膜炎：病因和治疗结果的预后因素。

Fungal keratitis at a tertiary eye care in Northern Thailand: Etiology and prognostic factors for treatment outcomes.

机构信息

Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

出版信息

J Infect. 2021 Jul;83(1):112-118. doi: 10.1016/j.jinf.2021.05.016. Epub 2021 May 24.

DOI:10.1016/j.jinf.2021.05.016

PMID:34038772

Abstract

PURPOSE

To evaluate etiology and prognostic factors for treatment outcomes of fungal keratitis (FK).

METHODS

Culture-positive FK patients between 2012 and 2017 were reviewed. Treatment outcomes were categorized into success (resolved within two weeks), slow response and medication failure (no improvement or required surgery). Etiology and risk factors for poor treatment outcomes were analyzed.

RESULTS

A total of 113 eyes of 113 patients (77% males) were recruited. Ocular trauma (69.0%) was the most common predisposing factor. Of this, 80% were exposed to organic foreign bodies. The most common pathogen was Fusarium spp. (45.2%), while dematiaceous fungi were discovered in 29.6%. Medical treatment was successful in 24.8% of eyes, while 29.2% had a slow response and 42.5% failed medication. Therapeutic keratoplasty was performed in 22.1% of eyes and 11.5% eventually required eye removal. Significant risk factors for medication failure were advanced age (P = 0.005), delayed antifungal treatment (P = 0.038) and large-size lesion (P = 0.003).

CONCLUSIONS

Ocular trauma was the major predisposing factor of FK in the Northern Thailand. Fusarium was the most common identified pathogen. Many cases were refractory to medications and required surgical intervention. Aging, delayed treatment and a large lesion were predictors for poor outcomes.

摘要

目的

评估真菌性角膜炎（FK）的病因和预后因素，以及其治疗结果。

方法

回顾了 2012 年至 2017 年间培养阳性的 FK 患者。将治疗结果分为治愈（两周内痊愈）、缓慢反应和药物治疗失败（无改善或需要手术）。分析了病因和不良治疗结果的危险因素。

结果

共纳入 113 例 113 只眼（77%为男性）患者。眼部创伤（69.0%）是最常见的诱发因素，其中 80%是由于有机性异物暴露引起的。最常见的病原体是镰刀菌属（45.2%），而暗色真菌则占 29.6%。药物治疗成功率为 24.8%，29.2%的患者反应缓慢，42.5%的患者药物治疗失败。22.1%的患者进行了治疗性角膜移植，11.5%的患者最终需要眼球摘除。药物治疗失败的显著危险因素是年龄较大（P=0.005）、抗真菌治疗延迟（P=0.038）和病变较大（P=0.003）。