2000-2009 年和 2010-2019 年成人患者中，前房蜂窝织炎和眶蜂窝织炎的特征、病因、分离病原体以及抗生素疗效的差异。

Differences in characteristics, aetiologies, isolated pathogens, and the efficacy of antibiotics in adult patients with preseptal cellulitis and orbital cellulitis between 2000-2009 and 2010-2019.

机构信息

Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

School of Medicine, National Yang Ming University, Taipei, Taiwan.

出版信息

Br J Ophthalmol. 2023 Mar;107(3):331-336. doi: 10.1136/bjophthalmol-2021-318986. Epub 2021 Oct 4.

DOI:10.1136/bjophthalmol-2021-318986

PMID:34607790

Abstract

BACKGROUND/AIMS: To understand whether the epidemiology, aetiologies, common pathogens and the antibiotic efficacy against the identified bacteria of periorbital cellulitis in adults have changed recently (2010-2019) compared with the past decade (2000-2009).

METHODS

Adult patients (n=224) diagnosed with preseptal cellulitis and orbital cellulitis admitted to Kaohsiung Veterans General Hospital during 2000-2019 were retrospectively reviewed. Demographic and clinical characteristics, isolated pathogens and antibiotic susceptibility tests against the commonly cultured bacteria were analysed.

RESULTS

Preseptal cellulitis showed a tendency of female predominance. Patients in their 60s showed an incidence peak; more cases were observed during winter. The most common predisposing factor was dacryocystitis (15.5%-30.5%), followed by hordeolum (15.5%-24.8%). Aetiology of sinusitis (p=0.001) decreased and that of conjunctivitis (p=0.007) increased significantly with time. Culture results of nasopharyngeal swabs and local abscess showed higher positivity rate than conjunctival swab. The most common isolates were methicillin-susceptible , methicillin-resistant , coagulase-negative staphylococci and . Antibiotics including fluoroquinolones and vancomycin were effective; in contrast, ampicillin/sulbactam and oxacillin showed decreasing efficacy against gram-positive bacteria. For antibiotic treatment against , fluoroquinolones, ceftazidime, piperacillin and imipenem were ideal choices.

CONCLUSION

In isolated pathogens, the increasing trend of methicillin-resistant detection was compatible with reducing oxacillin efficacy against periorbital infection. In our study, the report of antibiotic efficacy against the most common identified bacteria offered empirical choices for hospitalised patients with periorbital infection before obtaining culture results.

摘要

背景/目的：了解成人眶周蜂窝织炎的流行病学、病因、常见病原体以及针对鉴定细菌的抗生素疗效在最近（2010-2019 年）与过去十年（2000-2009 年）相比是否发生了变化。

方法

回顾性分析了 2000-2019 年期间因眶周蜂窝织炎入住高雄荣民总医院的 224 例成人患者的临床资料。分析了患者的人口统计学和临床特征、分离的病原体以及针对常见培养细菌的抗生素药敏试验结果。

结果

眶周蜂窝织炎表现出女性为主的趋势。60 多岁的患者发病率最高；冬季发病较多。最常见的诱发因素是泪囊炎（15.5%-30.5%），其次是麦粒肿（15.5%-24.8%）。随着时间的推移，鼻窦感染的病因（p=0.001）显著减少，而结膜炎（p=0.007）的病因显著增加。鼻咽拭子和局部脓肿的培养结果阳性率高于结膜拭子。最常见的分离株为耐甲氧西林金黄色葡萄球菌、耐甲氧西林金黄色葡萄球菌、凝固酶阴性葡萄球菌和酿脓链球菌。包括氟喹诺酮类和万古霉素在内的抗生素有效；相反，氨苄西林/舒巴坦和苯唑西林对革兰阳性菌的疗效降低。对于治疗酿脓链球菌，氟喹诺酮类、头孢他啶、哌拉西林和亚胺培南是理想的选择。