危险因素和微生物特征：从伴有前房积脓的细菌性角膜炎到与角膜炎相关的眼内炎。

Risk factors and microbiological characteristics: from bacterial keratitis with hypopyon to keratitis-related endophthalmitis.

机构信息

Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, 372 Jingsi Road, Jinan, 250021, China.

School of Ophthalmology, Shandong First Medical University, Jinan, China.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2022 Sep;260(9):3019-3025. doi: 10.1007/s00417-022-05657-y. Epub 2022 Apr 20.

DOI:10.1007/s00417-022-05657-y

PMID:35441875

Abstract

PURPOSE

To compare the clinical and microbiological characteristics in patients with bacterial keratitis with hypopyon (BKH), bacterial keratitis-related endophthalmitis (BKE), and bacterial endophthalmitis without keratitis (BE).

METHODS

Data from all inpatients who were clinically diagnosed with BKH, BKE, and BE from 2018 to 2020 were collected retrospectively. The demographics, predisposing risk factors, clinical characteristics, microbiological profiles, and antibiotic susceptibility of the patients were evaluated.

RESULTS

Approximately 9.46% (28/296) of eyes with BKH progressed to endophthalmitis. The hypopyon (OR = 5.35, 95% CI: 2.17-7.08) and corneal perforation (OR = 2.47, 95% CI: 1.04-4.86) were significantly related to the development of BKE. The odds ratios for hypopyon of less than 1 mm, 1-3 mm, and greater than 3 mm were 1, 2.09 (95% CI: 1.17-3.15), and 4.12 (95% CI:2.59-5.68), respectively. The predominant causative pathogen was Staphylococcus epidermidis (36.43%, 38.89%), followed by Streptococci (14.73%, 16.67%), Staphylococcus aureus (8.53%, 7.79%), and Pseudomonas aeruginosa (9.30%, 7.14%) in eyes with BKH and BE. However, the main pathogens were Pseudomonas aeruginosa (37.50%) and Staphylococcus aureus (31.25%) in eyes with BKE. In the BKH, BKE, and BE groups, almost 100% of Staphylococcus aureus isolates were sensitive to vancomycin (97.70%, 100%, 95.56%), about a half were sensitive to fluoroquinolones (51.85%, 39.90%, 62.34%), and approximately 30% were sensitive to trimethoprim/sulfa (27.77%, 21.56%, 33.56%) and cefazolin (41.47%, 20.31%, 38.81%). The susceptibility of Pseudomonas aeruginosa to fluoroquinolones antibiotics was 55.75%, 66.67%, and 62.58%, respectively, in the three groups.

CONCLUSIONS

The height of hypopyon and corneal perforation are risk factors for progression to endophthalmitis in eyes with bacterial keratitis. When Staphylococcus aureus and Pseudomonas aeruginosa are identified, vigilance is required for advanced endophthalmitis.

摘要

目的

比较伴有前房积脓（BKH）、细菌性角膜炎相关眼内炎（BKE）和无角膜炎的细菌性眼内炎（BE）患者的临床和微生物学特征。

方法

回顾性收集 2018 年至 2020 年临床诊断为 BKH、BKE 和 BE 的所有住院患者的数据。评估患者的人口统计学、易患风险因素、临床特征、微生物特征和抗生素敏感性。

结果

约 9.46%（28/296）的 BKH 眼进展为眼内炎。前房积脓（OR=5.35，95%CI：2.17-7.08）和角膜穿孔（OR=2.47，95%CI：1.04-4.86）与 BKE 的发生显著相关。前房积脓高度<1mm、1-3mm 和>3mm 的比值比分别为 1、2.09（95%CI：1.17-3.15）和 4.12（95%CI：2.59-5.68）。主要病原体是表皮葡萄球菌（36.43%，38.89%），其次是链球菌（14.73%，16.67%）、金黄色葡萄球菌（8.53%，7.79%）和铜绿假单胞菌（9.30%，7.14%），在 BKH 和 BE 眼中。然而，在 BKE 眼中，主要病原体是铜绿假单胞菌（37.50%）和金黄色葡萄球菌（31.25%）。在 BKH、BKE 和 BE 组中，几乎 100%的金黄色葡萄球菌分离株对万古霉素敏感（97.70%、100%、95.56%），约一半对氟喹诺酮类药物敏感（51.85%、39.90%、62.34%），约 30%对甲氧苄啶/磺胺类药物敏感（27.77%、21.56%、33.56%）和头孢唑啉（41.47%、20.31%、38.81%）。三组中铜绿假单胞菌对氟喹诺酮类抗生素的敏感性分别为 55.75%、66.67%和 62.58%。