Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Arq Bras Oftalmol. 2023 Oct 20;87(6):e202200660. doi: 10.5935/0004-2749.2022-0060. eCollection 2023.
To study epidemiological data, laboratory results, and risk factors associated with microbial keratitis.
We conducted a retrospective study of corneal sample cultures from patients with microbial keratitis from January 2010 to December 2019. Results were analyzed according to the etiological diagnosis of bacterial, mycotic, or parasitic infection and were associated with related risk factors.
We analyzed 4810 corneal samples from 4047 patients (mean age 47.79 ± 20.68 years; male 53.27%). The prevalence of bacterial, fungal, and Acanthamoeba infections were 69.80%, 7.31%, and 3.51%, respectively. The most frequently isolated bacteria were coagulase-negative Staphylococcus (CoNS) (45.14%), S. aureus (10.02%), Pseudomonas spp. (8.80%), and Corynebacterium spp. (6.21%). Among CoNS, the main agent was S. epidermidis (n=665). For mycotic keratitis, Fusarium spp. (35.42%) and Candida parapsilosis (16.07%) were the most common agents among filamentous and yeasts isolates, respectively. Contact lens use was associated with a positive culture for Acanthamoeba spp. (OR = 19.04; p < 0.001) and Pseudomonas spp. (OR = 3.20; p < 0.001). Previous ocular trauma was associated with positive fungal cultures (OR = 1.80; p = 0.007), while older age was associated with positive bacterial culture (OR = 1.76; p = 0.001).
Our findings demonstrated a higher positivity of corneal sample cultures for bacteria. Among those, CoNS was the most frequently identified, with S. epidermidis as the main agent. In fungal keratitis, Fusarium spp. was the most commonly isolated. Contact lens wearers had higher risks of positive cultures for Acanthamoeba spp. and Pseudomonas spp. Ocular trauma increased the risk of fungal infection, while older age increased the risk of bacterial infection.
研究微生物角膜炎的流行病学数据、实验室结果和相关危险因素。
我们对 2010 年 1 月至 2019 年 12 月间微生物角膜炎患者的角膜样本培养进行了回顾性研究。根据细菌、真菌或寄生虫感染的病因诊断对结果进行了分析，并与相关危险因素相关联。
我们分析了 4047 名患者的 4810 个角膜样本（平均年龄 47.79±20.68 岁；男性 53.27%）。细菌、真菌和棘阿米巴感染的患病率分别为 69.80%、7.31%和 3.51%。最常分离到的细菌是凝固酶阴性葡萄球菌（CoNS）（45.14%）、金黄色葡萄球菌（10.02%）、假单胞菌属（8.80%）和棒状杆菌属（6.21%）。在 CoNS 中，主要病原体是表皮葡萄球菌（n=665）。对于真菌性角膜炎，丝状真菌和酵母菌分离物中最常见的病原体分别是镰孢菌属（35.42%）和近平滑假丝酵母（16.07%）。角膜接触镜的使用与棘阿米巴属的阳性培养相关（OR=19.04；p<0.001）和假单胞菌属（OR=3.20；p<0.001）。既往眼外伤与真菌培养阳性相关（OR=1.80；p=0.007），而年龄较大与细菌培养阳性相关（OR=1.76；p=0.001）。
我们的研究结果显示，角膜样本培养中细菌的阳性率更高。其中，CoNS 是最常被识别的，表皮葡萄球菌是主要病原体。在真菌性角膜炎中，镰孢菌属是最常见的分离物。角膜接触镜佩戴者棘阿米巴属和假单胞菌属的阳性培养风险更高。眼外伤增加了真菌感染的风险，而年龄较大则增加了细菌感染的风险。
