Ghita Aurelian Mihai, Iliescu Daniela Adriana, Ghita Ana Cristina, Ilie Larisa Adriana
Department of Physiology, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bld., 050474 Bucharest, Romania.
Ophthalmology Department, Bucharest University Emergency Hospital, 169 Splaiul Independenței Street, 050098 Bucharest, Romania.
Diagnostics (Basel). 2023 Nov 9;13(22):3409. doi: 10.3390/diagnostics13223409.
Periodic assessment of bacterial contamination is necessary as it allows proper guidance in cases of eye infections through the use of appropriate antibiotics. Due to the extensive use of antibiotic treatment, many strains of the microbiota that cause infections are resistant to the usual ophthalmic antibiotics. The present study provides an updated assessment of the susceptibility of Gram-positive and Gram-negative bacteria found on the ocular surface to the most commonly used antibiotic agents in patients undergoing cataract surgery. A total of 993 patients were included in the study with ages between 44 and 98 years old. Conjunctival cultures were collected 7 days before cataract surgery. The response of Gram-positive and Gram-negative bacteria to various antibiotic classes, such as glycopeptides, cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, phenicols, tetracyclines, rifamycins, macrolides and penicillins, was assessed. From the tested antibiotics, vancomycin had 97.8% efficacy on Gram-positive bacteria. In the cephalosporin category, we observed a high level of resistance of the cefuroxime for both Gram-positive and negative bacteria. Antibiotics that have more than 90% efficacy on Gram-positive bacteria are meropenem, imipenem, netilmicin, amikacin and rifampicin. On Gram-negative bacteria, we found 100% efficacy of all tested fluoroquinolones, i.e., aminoglycosides (except for tobramycin), doxycycline, azithromycin, clarithromycin and chloramphenicol. The current study illustrates patterns of increased resistance in certain bacteria present on the ocular surface to some of the commonly used antibiotics in ophthalmological clinical practice. One such revealing example is cefuroxime, which has been highly used as an intracameral antibiotic for the prevention of bacterial endophthalmitis after cataract surgery.
定期评估细菌污染情况很有必要，因为这有助于在眼部感染时通过使用适当的抗生素提供正确的指导。由于抗生素治疗的广泛使用，许多引起感染的微生物菌株对常用的眼科抗生素具有耐药性。本研究提供了对白内障手术患者眼表发现的革兰氏阳性和革兰氏阴性细菌对最常用抗生素药物敏感性的最新评估。共有993名年龄在44至98岁之间的患者纳入研究。在白内障手术前7天收集结膜培养物。评估了革兰氏阳性和革兰氏阴性细菌对各种抗生素类别的反应，如糖肽类、头孢菌素类、碳青霉烯类、氟喹诺酮类、氨基糖苷类、酚类、四环素类、利福霉素类、大环内酯类和青霉素类。在测试的抗生素中，万古霉素对革兰氏阳性细菌的疗效为97.8%。在头孢菌素类别中，我们观察到头孢呋辛对革兰氏阳性和阴性细菌均有较高水平的耐药性。对革兰氏阳性细菌疗效超过90%的抗生素有美罗培南、亚胺培南、奈替米星、阿米卡星和利福平。对革兰氏阴性细菌，我们发现所有测试的氟喹诺酮类药物、即氨基糖苷类（除妥布霉素外）、多西环素、阿奇霉素、克拉霉素和氯霉素的疗效均为100%。当前研究说明了眼表某些细菌对眼科临床实践中一些常用抗生素的耐药性增加模式。一个这样具有启发性的例子是头孢呋辛，它一直被大量用作前房内抗生素以预防白内障手术后的细菌性眼内炎。
