de Miranda Gonçalves Luca Bongiovanni, Campos Maria Leticia Lasca Sales, Barros Guilherme Feltrin, da Veiga Glaucia Luciano, Silva Juliana Antoniali, Fonseca Fernando Luiz Affonso, Gascón Thaís Moura, de Carvalho Samantha Sanches, de Carvalho Andrea Karla Ribeiro, Fernandes Greicy Ellen Pinheiro, Lima Vagner Loduca, Lima Tiago Mirco
Centro Universitário Faculdade de Medicina Do ABC/FMABC, Santo André, Brazil.
Universidade Federal de São Paulo/UNIFESP, São Paulo, Brazil.
Int J Retina Vitreous. 2024 Dec 20;10(1):99. doi: 10.1186/s40942-024-00604-x.
Intravitreal injections, a relatively recent treatment in ophthalmology, is being adopted rapidly worldwide and becoming one of the most common therapies in the field. Numerous complications are associated with this treatment, ranging from minor inflammatory ailments to endophthalmitis. We analyzed the conjunctival flora of patients treated with intravitreal injections and topical antibiotics.
The study was a longitudinal prospective analysis of cultures and antibiograms collected from patients who underwent intravitreal injections and topical antibiotics afterwards at the retina clinic in ABC's Medical University.
A total of 148 swabs obtained from 98 patients were cultured and underwent antibiotic sensitivity testing. All bacteria were sensitive to vancomycin, and with the exception of Escherichia coli samples, they were also sensitive to a third-generation cephalosporin (ceftriaxone-same class and generation as ceftazidime), both of which are important antibiotics for the treatment of endophthalmitis. The bacteria species were specifically coagulase-negative Staphylococcus sp. 92% of which was penicillin-resistant and 56.9% was resistant to ciprofloxacin, a second-generation fluoroquinolone. The culture results were similar to that described in the literature and showed the same higher prevalence of coagulase-negative Staphylococcus sp. and S. epidermidis. Regarding the antibiotic resistance profiles, vancomycin, a third-generation cephalosporin, and penicillin showed almost identical results to those reported previously. Regarding fluoroquinolones, the incidence of resistant coagulase-negative Staphylococcus sp. was lower than the findings worldwide, but the resistance rates found were: S. aureus (26.7%), S. epidermidis (61.3%), and Staphylococcus sp. (coagulase negative, 56.9%).
The current results showed that the typical conjunctival bacteria had higher resistance to fluoroquinolones (although they were not tested specifically to ofloxacin), suggesting a possible selection of resistant bacteria that should not be taken for granted in clinic. However, the same bacteria did not exhibit cross-resistance in the analysis of vancomycin and third-generation cephalosporins. This real-world, longitudinal, prospective study on conjunctival flora analyzed bacterial resistance profiles and contemporary antibiotic use, offering deeper insights into this subject.
玻璃体内注射是眼科领域一项相对较新的治疗方法，正在全球范围内迅速被采用，并成为该领域最常见的治疗方法之一。这种治疗方法会引发许多并发症，从轻微的炎症性疾病到眼内炎不等。我们分析了接受玻璃体内注射和局部使用抗生素治疗的患者的结膜菌群。
该研究是对在ABC医科大学视网膜诊所接受玻璃体内注射及随后局部使用抗生素治疗的患者所采集的培养物和药敏试验结果进行的纵向前瞻性分析。
共对从98名患者身上获取的148份拭子进行了培养和抗生素敏感性测试。所有细菌对万古霉素敏感，除大肠杆菌样本外，它们对第三代头孢菌素（头孢曲松，与头孢他啶属于同一类别和代次）也敏感，这两种都是治疗眼内炎的重要抗生素。细菌种类具体为凝固酶阴性葡萄球菌属，其中92%对青霉素耐药，56.9%对第二代氟喹诺酮类药物环丙沙星耐药。培养结果与文献中描述的相似，显示凝固酶阴性葡萄球菌属和表皮葡萄球菌的患病率较高。关于抗生素耐药谱，万古霉素、第三代头孢菌素和青霉素的结果与先前报道的几乎相同。关于氟喹诺酮类药物，凝固酶阴性葡萄球菌属的耐药发生率低于全球调查结果，但所发现的耐药率分别为：金黄色葡萄球菌（26.7%）、表皮葡萄球菌（61.3%）和葡萄球菌属（凝固酶阴性，56.9%）。
目前的结果表明，典型的结膜细菌对氟喹诺酮类药物具有较高的耐药性（尽管未对氧氟沙星进行专门测试），这表明在临床中可能存在耐药菌的选择，不应被视为理所当然。然而，在对万古霉素和第三代头孢菌素的分析中，相同的细菌并未表现出交叉耐药性。这项关于结膜菌群的真实世界纵向前瞻性研究分析了细菌耐药谱和当代抗生素的使用情况，为该主题提供了更深入的见解。
