Xu Yi, Sun Bianjin, Shen Yangyang, Xu Huijing, Gu Yunfeng, Mao Liping, Liang Ying, Lu Qingsong, Zheng Meiqin
National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, School of Laboratory Medicine and Life Sciences, Ministry of Education, Wenzhou Medical University, Wenzhou, Zhejiang, China.
Microbiol Spectr. 2025 Mar 31;13(5):e0263024. doi: 10.1128/spectrum.02630-24.
The etiological spectrum of microbial keratitis exhibits significant regional variability. However, existing domestic and international resistance monitoring systems do not adequately address the specific needs of clinical practice. We analyzed a cohort of 3,691 patients diagnosed with microbial keratitis in the southern region of Zhejiang Province, China between 2016 and 2023. The patients' ages ranged from 2 to 93 years (979 men and 403 women). The microbial culture positivity rate is relatively low (38.72%). Trauma and foreign body entry emerged as significant risk factors. Mixed infections accounting for 4.85% posed challenges for diagnosis and treatment. Filamentous fungi, predominantly spp., dominated the microbial landscape. Prominent bacterial pathogens included , , , and was an important pathogen affecting the cornea in this region. The observed resistance patterns emphasized the urgency for alternative therapeutic strategies targeting resistant gram-positive (e.g., erythromycin, penicillin, oxacillin) and -negative (e.g., trimethoprim-sulfamethoxazole, tetracycline) bacteria as well as refractory fungi, such as (voriconazole-resistant) and (resistant to itraconazole and amphotericin B). Resistance to ceftazidime, meropenem, and erythromycin exhibited a slight upward trend, diverging from the overall bacterial resistance trend observed in China. High isolation rates of methicillin-resistant and macrolide-resistant underscored the need for enhanced infection control measures and targeted interventions against these resistant pathogens. This study elucidated the evolving patterns of antibiotic resistance among ocular isolates in the region, providing a critical foundation for the effective application of antimicrobial therapies in clinical practice.IMPORTANCECurrently, our region does not possess extensive monitoring data regarding antibiotic resistance trends in ocular isolates, especially those derived from corneal infections. This study addresses a critical component of ophthalmic microbiology by analyzing long-term data to identify trends in etiological agents and their clinical implications. It aimed to fill the void in epidemiological data on ocular isolates within our region, providing scientific insights essential for the comprehensive monitoring of ocular microbial drug resistance.
微生物性角膜炎的病因谱存在显著的地区差异。然而，现有的国内外耐药监测系统并未充分满足临床实践的特定需求。我们分析了2016年至2023年间在中国浙江省南部地区诊断为微生物性角膜炎的3691例患者。患者年龄在2岁至93岁之间（男性979例，女性403例）。微生物培养阳性率相对较低（38.72%）。外伤和异物进入是重要的危险因素。占4.85%的混合感染给诊断和治疗带来了挑战。丝状真菌，主要是 属，在微生物构成中占主导地位。主要的细菌病原体包括 、 、 和 是该地区影响角膜的重要病原体。观察到的耐药模式凸显了针对耐药革兰氏阳性菌（如红霉素、青霉素、苯唑西林）和革兰氏阴性菌（如甲氧苄啶 - 磺胺甲恶唑、四环素）以及难治性真菌（如 对伏立康唑耐药）和 对伊曲康唑和两性霉素B耐药）的替代治疗策略的紧迫性。对头孢他啶、美罗培南和红霉素的耐药性呈轻微上升趋势，与中国观察到的总体细菌耐药趋势不同。耐甲氧西林 和耐大环内酯 的高分离率强调了加强感染控制措施和针对这些耐药病原体的靶向干预的必要性。本研究阐明了该地区眼部分离株抗生素耐药性的演变模式，为抗菌疗法在临床实践中的有效应用提供了关键基础。重要性目前，我们地区缺乏关于眼部分离株，尤其是角膜感染分离株抗生素耐药趋势的广泛监测数据。本研究通过分析长期数据以确定病原体趋势及其临床意义来解决眼科微生物学的一个关键组成部分。它旨在填补我们地区眼部分离株流行病学数据的空白，为全面监测眼部微生物耐药性提供至关重要的科学见解。
