眼内炎的经验性治疗。氨基糖苷类药物是否必要？
Empiric treatment of endophthalmitis. Are aminoglycosides necessary?
作者信息
Donahue S P, Kowalski R P, Eller A W, DeVaro J M, Jewart B H
机构信息
Department of Ophthalmology, University of Pittsburgh, Pa.
出版信息
Arch Ophthalmol. 1994 Jan;112(1):45-7. doi: 10.1001/archopht.1994.01090130055016.
OBJECTIVE
To reevaluate the necessity of empiric gram-negative therapy for postoperative endophthalmitis based on the recognition of aminoglycoside-induced toxic effects.
METHODS
A review of 162 cases of culture-positive bacterial endophthalmitis to determine bacterial prevalence, antibiotic susceptibilities, and laboratory staining results of intraocular material.
RESULTS
One hundred fifty (93%) gram-positive and 12 (7%) gram-negative isolates. All the gram-positive bacteria were susceptible to vancomycin hydrochloride; and gram-negative bacteria were susceptible to gentamicin sulfate, amikacin sulfate, and ceftazidime sodium. Bacterial rods were observed on smear of intraocular material in 10 gram-negative cases submitted for examination.
CONCLUSION
Vancomycin is an appropriate single agent if laboratory studies rule out gram-negative infection. In the absence of laboratory support, an aminoglycoside (possible toxic effects) or another gram-negative antibiotic (possibly ceftazidime) should also be administered.
目的
基于对氨基糖苷类药物毒性作用的认识，重新评估术后眼内炎经验性革兰氏阴性菌治疗的必要性。
方法
回顾162例培养阳性细菌性眼内炎病例，以确定细菌流行情况、抗生素敏感性及眼内物质的实验室染色结果。
结果
150株（93%）革兰氏阳性菌和12株（7%）革兰氏阴性菌。所有革兰氏阳性菌对盐酸万古霉素敏感；革兰氏阴性菌对硫酸庆大霉素、硫酸阿米卡星和头孢他啶钠敏感。在送检检查的10例革兰氏阴性菌病例的眼内物质涂片中观察到杆菌。
结论
如果实验室研究排除革兰氏阴性菌感染，万古霉素是合适的单一用药。在缺乏实验室支持的情况下，还应使用氨基糖苷类药物（可能有毒性作用）或另一种革兰氏阴性菌抗生素（可能是头孢他啶）。
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