McLeod S D, DeBacker C M, Viana M A
Illinois Eye and Ear Infirmary, University of Illinois at Chicago, 60612, USA.
Ophthalmology. 1996 Mar;103(3):479-84. doi: 10.1016/s0161-6420(96)30668-4.
To describe current practice patterns in treating infectious keratitis.
A questionnaire was designed that asked ophthalmologists to describe the diagnostic equipment accessible to their practice for performing smears and obtaining scrapings for microbial culture and sensitivity testing. The questionnaire also presented two hypothetical cases of patients with infectious keratitis. Bacterial keratitis was relatively early and less severe in the first patient, and it was more advanced and more severe in the second patient. Recipients were asked about their diagnostic and therapeutic approach. The survey was mailed to 300 ophthalmologists in Florida, Illinois, and New York.
One hundred twenty-four completed surveys (45%) were returned. Six surveys were from cornea specialists, who were excluded from the analysis. Only 18 practices (15%) maintained access to Gram stain supplies, and 58 (50%) maintained culture supplies. Whereas 56% of respondents would treat the patient with the less severe bacterial keratitis without obtaining samples for cultures, only 13% would treat the patient with the more severe condition in this manner (P<0.00001). Of the respondents, 82% would treat the patient with the less severe bacterial keratitis with a fluoroquinolone, compared with 62% for the patient with the more severe infection (P=0.002). The mean frequency of fluoroquinolone administration for the patient with more-severe bacterial keratitis was one drop every 0.88 hours, compared with one drop every 1.48 hours for the patient with the less severe infection.
Ophthalmologists appear to treat suspected infectious keratitis differently, depending on perceived severity; they choose different antibiotic regimens; and are more likely to forgo scrapings for Gram staining and cultures for ulcers that appear less severe. The justification for this approach should be established.
描述当前治疗感染性角膜炎的实践模式。
设计了一份问卷，询问眼科医生描述其诊所可用于进行涂片以及获取用于微生物培养和药敏试验的刮片的诊断设备。问卷还给出了两个感染性角膜炎患者的假设病例。第一个患者的细菌性角膜炎相对处于早期且病情较轻，第二个患者的病情则更严重且处于更晚期。受访者被问及他们的诊断和治疗方法。该调查被邮寄给佛罗里达州、伊利诺伊州和纽约州的300名眼科医生。
共收到124份完整的调查问卷（45%）。有6份问卷来自角膜专科医生，在分析中被排除。只有18家诊所（15%）备有革兰氏染色用品，58家（50%）备有培养用品。56%的受访者会在不获取培养样本的情况下治疗病情较轻的细菌性角膜炎患者，而只有13%的受访者会以这种方式治疗病情更严重的患者（P<0.00001）。在受访者中，82%会用氟喹诺酮类药物治疗病情较轻的细菌性角膜炎患者，相比之下，病情更严重感染的患者这一比例为62%（P=0.002）。病情更严重的细菌性角膜炎患者使用氟喹诺酮类药物的平均给药频率为每0.88小时一滴，而病情较轻感染的患者为每1.48小时一滴。
眼科医生似乎根据感知到的严重程度对疑似感染性角膜炎采取不同的治疗方法；他们选择不同的抗生素治疗方案；对于看起来不太严重的溃疡，更有可能放弃进行革兰氏染色刮片和培养。应确定这种方法的合理性。
