Herde J, Tost M, Wilhelms D, Höhne C, Thiele T
Klinik und Poliklinik für Augenheilkunde, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg.
Klin Monbl Augenheilkd. 1996 Jul;209(1):13-20. doi: 10.1055/s-2008-1035270.
The conjunctival flora is of great interest for each case of intraocular operation preventing postoperative infections. Despite of negative cultures before the operation we investigated in a prospective randomized study perioperatively the bacterial situation of the conjunctiva in 105 patients.
We took conjunctival swabs for microbiological examination from patient's eye operated on cataract or glaucoma, on the day of admission to the eye clinic and in the morning of the operating day. In addition, specimens were taken by nurses with Transwab MW-172 P before the local anaesthesia, disinfection of the conjunctiva and lids and application of eye drops, after these procedures by a research worker, at the end of the operation by the surgeon and two to three days after the operation by nurses with Transwab MW-172 P again. In 53 patients we collected lacrimal fluid to measure the lysozyme concentration.
Out of 686 conjunctival swabs we have found 126 (18.4%) positive cultures. Staphylococcus epidermidis had the highest incidence (109 = 86.5%) followed by Staphylococcus aureus (7 = 5.5%). Only in 28 eyes all conjunctival swabs, taken at different times, were negative. There was an increase of positive cultures from routine swabs on the day of admission from 13 (12.4%), to 33 (31.7%) in the swabs taken on the day of the operation in the morning. On the other side the positive cultures decreased then continuously before and after the preparation of the operation, at the end of the operation and during two to three days postoperatively. There was'nt any statistical correlation between the concentration of the lacrimal lysozyme and the rate of positive cultures.
The preoperative bacteriological diagnostic of the conjunctiva is important mainly for the prevention of postoperative endophthalmitis despite the transience and fluctuation of the conjunctival flora but also in case of endophthalmitis for rapid specific antibiotical therapy.
结膜菌群对于每一例眼内手术预防术后感染都具有重要意义。尽管术前培养结果为阴性，但我们在一项前瞻性随机研究中，对105例患者围手术期的结膜细菌状况进行了调查。
我们从眼科门诊入院当天以及手术当天上午，对接受白内障或青光眼手术患者的眼睛采集结膜拭子进行微生物学检查。此外，护士在局部麻醉、结膜和眼睑消毒以及滴眼药水之前，用Transwab MW - 172 P采集标本；之后由研究人员在这些操作之后、手术结束时由外科医生以及术后两到三天由护士再次用Transwab MW - 172 P采集标本。在53例患者中，我们收集泪液以测量溶菌酶浓度。
在686份结膜拭子中，我们发现126份（18.4%）培养结果为阳性。表皮葡萄球菌的发生率最高（109份 = 86.5%），其次是金黄色葡萄球菌（7份 = 5.5%）。只有28只眼在不同时间采集的所有结膜拭子均为阴性。入院当天常规拭子培养结果阳性率从13份（12.4%）增加到手术当天上午拭子的33份（31.7%）。另一方面，在手术准备前后、手术结束时以及术后两到三天，阳性培养结果持续下降。泪液溶菌酶浓度与阳性培养率之间没有任何统计学相关性。
结膜的术前细菌学诊断主要对于预防术后眼内炎很重要，尽管结膜菌群具有短暂性和波动性，但在发生眼内炎时对于快速进行特异性抗生素治疗也很重要。
