Oshima Y, Ohji M, Inoue Y, Harada J, Motokura M, Saito Y, Emi K, Tano Y
Department of Ophthalmology, Osaka Rosai Hospital, Japan.
Ophthalmology. 1999 Jan;106(1):142-7. doi: 10.1016/S0161-6420(99)90025-8.
To determine the incidence and the clinical course of methicillin-resistant Staphylococcus aureus as a cause of acute-onset infections in patients with atopic dermatitis after a scleral buckling procedures.
A retrospective chart review.
Two hundred eighty-seven patients (293 eyes) who underwent scleral buckling procedures to treat rhegmatogenous retinal detachments at either Osaka Rosai Hospital or Osaka University Medical School between July 1, 1995, and June 30, 1997, participated. Of these, 32 eyes (10.9%) were associated with atopic dermatitis.
Demographic and clinical data were abstracted from patients' medical records.
The incidence, clinical features, and management of postoperative infections associated with methicillin-resistant S. aureus were studied.
Methicillin-resistant S. aureus infection after scleral buckling procedures was identified in 6 (18.8%) of 32 eyes of patients with atopic dermatitis but in only 1 (0.4%) of the other 261 cases without atopic dermatitis (P < 0.001). The average interval from the scleral buckling procedures to the initial onset of infection was 8.3 +/- 9.1 days (range, 2-28 days). Bacterial infection and inflammation were controlled in four eyes by prompt removal of the infected buckle in combination with vancomycin administration. In the other three eyes, however, repeat intravitreous injections of vancomycin or emergent vitrectomies were required because of the development of endophthalmitis.
Methicillin-resistant S. aureus is an important causative pathogen of scleral buckling infections, particularly in patients with retinal detachment associated with atopic dermatitis. Preoperative evaluation and intraoperative attention to contamination are recommended to prevent methicillin-resistant S. aureus infections in these patients.
确定耐甲氧西林金黄色葡萄球菌作为巩膜扣带术后特应性皮炎患者急性感染病因的发病率及临床病程。
回顾性病历审查。
1995年7月1日至1997年6月30日期间在大阪罗赛医院或大阪大学医学院接受巩膜扣带术治疗孔源性视网膜脱离的287例患者（293只眼）参与研究。其中，32只眼（10.9%）与特应性皮炎相关。
从患者病历中提取人口统计学和临床数据。
研究与耐甲氧西林金黄色葡萄球菌相关的术后感染的发病率、临床特征及处理方法。
32例特应性皮炎患者的眼中有6例（18.8%）在巩膜扣带术后发生耐甲氧西林金黄色葡萄球菌感染，而在另外261例无特应性皮炎的病例中仅有1例（0.4%）发生感染（P<0.001）。从巩膜扣带术至感染初发的平均间隔时间为8.3±9.1天（范围2 - 28天）。4只眼中通过及时取出感染的扣带并联合应用万古霉素控制了细菌感染和炎症。然而，在另外3只眼中，由于发生了眼内炎，需要重复玻璃体内注射万古霉素或进行急诊玻璃体切除术。
耐甲氧西林金黄色葡萄球菌是巩膜扣带感染的重要致病病原体，尤其是在伴有特应性皮炎的视网膜脱离患者中。建议进行术前评估并在术中注意防止污染，以预防这些患者发生耐甲氧西林金黄色葡萄球菌感染。
