感染性眼内炎的致病菌培养结果分析

目的：探讨引起感染性眼内炎的致病菌对广谱抗生素的耐药性及敏感性。

方法：对我院15例白内障术后眼内炎术中抽取玻璃体做病原学检查并对治疗结果进行回顾性分析。

结果：此15例在术中采集前房水及玻璃体做细菌培养与药物敏感试验，7例培养出致病菌，细菌培养阳性率47%(其中真菌1例，表皮葡萄球菌3例，缓慢葡萄球菌1例，凝固酶阴性葡萄球菌1例，浅绿气球菌1例)，8例示无菌生长。培养阳性病例中3例表皮葡萄球菌和1例缓慢葡萄球菌的药敏试验均显示对左氧氟沙星是耐药的，MIC均>4； 另外1例凝固酶阴性葡萄球菌和1例浅绿气球菌药敏试验显示对左氧氟沙星是敏感的，MIC均<2，万古霉素与利福平均为敏感抗生素，MIC均<1。

结论：大多数医疗机构常规使用左氧氟沙星作为内眼手术预防性用药，但本文章总结后对此现象提出质疑。临床医生对致病菌经验性用药经常出现，但当未做细菌培养和药物敏感性试验同时致病菌出现耐药时经验性用药往往导致治疗效果降低或更严重的后果。因此应该及时根据细菌培养和药物敏感性试验结果合理选择抗生素，适时调整用药方案是规范治疗的首选。

Analysis of the results about the pathogens culturing of infectious endophthalmitis

AIM: To discuss the drug resistance and sensitivity of broad-spectrum antibiotics about the pathogens that resulting in infectious endophthalmitis.

METHODS: The vitreous bodies of 15 patients were extracted in our hospital during the operation of infectious endophthalmitis after their cataract operation and then did the etiological examination and analyzed the results.

RESULTS: The anterior chamber aqueous and vitreous bodies of the 15 patients were collected during the operation and did the bacterial culturing and drug sensitivity tests. Seven of the 15 cultured pathogenic bacteria. Positive rate of the bacterial culture was 46%(1 fungus, 3 staphylococcus epidermidis, 1 staphylococcus lentus, 1 coagulase negative staphylococcus, 1 aerococcus viridians). Eight of the 15 didn't culture any bacteria. Three staphylococcus epidermidis and 1 staphylococcus lentus among the positive cases showed resistance to levofloxacin in the drug sensitivity test and the MIC were all more than 4. In addition 1 coagulase negative staphylococcus and 1 aerococcus viridians showed sensitivity to levofloxacin and the MIC were all less than 2. Vancomycin and rifampicin were sensitive antibiotics and the MIC were all less than 1.

CONCLUSION: Most medical institution use levofloxacin as the prophylactic therapy routinely in inner eye operation, but this article questions this phenomenon. It's common that clinicians use drugs to resist pathogens by their experiences. When pathogens show drug resistance, empirical medication will lead to worse treatment effect or even much worse consequence without bacterial culturing and drug sensitivity tests. So it's right to choose the antibiotics according to the results of the bacterial culturing and drug sensitivity tests properly and timely. It's the first choice of standard treatments to adjust the therapeutic regimens timely.