Curative effects of probing alone and probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital duct obstruction of children from 3-12 months of age

Background: To investigate the 1-time success rate of probing alone and nasolacrimal duct probing combined with nasolacrimal injection of levofloxacin ophthalmic gel on congenital nasolacrimal duct obstruction (CNLDO) in young children. Methods: A retrospective case series was performed on 494 cases (647 eyes) of 3–12 month-old children with CNLDO between July 2014 and July 2015. Material obtained from the lacrimal sac was cultured to isolate infectious agents. Susceptibility testing was done. Children from 3–12 months of age who were found to be sensitive to Levofloxacin (n=493 eyes) were separated into two groups: 3–6 months of age (276 eyes) and 7–12 months of age (217 eyes). Each of the groups were then randomized into group A (138 eyes of 3–6 months of age; 102 eyes of 7–12 months of age) and group B (138 eyes of 3–6 months of age; 115 eyes of 7–12 months of age). Children in group A underwent nasolacrimal duct probing alone; those in group B underwent nasolacrimal duct probing plus nasolacrimal duct injection of levofloxacin and the efficacy of probing was evaluated. Results: The average detection rate of pathogenic bacteria in dacryocystitis was 75.1%, andStaphylococcus aureuswas found to be the main pathogenic bacteria (42.59%, 106 cases). Among children from 7–12 months of age, the 1-time success rate of nasolacrimal duct probing alone was 88.24% and the 1-time success rate of probing combined with nasolacrimal duct injection of levolfoxacin ophthalmic gel was 96.52% (statistical signiifcance, P=0.02<0.05). Conclusions: Most pathogenic bacteria (96.81%) were sensitive to levofloxacin. Nasolacrimal duct probing combined with nasolacrimal duct injection of levolfoxacin may improve the success rate of probing in children older than 6 months of age.     

多重细菌感染性眼病病原学分析

目的回顾性分析眼科细菌培养中多重病原菌的分布及变化。设计回顾性研究。研究对象眼部细菌培养标本。方法对北京同仁医院眼科1994～2004年眼部7786份标本进行细菌分离培养，对多重感染的标本培养结果进行回顾性分析。主要指标多重细菌培养阳性率、病原菌眼部分布情况及其耐药性。结果细菌培养阳性者1966株，其中多重感染者393株（患者191例）（20．0％）。在多重感染者中，革蓝阳性与阴性球菌分别占51．7％、6．1％；革蓝阳性与阴性杆菌分别占23．4％、18．8％。在多重感染者中，表皮葡萄球菌占首位（23．6％），其次为棒状杆菌属（21．8％）。眼部多重感染者多数为2种细菌的感染（94．8％），少数为3种或3种以上细菌感染。多重细菌感染的标本分布为结膜占54．5％，角膜占19、4％，玻璃体及房水占6．3％，泪器及其他部位占19．8％。儿童占27．8％，成年人占52．9％，老年人占19．3％。393株培养阳性细菌对氧氟沙星、环丙沙星、庆大霉素及妥布霉素的敏感率分别为78．6％、78．2％、72．0％及62．2％。结论多重细菌感染者以两种细菌同时感染为主，多数菌株对氧氟沙星和环丙沙星敏感。（眼科，2007，16：55-58）     

Conjunctival flora in anophthalmic patients: microbiological spectrum and antibiotic sensitivity

AIM: To identify the spectrum and susceptibility pattern of isolated microorganisms from conjunctival flora of anophthalmic patients. METHODS: A cross-sectional clinical study including 60 patients with unilateral anophthalmia. Patients with use of antibiotic drops in their socket during the last month were also included. From each patient, three microbiological samples were taken from the lower conjunctival sac (healthy eye, pre-prosthesis, and retro-prosthesis space of socket). The 180 samples obtained were cultured. Isolates were identified and their antibiotic sensitivities were determined. RESULTS: A total of 251 isolates were recovered (62 isolates from healthy eye, 93 from pre-prosthesis, and 96 from retro-prosthesis space). The most common organism was Staphylococcus epidermidis, in both healthy eyes (64.5%) and sockets (45.5%). Altogether, coagulase-positive Staphylococci, Streptococci, and Gram-negative bacteria accounted for less than 15% of isolates in healthy eyes and more than 35% in sockets. Regarding the antibiotic sensitivities, there were no significant differences between isolates from sockets and healthy eyes. Nine patients recognized the use of self-prescribed antibiotic drops in their socket. In the healthy eyes of these subjects, Gram-positive microorganisms showed significantly greater resistance to aminoglycosides and tetracycline. CONCLUSION: Sockets of anophthalmic patients show a greater number of pathogens compared to healthy eyes. The use of antibiotic drops in the socket promotes a resistant flora not only in the socket but also in the healthy eye. Quinolones and macrolides may be better therapeutic options than aminoglycosides for treating conjunctivitis of anophthalmic sockets, since these antibiotics are less active against Staphylococcus epidermidis.     

临床细菌性眼内炎的病原学分析

目的探讨细菌性眼内炎致病菌的菌属分布及其药物敏感性,为临床诊断与治疗提供依据。方法对1999年1月至2006年12月北京同仁眼科中心临床送检的728份房水和玻璃体标本,进行常规细菌培养鉴定和纸片扩散法药物敏感性试验;对培养阳性菌株的菌属分布及其药物敏感性进行回顾性分析。结果728份房水和玻璃体标本中,细菌培养阳性标本160份,平均培养阳性率为22．0％;共培养出168株细菌,其中革兰阳性球菌96株（57．1％）,革兰阳性杆菌18株（10．7％）,革兰阴性球菌2株（1．2％）,革兰阴性杆菌52株（31．0％）。主要分离菌为表皮葡萄球菌36株（21．4％）,金黄色葡萄球菌19株（11．3％）,铜绿假单胞菌15株（8、9％）。革兰阳性球菌对万古霉素敏感率为93．4％（85／91）、对左旋氧氟沙星为84．4％（81／96）,革兰阴性杆菌对左旋氧氟沙星敏感率为88．2％（45／51）、对氧氟沙星为76．9％（40／52）、对环丙沙星为75．0％（39／52）。前4年（1999年至2002年）与后4年（2003年至2006年）主要致病菌药物敏感性比较,结果发现常用药物的敏感性均有不同程度的下降。结论细菌性眼内炎致病菌谱较广,临床常用抗菌药单一使用时常不能有效覆盖主要致病菌,因此治疗时应考虑联合用药。     

儿童感染性眼病的病原学及其耐药性分析

目的 探讨14岁以下儿童非病毒性感染性眼病的病原体类型、分布及其耐药性.方法 实验研究.回顾性分析1999至2004年期间首都医科大学附属北京同仁医院、北京同仁眼科中心临床诊断为感染性眼病儿童的眼部标本785份,对其进行细菌、真菌及阿米巴的培养与鉴定,分析培养阳性病原体的种类、分布以及细菌和真菌体外药物敏感性.结果 采用X2检验进行统计学分析.结果 在785份送检标本中,微生物培养阳性211份,培养阳性率为26.88%,其中细菌培养阳性176份,占83.41%;真菌培养阳性32份,占15.17%;阿米巴培养阳性3份,占1.42%.176份细菌培养阳性标本中,单株细菌感染138份;多重细菌感染33份;细菌与真菌混合感染5份.共培养鉴定出细菌214株.其中淋球菌属39株,占18.22%;表皮葡萄球菌属37株,占17.29%;棒状杆菌属36株,占16.82%.培养鉴定的32株真菌中,镰刀菌属8株,占25.00%;曲霉菌属5株,占15.63%.眼部细菌对妥布霉素、诺氟沙星、庆大霉素、阿米卡星、环丙沙星、氧氟沙星、利福平及左氧氟沙星的敏感百分比分别为62.57%、64.94%、70.06%、70.87%、71.19%、73.89%、85.80%及87.50%.左氧氟沙星和利福平的敏感性百分比均分别高于妥布霉素、诺氟沙星、庆大霉素、阿米卡星、环丙沙星及氧氟沙星(左氧氟沙星X2=15.654、13.536、8.767、7.908、7.286、5.538,利福平X2=13.923、11.921、7.459、6.666、6.095、4.500;均P<0.05).革兰阳性菌对左氧氟沙星敏感;革兰阴性菌对氧氟沙星、环丙沙星及左氧氟沙星敏感.眼部感染真菌对那他霉素敏感性最高,其次为特比萘酚,对氟康唑敏感性较差.结论 细菌是儿童非病毒性感染件眼病最主要的病原体;其中淋病奈瑟菌、表皮葡萄球菌、棒状杆菌属常见,对左氧氟沙星与利福平敏感性较高.儿童眼部致病真菌中,镰刀菌与曲霉菌属常见,对那他霉素敏感性最高,对氟康唑敏感性较差.(中华眼科杂志,2009,45:141-145)     

Prospective randomized comparison of 3-day versus 1-hour preoperative ofloxacin prophylaxis for cataract surgery

PURPOSE: To determine the efficacy of reducing conjunctival bacterial flora with topical ofloxacin when given for 3 days compared with 1 hour before surgery. DESIGN: Prospective, randomized, controlled trial. PARTICIPANTS: Ninety-two eyes from 89 patients were randomized to a control group (48 eyes) or study group (44 eyes). METHODS: All patients from both groups received topical ofloxacin 0.3% 1 hour before surgery and a 5% povidone iodine scrub of the periorbital area before surgery. The patients in the study group received additional ofloxacin four times daily for 3 days before surgery. MAIN OUTCOME MEASURES: Conjunctival cultures were obtained at five separate time points and were inoculated in solid and liquid culture media. The presence of bacteria was determined, quantified, and identified. RESULTS: Forty-two percent of eyes in the control group had positive conjunctival culture immediately before surgery, compared with 19% of eyes in the study group (P < 0.05). Immediately after surgery, 34% and 14% of eyes had positive cultures in the control and study groups, respectively (P < 0.05). Quantitatively, fewer bacteria were isolated from eyes in the study group compared with those in the control group for culture samples that were obtained both before povidone iodine scrub and at the conclusion of surgery (P 相似文献   

2007-2013年眼部细菌培养阳性菌株的分布及其耐药性分析

目的 观察眼部分离细菌的菌株分布情况及对常用抗菌药物的敏感性和耐药性。设计 实验研究。研究对象 2007年1月至2013年12月北京同仁医院眼科研究所微生物室细菌培养阳性菌株2271株。方法 将眼部分离培养获得的病原菌调制菌液,应用ATB 半自动细菌鉴定仪行细菌鉴定;采用Kirby-Bauer纸片扩散法观察其对眼科常用抗菌药物敏感性和耐药性,按临床实验室标准化委员会（CLSI）2012年版标准判定结果。采用WHONET 5.6进行数据处理。主要指标 药物敏感性和耐药性。结果 2271株细菌中革兰阳性球菌1514株（66.7%）,革兰阳性杆菌261株（11.5%）,革兰阴性球菌28株（1.2%）,革兰阴性杆菌468株（20.6%）。革兰阳性菌中常见的依次是表皮葡萄球菌、金黄色葡萄球菌、缓症链球菌、肺炎链球菌;革兰阴性菌最多见的是铜绿假单胞菌。葡萄球菌属对万古霉素均敏感,耐甲氧西林葡萄球菌检出率占59.4%。葡萄球菌属、链球菌属、肠球菌属、棒状杆菌属、非发酵菌群对头孢他啶的耐药率分别为65.1%、22.1%、92.3%、34.4%、26.1%。链球菌属0.3%的菌株对万古霉素不敏感。肠球菌属对眼科常用抗菌药耐药率显著高于其他菌株,并检出1例万古霉素中敏株。非发酵菌群和肠杆菌科对莫西沙星的耐药率分别为27.3%、23.9%,略高于其他药物。结论 眼部多数细菌对喹诺酮类抗菌药敏感性较高,葡萄球菌属未检测到万古霉素耐药株。大多数细菌对头孢类抗菌药耐药率较高,特别是肠球菌属多数对眼部常用抗菌药耐药率高。（眼科,2015,24：262-267）     

对疑为眼内炎患者房水玻璃体细菌培养结果的临床分析

目的 探讨眼内炎患者房水玻璃体培养细菌菌属的分布特点及其变化规律。 方法 对10年（1989～1998）间培养的522份眼内炎患者的房水玻璃体标本革兰氏染色，培养阳性细菌菌属分布及其变化规律进行回顾性分析。 结果 细菌培养标本522份（房水261份，玻璃体261份），培养阳性菌共119株（房水44株，玻璃体75株），平均培养阳性率为22.8%（房水阳性率为16.9%,玻璃体阳性率为28.7%）。培养阳性菌中，革兰氏阳性（G+）球菌54株占45.4%，G+杆菌24株，占20.2%，革兰氏阴性（G-）杆菌41株占34.5%。肠杆菌科比例最高占18.5%，其次为微球菌占16%，凝固酶阴性葡萄球菌占12.6%，假单胞属占10.9%。前后5年的比较结果显示，G+球菌的百分比变化不大，G+杆菌下降了13.9%，G-杆菌阳性增长了11.7%。 结论 G+球菌与G-杆菌仍是导致细菌性眼内炎主要菌属，后者比例近5年升高，这些变化应在临床诊治细菌性眼内炎时引起注意。 (中华眼底病杂志, 2002, 18: 104-105)     

Microbiological profile of donor corneas: a retrospective study from an eye bank in north India

PURPOSE: To study the microbiological profile and the antibiotic sensitivity of the microorganisms cultured from donor corneas and evaluate with respect to the decontamination protocols during the study period. METHODS: Retrospective review of microbiological culture reports of 2,291 donor eyes sent from January 2000 to December 2003. Donor corneas were treated with 0.4% gentamicin (phase I), 1% povidone-iodine and 0.4% gentamicin (phase II), and 5% povidone-iodine with 0.4% amikacin (phase III). Limbal swabs taken by the eye bank technician after antimicrobial decontamination of donor eyes and sent to the microbiology laboratory for culture were tracked. The positive culture reports with antibiotic sensitivity pattern were studied and results correlated with decontamination protocols. RESULTS: Staphylococcus epidermidis, Pseudomonas aeruginosa, and Alkaligenes faecalis were the 3 most common isolates overall. The percentage of positive bacterial cultures reduced when we used 5% povidone-iodine and 0.4% amikacin (31.3%) as compared to 1% povidone-iodine and 0.4% gentamicin (61.8%) (P < 0.001). Addition of povidone-iodine decreased positive fungal cultures from 6% in phase I to 2.2% in phase II (P < 0.01) and 1.9% in phase III (P < 0.01). Amongst the total bacterial cultures sent after antimicrobial treatment, Gram-positive bacteria decreased from 38.6% (64/166) in phase I to 27.6% (402/1457) and 10.8% (72/668) in phases II and III, respectively (P < 0.001), and Gram-negative bacteria increased from 10.2% (17/166) to 18.8% (274/1457) and 19.8% (132/668), respectively (P = 0.02). Amongst the positive bacterial cultures, the proportion of Gram-positive bacteria decreased from 79.0% (64/81) in phase I to 59.5% (402/676) and 35.3% (72/204) in phases II and III, respectively (P < 0.001), and that of Gram-negative bacteria increased from 21.0% (17/81) to 40.5% (274/676) and 64.7% (132/204), respectively (P < 0.001). CONCLUSIONS: Different combinations of antimicrobials failed to eliminate all organisms, especially Gram-negative bacteria from the donor corneal surface. The increase in proportion of Gram-negative bacteria despite the use of amikacin combined with povidone-iodine suggests a need to find a better combination for decontamination of donor corneal tissue.     

Changing Bacterial Isolates and Antibiotic Sensitivities of Purulent Dacryocystitis

OBJECTIVE: To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities. MATERIALS AND METHODS: We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing. RESULTS: The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria; 16 isolates (39%) were Gram-positive and 25 (61%) were Gram-negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, E. coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in two cases (5%), and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciproxin in 86%, and cefuroxime in 50% of cases, with sensitivity of less than 30% to cephalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidine, 86% were sensitive to ciprofloxacin, with only 20% being sensitive to ampicillin and 14% to cephalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidine. CONCLUSION: This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer highly resistant Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.     

Morganella morganii endophthalmitis after vitrectomy: case report and review of the literature

BACKGROUND: Postoperative bacterial endophthalmitis are caused in 80 % of the cases by the patient's own flora. Most of the time, bacterial agents are Gram-positive ((2/3) of cases) and more rarely Gram-negative ((1/3) of cases). Usually, Pseudomonas sp, Proteus sp or Klebsiella sp are isolated, but very rarely Morganella morganii. HISTORY AND SIGNS: We describe a case of a Morganella morganii endophthalmitis which occurred after a vitrectomy. THERAPY AND OUTCOME: Bacterial examinations disclosed the presence of Morganella morganii in the vitreous. An aggressive treatment (intravitreous [ceftazidim, vancomycin], topical [gentamycin, chloramphenicol] and intravenous [imipenem, ofloxacin] antibiotics) was introduced. In spite of this treatment, the outcome was not favorable. CONCLUSIONS: Post-vitrectomy endophthalmitis is very rare and the isolation of a Gram-negative bacteria, in this case Morganella morganii, is infrequent. The outcome of these infections is often poor despite the introduction of a rapid, specific and aggressive treatment.     

The etiology of infectious corneal ulceration in Sierra Leone

The microbial etiology of infectious corneal ulceration in Sierra Leone has been investigated. Patients either presenting to district health centers or encountered on rural surveillance expeditions with suspected infectious ulcerative keratitis were recruited into the study. Infectious corneal ulceration was defined as clinical evidence of corneal infection with epithelial defect with or without hypopyon. Cultures were obtained in a standard fashion and subsequent microbial analysis performed on all specimens. Seventy-three (73) cases of suspected infectious ulcerative keratitis were obtained between January 2005 and January 2006. The most commonly isolated organisms from microbial cultures of infected eyes were Gram-negative bacteria (45.2%), Gram-positive bacteria (37.0%), and fungal species (35.6%). Mixed bacterial and fungal organisms were isolated from ten eyes (13.7%) and no organisms were isolated from four eyes (5.5%). There is a high incidence of Gram-negative and fungal ulcerative keratitis in the population studied in Sierra Leone. Empirical therapy for corneal ulceration in this region should be aimed towards treatment of bacterial, fungal, and mixed infections.     

98例医务人员眼结膜囊细菌学分析

目的 了解部分医务人员眼结膜囊细菌的种类与分布。设计 横断面调查。研究对象 98例医务人员眼部细菌培养标本。方法 随机选择青海省西宁市三所市级医院医务工作者98例（98眼），取结膜囊拭子，行常规细菌培养，按细菌常规鉴定方法鉴定阳性菌属种。主要指标 细菌培养阳性率、病原菌的菌群分布。结果 98例标本中有菌生长50例（51．0％），无菌生长48例（49．0％）。共分离培养出菌株65株，其中革兰阳性菌34株（52.3％），革兰阴性菌31株（47．7％）。革兰阳性菌中葡萄球菌属比例最高，占总数46．1％，其中表皮葡萄球菌11株（16．9％），金黄色葡萄球菌9株（13．8％），其他葡萄球菌10株（15．4％）；革兰阴性菌中主要以莫拉菌属（18．5％）和假单胞菌属（16．9％）为主，共占总数35．4％。单例标本分离出一种细菌共38例，两种及两种以上细菌共12例。结论 西宁市部分医务人员眼结膜囊细菌以革兰阳性球菌和革兰阴性杆菌为主。在医务人员结膜囊中革兰阴性菌比例较高。     

Bacteriology of chronic dacryocystitis in a tertiary eye care center

PURPOSE: To determine the current bacteriology of adult chronic dacryocystitis in a tertiary eye care center and compare it with previously reported studies. METHODS: Clinical and microbiological records of patients with diagnosis of chronic dacryocystitis between January 1999 and March 2002 were reviewed for age, sex, lacrimal sac side involved, and culture results. Patients younger than 16 years of age and patients who were receiving any systemic or topical antibiotics were excluded from the study. RESULTS: One hundred eighty-eight adult patients with an average age of 50.5 years (range, 16 to 91 years), who had a diagnosis of chronic dacryocystitis, were identified. The study was predominated by female subjects (65.4%). Of the cultures from the nasolacrimal sac, 183 (97.3%) were positive for bacteria, with an average of 2.3 (1 to 6) microorganisms. More than 2 microorganisms were present in 66.1% of the cultures, whereas a single microorganism was recovered from 33.9% of the cultures. The majority of microorganisms in our study were Gram-positive bacteria, representing 53.7% of the overall microorganisms cultured with a predominance of Staphylococcus species. Gram-negative bacteria were recovered from 26.0% of the specimens with predominance of Haemophilus influenzae. Anaerobic microorganisms were present in 19.1% of the samples. The most frequently isolated anaerobic microorganisms were Propionibacterium acne and Peptostreptococcus species. CONCLUSIONS: Several bacterial species may be involved in the pathogenesis of chronic dacryocystitis in adults, and the majority of patients harbor multiple microorganisms in their nasolacrimal sacs. The high rate of microorganism-positive lacrimal sac cultures suggests that adult patients should be treated for their infection before any intraocular surgery because of the potential risk of infection.     

Three-day application of topical ofloxacin reduces the contamination rate of microsurgical knives in cataract surgery: a prospective randomized study

PURPOSE: To determine the rate of contamination of microsurgical knives during cataract surgery and the benefit of a 3-day versus a 1-hour preoperative application of topical ofloxacin in reducing the contamination rate. DESIGN: Prospective, randomized controlled trial. PARTICIPANTS: Seventy-eight eyes of 75 patients were randomly assigned to control (39 eyes) or study groups (39 eyes). METHODS: All patients from both groups received 0.3% topical ofloxacin 1 hour before surgery, 5% povidone-iodine (PVI) scrub of the periorbital area, and 2 drops of PVI onto the ocular surface preoperatively. The patients in the study group also received ofloxacin 4 times a day for 3 days before surgery. MAIN OUTCOME MEASURES: Microsurgical knives were placed in blood culture broth media immediately after the incision had been made. The number of positive cultures and types of bacteria isolated were determined. RESULTS: Ten of 39 knives (26%) in the control group were found to be positive for bacterial growth compared with only 2 of 39 (5%) in the study group (P = 0.028). CONCLUSIONS: The initial paracentesis incision frequently results in contamination of the microsurgical knife and may serve as a mechanism for introducing bacteria from the ocular surface into the anterior chamber. The application of topical ofloxacin for 3 days before surgery significantly reduces the contamination rate of the microsurgical knives, compared with a preoperative application of ofloxacin given 1 hour before surgery.     

泪道探通联合眼膏灌注治疗先天性鼻泪管阻塞

目的评价对患先天性鼻泪管阻塞的1岁内婴儿施行泪道探通术联合泪道内灌注氧氟沙星眼膏的临床效果。方法因持续性泪溢、泪道冲洗不通,经泪囊区局部按摩无效而被确诊为先天性鼻泪管阻塞的1岁内婴儿60例(67眼),在局麻下施行泪道探通术,并注入泪道以甲基纤维素为赋形剂的氧氟沙星眼膏,术后点滴氧氟沙星眼水1wk。分别于术后3,7d进行泪道冲洗,随访3mo,观察其临床症状的改善情况。结果所有60例(67眼,100%)通过1～3次的治疗均获临床治愈。其中,1次治愈64眼,治愈率95.5%(64/67);2例(2眼)在首次术后3d因冲洗泪道不通而再次手术后获治愈(3%,2/67);1例1眼)则连续进行了3次手术方获治愈(1.5%,1/67)。无1例造成假道,唯一常见的并发症是在9例(10眼,14.9%)术后鼻腔分泌物中见少许血染。结论对不满1岁的婴儿在局麻下施行鼻泪管探通术联合氧氟沙星眼膏灌注治疗其先天性鼻泪管阻塞是十分安全、简捷而有效的方法。     

Comparative outcomes of the pathogen in cultured Jones tubes used in lacrimal bypass surgery according to follow up periods

AIM: To evaluate the pathogens in cultured Jones tubes used in lacrimal bypass surgery according to the postoperative periods and to obtain data for the prevention of infection of functional lacrimal stent invention. METHODS: Totally 71 patients (81 eyes) who underwent the removal of Jones tubes were enrolled in study. All the removed Jones tubes were cultured for bacterial and fungal identification and tested for bacterial antibiotic sensitivity. The results were analyzed according to the duration of the inserted Jones tube after lacrimal bypass surgery. RESULTS: Of the 81 eyes, bacteria were isolated from 69 eyes (85.2%) and fungi from 6 eyes (7.4%). Among 69 eyes, 40.6% showed Staphylococcus aureus (S. aureus), 11.6% were Pseudomonas aeruginosa (P. aeruginosa). Gram-positive bacteria were isolated more than Gram-negative bacteria, but Gram-negative bacteria showed a higher incidence in the Jones tube implanted for over 10y (P=0.035). The antibiotic sensitivity test showed that 46.4% of S. aureus were resistant to oxacillin. In terms of antibiotics commonly used in ocular clinical practice, vancomycin was sensitive to S. aureus and Streptococcus pneumoniae (S. pneumoniae), amikacin responded to P. aeruginosa and Proteus mirabilis (P. mirabilis). Trimethoprim/sulfamethoxazole (TMP/SMX) was all sensitive to S. aureus, S. pneumoniae and P. mirabilis except P. aeruginosa. CONCLUSION: S. aureus is the most commonly found organism in the Jones tube after lacrimal bypass surgery, and 46.4% of them are methicillin-resistant S. aureus (MRSA), sensitive to vancomycin. Especially, P. mirabilis responded with amikacin is dominantly detected in the Jones tubes implanted for more than 10y.     

Value of microbiology study in congenital nasolacrimal duct obstruction

PurposeEvaluation of the effect of different microorganisms on congenital nasolacrimal duct obstruction (CNLDO) tightness and whether probing or silastic intubation is likely to fail in a particular microorganism infection.MethodsThe culture and sensitivity results of lacrimal drainage system (LDS) discharge samples from patients with CNLDO were reviewed. Different microorganisms were correlated with the severity of nasolacrimal duct (NLD) obstruction observed during surgical intervention. The success rates of probing and silastic intubation as a primary procedure for each identifiable microorganism were documented. Statistical analysis was conducted to correlate the type of microorganism with the tightness of CNLDO and treatment failure.ResultsOut of 181 specimens, 22 had no growth (12.1%). LDS with positive culture had 76.6% successful probing (n = 49) and 82.1% successful silastic intubation (n = 78). Gram-positive and Gram-negative species were almost equally detected. The most prevalent organisms were Streptococcus pneumoniae and Hemophilus influenzae (48.1% and 39.2%, respectively). Tight CNLDO was more prevalent in Serratia marcescens (n = 2; 100%) and Staphylococcus aureus (n = 4; 33.3%) infections with a 7.75 Odds ratio [95% confidence interval (CI), 1.67–34.63]. Staphylococcus aureus had 37.5% successful probing; however, success was achieved in all cases with silastic intubation. Serratia marcescens infections had 100% successful silastic intubation.ConclusionMicrobiology study can predict tight CNLDO and helps in choosing the most successful treatment option. CNLDO with Staphylococcus infection and Serratia marcescens were likely to have tight NLD obstruction and silastic intubation had better outcomes.     

Increasing ofloxacin resistance of bacterial flora from conjunctival sac of preoperative ophthalmic patients in Japan

PURPOSE: To examine the in vitro resistance to ofloxacin of preoperative bacterial isolates from the conjunctival sac of Japanese patients.METHODS: The database of bacterial flora cultured preoperatively from the conjunctival sac of 1455 Japanese patients (1455 eyes) between 1995 and 1999 was reviewed retrospectively.RESULTS: The incidence of resistance of isolates to ofloxacin in vitro increased from 13.5% in 1995 to 32.8% in 1999. The percentage of Staphylococcus epidermidis and Staphylococcus aureus isolates resistant to ofloxacin was 19.6% and 15.0%, respectively, in 1995 and 33.7% and 28.1%, respectively, in 1999. Logistic regression analysis showed that diabetes mellitus and aging were significantly associated with ofloxacin-resistant strains of bacteria.CONCLUSION: Clinicians should be aware of the increased likelihood that conjunctival sac flora is resistant to ofloxacin, especially in elderly and diabetic patients.     

结膜囊需氧菌的变化趋势及其影响因素

目的观察[科住院患者结膜囊需氧菌培养的阳性率、种类、耐药性以及影响因素和变化趋势。方法收集我院2005年5月～2005年12月连续239例住院患者(250只[)的结膜囊标本做需氧菌培养,阳性者作细菌鉴定和药物敏感性试验。结果250例标本中129例培养阳性,阳性率51.9%,主要为革兰氏阳性凝固酶阴性葡萄球菌,占81.1%。葡萄球菌的多重耐药菌株达42.1%,明显高于其它种类的细菌。高龄患者和男性患者结膜囊培养阳性率较高(P<0.01),而轻度的全身疾病不影响结膜囊带菌状况(P>0.05)。结论我院[科住院患者结膜囊需氧菌以革兰氏阳性凝固酶阴性葡萄球菌占绝对优势,且耐药性强。高龄和男性是结膜囊带菌量较高的危险因素。