南阳地区学龄前儿童感染性眼病病原菌分布及耐药性分析

目的：分析南阳地区学龄前儿童感染性眼病病原菌分布及耐药性。

方法：回顾性分析南阳地区拟诊为学龄前儿童感染性眼病480例480眼,分析病原菌的分布及其耐药性。

结果：480份样本共培养出阳性144份,细菌培养阳性122份; 122份细菌样本中,革兰氏阳性球菌占45.9%(56/122),以表皮葡萄球菌所占比例最高(46.4%,26/56); 革兰氏阳性杆菌占18.9%(23/122),以棒状杆菌所占比例最高(82.6%,19/23)。药敏结果显示：表皮葡萄球菌对多数抗生素均有不同程度耐药; 肺炎克雷伯菌对氨苄西林、哌拉西林完全耐药。

结论：南阳地区学龄前儿童感染性眼病的致病原以革兰氏阳性球菌为主,耐药率较高,临床上应根据药敏结果合理用药。     

眼科院内感染的临床分析

目的:了解眼科院内感染的特点及危险因素,为预防提供有用的线索.方法:回顾分析我院8年来的住院患者发生感染病例的发病特点.结果:8年来我院共发生276例的院内感染,发病率为3.47‰.其中急性结膜炎131例,呼吸系统感染100例,眼内炎27例,其他感染18例.急性结膜炎中以青光眼患者的发生率最高5.255‰,其次为视网膜病2.036‰,白内障及其他眼病为1.183‰.急性结膜炎中78例做了接触性眼压测量,82例做了三面镜或房角镜检查;85例发生在4～9月.呼吸系统感染中,72例是年龄小于12岁的儿童.在眼内炎中,19例是白内障摘除及人工晶体植入,5例是玻璃体切除术.结论:天气炎热及接触角膜的眼科检查,可能是眼科住院患者急性结膜炎诱发因素;在医院里,儿童可能更易患呼吸系统的感染;反复灌注性的内眼手术,可能是术后眼内炎的诱因.     

新生儿眼部感染情况分析

目的:研究2014/2018年浙江苍南县新生儿眼部感染病原菌分布、常用抗生素耐药性及流行特征,为临床病情的预防、诊断与治疗提供依据。方法:将本院2014-01/2018-12新生儿门诊294份眼部标本中分离所得108株病原菌进行鉴定、常用药物敏感试验和流行病特征汇总分析。结果:眼部分泌物标本294份中病原菌检出率为36.7%(108/294)。主要菌群包括表皮葡萄球菌48株(44.4%),金黄色葡萄球菌16株(14.8%),大肠埃希菌24株(22.2%),淋病奈瑟菌12株(11.1%),类白喉棒状杆菌5株(4.6%),肠球菌属2株(1.9%),链球菌属1株(0.9%)。主要病原菌对阿米卡星和奈替米星具有高度敏感性,对洁霉素和庆大霉素活性较差。对喹诺酮类抗生素活性较好。结论:新生儿眼部感染的致病菌以葡萄球菌属为主,临床常用眼部抗菌药物对各类病原菌具有良好的抗菌活性。     

成人慢性化脓性中耳炎耳道分泌物病原菌分布及耐药性分析

目的分析慢性化脓性中耳炎成人患者耳道分泌物中病原菌分布及耐药情况,为临床诊断与治疗提供参考。方法选取2017年7月~2018年6月于我院确诊的慢性化脓性中耳炎患者300例,取耳道分泌物进行病原菌分离培养鉴定和药敏试验。结果300份分泌物标本中病原菌检出率为82.33%(247/300)。共分离出268株病原菌,其中真菌112株(41.79%)、革兰阳性菌107株(39.93%)、革兰阴性菌49株(18.28%)。曲霉属(29.11%,78/268)、金黄色葡萄球菌(25.75%,69/268)和铜绿假单胞菌(9.33%,25/268)是慢性化脓性中耳炎患者外耳道分泌物中的常见病原菌。金黄色葡萄球菌及凝固酶阴性葡萄球菌对青霉素的耐药率最高,分别为72.46%和90.00%,而金黄色葡萄球菌对头孢西丁的耐药率达到27.54%;铜绿假单胞菌对左氧氟沙星的耐药率最高,达到52.00%。结论广泛开展针对慢性化脓性中耳炎患者外耳道分泌物病原菌的培养鉴定及药敏试验,对指导临床选取合理的抗菌药物进行有效治疗具有重要意义。     

成人慢性化脓性中耳炎耳道分泌物病原菌分布及耐药性分析

目的 分析慢性化脓性中耳炎成人患者耳道分泌物中病原菌分布及耐药情况,为临床诊断与治疗提供参考。方法 选取2017年7月~2018年6月于我院确诊的慢性化脓性中耳炎患者300例,取耳道分泌物进行病原菌分离培养鉴定和药敏试验。结果 300份分泌物标本中病原菌检出率为82.33%(247/300)。共分离出268株病原菌,其中真菌112株(41.79%)、革兰阳性菌 107株(39.93%)、革兰阴性菌 49株(18.28%)。曲霉属(29.11%,78/268)、金黄色葡萄球菌(25.75%,69/268)和铜绿假单胞菌(9.33%,25/268)是慢性化脓性中耳炎患者外耳道分泌物中的常见病原菌。金黄色葡萄球菌及凝固酶阴性葡萄球菌对青霉素的耐药率最高,分别为72.46%和90.00%,而金黄色葡萄球菌对头孢西丁的耐药率达到27.54%;铜绿假单胞菌对左氧氟沙星的耐药率最高,达到52.00%。结论 广泛开展针对慢性化脓性中耳炎患者外耳道分泌物病原菌的培养鉴定及药敏试验,对指导临床选取合理的抗菌药物进行有效治疗具有重要意义。     

婴儿眼部感染细菌的耐药性分析

目的根据对婴儿眼部感染所检出的细菌谱,分析对抗菌素的耐药状况,指导临床选择敏感、有效抗菌素,以增加小儿用药安全,减少耐药性方法对近二年多以眼分泌物多、流泪为主要症状,且在1个月内全身、局部未使用过抗菌素的1岁以下患儿的眼分泌物进行细菌培养加药物敏感试验结果检测696份标本,细菌阳性检出率达21.98%;其中革兰氏阳性菌111例占72.55%,以金黄色、表皮葡萄球菌为多数,耐药率以青霉素最高,呋喃妥因最低;革兰氏阴性菌(G-)42例占27.45%,以肠杆菌属、克雷伯氏菌属为主,其耐药率也是青霉素最高,最低为美洛培南。同时比较新生儿和1～12月龄组对G 、G-菌的耐药性,发现革兰氏阳性菌感染者,不同月龄对林可霉素、氯霉素、呋西地酸和左旋氧氟沙星四种抗菌素的耐药率有显著的统计学差异,而革兰氏阴性菌感染者,不同月龄对头孢呋辛、头孢西丁和替卡西林三种抗菌素的耐药有显著或非常显著的统计学差异。结论新生儿与1～12月龄的婴儿对感染菌的耐药率存在一定的差异,在选择抗菌种类时应充分考虑年龄因素,根据药敏试验合理选用耐药率低、敏感性高的药物,可避免滥用、盲目用药导致耐药性。     

眼科院内感染的临床分析

目的：了解眼科院内感染的特点及危险因素,为预防提供有用的线索。方法：回顾分析我院8年来的住院患者发生感染病例的发病特点。结果：8年来我院共发生276例的院内感染,发病率为3．47‰。其中急性结膜炎13l例,呼吸系统感染100例,眼内炎27例,其他感染18例。急性结膜炎中以青光眼患者的发生率最高5．255‰,其次为视网膜病2．036‰,白内障及其他眼病为1．183‰。急性结膜炎中78例做了接触性眼压测量,82例做了三面镜或房角镜检查;85例发生在4～9月。呼吸系统感染中,72例是年龄小于12岁的儿童。在眼内炎中,19例是白内障摘除及人工晶体植入,5例是玻璃体切除术。结论：天气炎热及接触角膜的眼科检查,可能是眼科住院患者急性结膜炎诱发因素;在医院里,儿童可能更易患呼吸系统的感染;反复灌注性的内眼手术,可能是术后眼内炎的诱因。     

兰州地区细菌性结膜炎的致病菌分布和耐药性分析

目的 了解兰州地区细菌性结膜炎结膜囊分泌物细菌分布和耐药状况,为细菌性结膜炎的治疗提供依据.方法 2008年10月至2009年12月,在兰州大学第二医院采集急性细菌性结膜炎患者的结膜囊分泌物,进行细菌的分离和鉴定,K-B法对分离细菌做敏感性试验,并对致病菌种类和药物敏感试验结果进行分析.结果 共采集到156例(156只眼)结膜囊分泌物标本,分离细菌116株(74.4％),其中革兰氏阳性细菌有78只眼(67.2％),前三位分别是表皮葡萄球菌29只眼(25.0％)、金黄色葡萄球菌22只眼(19.0％)和腐生葡萄球菌17只眼(14.7％);革兰阴性细菌38只眼(32.8％),前3位分别是:大肠埃希氏菌25只眼(21.6％)、肺炎克雷伯氏菌7只眼(6.0％)、普通变形杆菌3只眼(2.6％).革兰阳性菌对万古霉素以及革兰阴性菌对加替沙星分别100％敏感,此外所有菌株对其它抗生素均有不同程度的耐药.结论 葡萄球菌等条件致病菌是兰州地区急性细菌性结膜炎的主要致病菌,临床应根据菌株耐药情况合理用药.     

综合性医院的感染流行病学调查分析

目的 对本院1997年全年住院病历进行回顾性调查,摸清我院及各科室医院感染发病率、各感染部位感染率等本底数据。方法 采用回顾性流行病学进行调查,并进行整理和统计学处理。结果 全年院感发病率为2．95％;下呼吸道、手术伤口及泌尿道为高发感染部位;ICU、新生儿、脑外科为院感重点发病科室。结论 降低院感发病率必须提高护人员的院感意识,加强对重点部位及重点科室的医院感染预防控制和管理。     

白内障住院患者医院感染情况调查及危险因素分析

目的：了解白内障住院患者医院感染情况,探讨白内障住院患者医院感染的危险因素。

方法：回顾性分析2009-01/2014-12在本院眼科住院且发生医院感染患者68例的病历信息资料,采用多因素Logistic回归分析筛选白内障住院患者医院感染的危险因素。

结果：白内障住院患者医院感染发生率为1.37%,呼吸道感染发生率最高,有39例(57.35%); 经多因素Logistic回归分析显示：接触性检查、侵入性操作、住院天数是白内障住院患者医院感染的危险因素。

结论：白内障住院患者有合并医院感染的风险,应加强医院感染管理,严格执行无菌操作,减少医院感染的发生。     

Distribution of pathogenic bacteria and antimicrobial sensitivity of eye infections in Suzhou

AIM: To investigate the types of bacteria in patients with eye infections in Suzhou and their drug resistance to commonly used antibacterial drugs. METHODS: The clinical data of 155 patients were retrospectively collected in this study, and the pathogenic bacteria species and drug resistance of each pathogenic bacteria were analyzed. RESULTS: Among the 155 patients (age from 12 to 87 years old, with an average age of 57, 99 males and 56 females) with eye infections (160 eyes: 74 in the left eye, 76 in the right eye and 5 in both eyes, all of which were exogenous), 71 (45.81%) strains were gram-positive bacteria, 23 (14.84%) strains were gram-negative bacteria and 61 (39.35%) strains were fungi. Gram-positive bacteria were highly resistant to penicillin and erythromycin (78.87% and 46.48% respectively), but least resistant to vancomycin at 0. Gram-negative bacteria were highly resistant to cefoxitin and compound sulfamethoxazole (100% and 95.65% respectively), but least resistant to meropenem at 0. Comparison of the resistance of gram-positive and gram-negative bacteria to some drugs revealed statistically significant differences (P<0.05) in the resistance of both to cefoxitin, cotrimoxazole, levofloxacin, cefuroxime, ceftriaxone and ceftazidime, and both had higher rates of resistance to gram-negative bacteria than to gram-positive bacteria. The distribution of bacterial infection strains showed that Staphylococcus epidermidis was the most common strain in the conjunctiva, cornea, aqueous humor or vitreous body and other eye parts. Besides, Fusarium and Pseudomonas aeruginosa were also among the most common strains of conjunctival and corneal infections. CONCLUSION: Gram-positive bacteria are the dominant bacteria in eye infections, followed by gram-negative bacteria and fungi. Considering the resistance of gram-negative bacteria to multiple drugs, monitoring of bacteria should be strengthened in eye bacterial infections for effective prevention and control to reduce complications caused by eye infections.     

Prevalence and antibacterial resistance patterns of extended-spectrum beta-lactamase producing Gram-negative bacteria isolated from ocular infections

Purpose:Extended-spectrum beta-lactamases (ESBLs) mediated resistance is more prevalent worldwide, especially among Gram-negative bacterial isolates, conferring resistance to the expanded spectrum cephalosporins. As limited data were available on the prevalence of ESBLs in this area, the current study was undertaken to determine the prevalence, antibacterial resistance patterns, and molecular detection and characterization of ESBL encoding resistance genes among ocular Gram-negative bacterial isolates from ocular infections.Results:Of all Gram-negative bacteria, Pseudomonas aeruginosa (44%) was the most common strain, followed by Enterobacter agglomerans and Klebsiella pneumoniae each (10%). Among the 252, 42 (17%) were ESBL producers. The major source of ESBL producers were corneal scraping specimens, highest ESBL production was observed in P. aeruginosa 16 (38%) and Escherichia coli 7 (16.6%). Among ESBL-producing genes, the prevalence of bla_TEM-gene was the highest (83%) followed by bla_OXA-gene (35%), bla_SHV-gene (18.5%), and bla_CTX-M-1-gene (18.5%) alone or together.Conclusion:The higher rate of prevalence of ESBLs-encoding genes among ocular Gram-negative bacteria is of great concern, as it causes limitation to therapeutic options. This regional knowledge will help in guiding appropriate antibiotic use which is highly warranted.     

新型冠状病毒核酸检测在眼科医院疫情防控中的实践与有效性研究

目的:探索以系统化、标准化的新型冠状病毒核酸检测为核心和重要组成部分,建立适合于眼科医院新冠疫情精准防控切实可行的防控体系。方法:系列病例研究。自2020年2月24日至3月2日期间,以标准化病毒核酸检测联合血常规、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)等检测作为所有眼科手术患者术前筛查常规检测项目,同时也为返岗员工提供病毒核酸检测。设计调查问卷了解受检者对鼻咽拭子采样的接受度以及核酸检测结果对其心理状态的影响。结果:99例患者血液学检测结果有一定的异常比例,其中SAA检测结果增高13例,淋巴细胞计数减低12例、增高5例,白细胞计数增高11例、减低1例,CRP增高2例,新型冠状病毒核酸检测均阴性。33例本院职工新型冠状病毒核酸检测均阴性。12%的受访者对鼻咽拭子采样接受度评分较低。受检者在核酸检测前后思想压力评分较高的比例分别为46.7%和6.7%。结论:该项举措一方面为术前新冠病毒肺炎筛查及鉴别诊断提供了客观依据,很大程度上排除了隐性无症状感染者传播的可能,有利于减少二次传播的风险,降低院内交叉感染的概率;另一方面,核酸检测阴性结果有利于调整患者术前的心理状态并缓解医护人员在疫情防控期间的心理压力。     

2022年中国眼科药物临床试验进展

目的:了解2022年我国眼科药物临床试验的进展,探讨其与2014～2021年的变化,为新药研发、临床试验的实施提供最新数据参考,为相关决策提供依据。方法:采用横断面研究,检索国家药品监督管理局“药物临床试验登记与信息公示平台”数据库,纳入公示日期为2022-01-01/12-31且适应证为眼病的眼科药物临床试验。描述眼科药物试验整体情况、适应证及试验分期及占比情况、实施效率、主要研究者的地域分布情况。结果:2022年我国眼科药物临床试验共公示55项,占所有临床试验的1.66%,呈稳步增长趋势,以化学药物占比最高为58.18%。开展试验最多的前三个适应证为年龄相关性黄斑变性、近视、干眼。开展基因治疗药物临床试验2项。7个药物品种开展≥2项临床试验,其中以硫酸阿托品、重组抗血管内皮生长因子(VEGF)人源化单克隆抗体开展数量最多,分别为7、5项。试验分期以Ⅰ期、Ⅲ期为主,分别占比36.36%、27.27%。2022年Ⅰ期试验启动耗时为2.72(0.77,3.47)mo,较2014～2021年的启动耗时3.87(3.00,6.30)mo显著缩短(Z=-2.630,P=0.009),BE、Ⅱ、...     

Etiology and antibacterial susceptibility pattern of community-acquired bacterial ocular infections in a tertiary eye care hospital in south India

Aims:

To identify the etiology, incidence and prevalence of ocular bacterial infections, and to assess the in vitro susceptibility of these ocular bacterial isolates to commonly used antibiotics.

Materials and Methods:

Retrospective analysis of consecutive samples submitted for microbiological evaluation from patients who were clinically diagnosed with ocular infections and were treated at a tertiary eye care referral center in South India between January 2002 and December 2007.

Results:

A total of 4417 ocular samples was submitted for microbiological evaluation, of which 2599 (58.8%) had bacterial growth, 456 (10.3%) had fungal growth, 15 (0.34%) had acanthamoebic growth, 14 (0.32%) had mixed microbial growth and the remaining 1333 (30.2%) had negative growth. The rate of culture-positivity was found to be 88% (P < 0.001) in eyelids’ infection, 70% in conjunctival, 69% in lacrimal apparatus, 67.4% in corneal, 51.6% in intraocular tissues, 42.9% in orbital and 39.2% in scleral infections. The most common bacterial species isolated were Staphylococcus aureus (26.69%) followed by Streptococcus pneumoniae (22.14%). Sta. aureus was more prevalent more in eyelid infections (51.22%; P = 0.001) coagulase-negative staphylococci in endophthalmitis (53.1%; P = 0.001), Str. pneumoniae in lacrimal apparatus and corneal infections (64.19%; P = 0.001), Corynebacterium species in blepharitis and conjunctivitis (71%; P = 0.001), Pseudomonas aeruginosa in keratitis and dacryocystitis (66.5%; P = 0.001), Haemophilus species in dacryocystitis and conjunctivitis (66.7%; P = 0.001), Moraxella lacunata in blepharitis (54.17%; P = 0.001) and Moraxella catarrhalis in dacryocystitis (63.83%; P = 0.001). The largest number of gram-positive isolates was susceptible to moxifloxacin (98.7%) and vancomycin (97.9%), and gram-negative isolates to amikacin (93.5%) and gatifloxacin (92.7%).

Conclusions:

Gram-positive cocci were the most frequent bacteria isolated from ocular infections and were sensitive to moxifloxacin and vancomycin, while gram-negative isolates were more sensitive to amikacin and gatifloxacin.     

眼部分离培养棒状杆菌属的分布及耐药性分析

目的分析眼部分离棒状杆菌的分布、鉴定及药敏结果,讨论该菌属在眼部感染中的临床意义。设计实验研究。研究对象北京同仁医院眼科患者眼部分离的171株棒状杆菌属。方法由专业人员取材,对眼部分离细菌培养标本接种、培养,采用法国生物梅里埃棒状杆菌生化反应鉴定条（API Coryne）鉴定44株／171株菌株,并用纸片扩散法检测耐药性,进行12种抗生素临床测定。主要指标棒状杆菌种类及耐药情况。结果171株棒状杆菌主要来源于结膜（57．8％）和角膜（27．2％）。鉴定的菌株可分为9种,其中麦氏棒状杆菌21株（47．7％）,拥挤棒状杆菌6株（13．6％）,水生棒状杆菌和丙酸棒杆菌各4株（9．0％）。药物敏感率依次为万古霉素100％（37株）,替考拉宁90．2％（51株）,利福平85．9％（128株）,阿米卡星85．1％（134株）,庆大霉素84．3％（134株）,妥布霉素82．1％（134株）。结论麦氏棒状杆菌可能是中国北方眼部感染最常见的棒状杆菌。万古霉素对棒状杆菌属抑菌作用最好。     

新型冠状病毒肺炎疫情期间眼科急诊及手术的防控策略

新型冠状病毒(SARS-CoV-2)感染的肺炎,新型冠状病毒肺炎(COVID-19)已被中国列为按照甲类传染病管理的乙类传染病,由医院相关性传播导致的COVID-19并不少见,给临床医护人员和住院患者造成严重威胁。本文介绍眼科医生应掌握COVID-19的流行病学特点和临床表现,眼科医生如何应对眼科急诊患者,围绕眼科急诊及手术的感染防控要点和加强具体防控措施,为战疫在一线的眼科医护感染防控提供参考。