5785例白内障术前结膜囊细菌培养结果分析

目的分析近年来我院白内障手术前结膜囊细菌的构成和对药物的敏感性。方法对5785眼白内障手术前结膜囊细菌培养结果和药物敏感实验结果进行分析。结果白内障手术前结膜囊细菌培养的阳性率为2.61%,主要是革兰氏阳性球菌,占99.32%。以表皮葡萄球菌（66.67%）和微球菌（24.49%）为主。92.2%的结膜囊革兰氏阳性球菌对红霉素和青霉素耐药;大多数菌株对妥布霉素、万古霉素、环丙沙星和庆大霉素敏感;对妥布霉素和环丙沙星耐药有上升趋势。结论白内障手术前结膜囊细菌主要由表皮葡萄球菌构成,对红霉素和青霉素耐药;大多数菌株对妥布霉素、万古霉素、环丙沙星和庆大霉素敏感;对妥布霉素和环丙沙星耐药性有上升趋势。     

白内障术前结膜囊细菌培养及药物敏感性

目的 观察白内障患者术前结膜囊细菌培养及药物敏感性.方法 随机抽取2010年1月至2012年12月在我院行白内障超声乳化手术患者420例（420只眼）,男性208例,女性212例,年龄55~95岁,平均78.23岁,其中老年性白内障386例,并发性白内障34例.术前对患者结膜囊进行细菌培养及药物敏感性试验.结果 420例患者中,结膜囊细菌培养阳性者120例,阳性率28.57%,70岁以下组细菌培养阳性率明显低于70岁以上组,两组比较,χ2=6.03,P＆lt;0.01,差异有显著性.术前结膜囊细菌阳性者,菌谱为：革兰阳性球菌102例,占85%,革兰阴性杆菌17例占14.14%,革兰氏阴性球菌1例,占0.83%;主要菌种有表皮葡萄球菌、金黄色葡萄球菌、溶血性链球菌等,大多数菌株对氧氟沙星、左氧氟沙星、妥布霉素、万古霉素等敏感.结论 白内障患者术前局部滴用氧氟沙星、妥布霉素、左氧氟沙星等有效抗生素,能预防白内障术后感染,增加手术安全性,降低手术风险.     

白内障术前结膜囊细菌培养结果及药敏变化

目的回顾分析近年来白内障患者术前结膜囊细菌构成和对药物敏感情况的变化。方法对1733例眼部无感染的白内障患者术前进行结膜囊细菌培养，并对培养和药物敏感实验结果进行分析。结果白内障患者术前结膜囊细菌培养阳性率为51.6％(894／1733)，主要由革兰阳性球菌(81．4％)和革兰阴性杆菌(12.9％)构成。革兰阳性球菌以表皮葡萄球菌(54．7％)和金黄色葡萄球菌(10.3％)为主，比例呈现逐年升高趋势；革兰阴性杆菌所占比例基本稳定在13％左右。这些结膜囊常见细菌对妥布霉素、环丙沙星和氧氟沙星的耐药率逐年升高，对庆大霉素的耐药率呈下降趋势。结论白内障患者术前结膜囊细菌主要由革兰阳性球菌和革兰阴性杆菌构成，其中革兰阳性球菌比例呈现逐年升高趋势，革兰阴性杆菌比例比较稳定；由于临床上广谱抗生素的广泛、大量应用，这些细菌对常用药物(如环丙沙星、氧氟沙星、妥布霉素)的耐药性逐年增高，对目前不常用的药物(如庆大霉素)的耐药性呈现下降的趋势。     

白内障术前结膜囊预防性用药后细菌检测分析

目的探讨白内障待手术患者术前使用抗生素前后及术后结膜囊细菌学状态,了解不同药物对结膜囊的抑菌效果,为临床治疗提供参考依据。方法调查200例结膜囊外观清洁、无眼部炎症、泪道冲洗通畅的白内障住院患者,分别于入院未用抗生素眼液点眼前、手术消毒前运用不同抗生素眼液点眼及术后第1天拆开眼垫换药前进行结膜囊细菌培养。结果术前未使用抗生素眼液点眼前的结膜囊细菌培养阳性率为35.5%（7l/200）,分为四组予以林可霉素,氧氟沙星,左氧氟沙星,妥布霉素点眼后,结膜囊细菌的清除率分别为70.59%（12/17）、94.74%（18/19）、100%（16/16）、89.47%（17/19）,术后第1天拆开眼垫后结膜囊的细菌培养阳性率为6%（12/200）。革兰阳性球菌最多见,约为81.69%（58/71）,革兰阴性杆菌其次。结论结膜囊可以有各种细菌存在。使用不同抗生素后结膜囊细菌培养率有一定的区别,几种药物的抑菌效果有差异。使用抗生素眼液后及白内障术后第1天都有结膜囊细菌存在,提示白内障术前及术后均应加强抗生素眼液点眼,以减少术后眼内炎的发生。     

白内障术前结膜囊细菌培养影响因素分析

目的:研究影响白内障人工晶状体植入术前结膜囊细菌培养阳性率的主要影响因素。方法:对2010-12/2012-12在本院住院行白内障人工晶状体植入术的老年患者,分别于入院时、滴眼药水后、术眼准备后3个时间点,采集结膜囊标本进行细菌培养,并将培养结果与年龄、性别、眼别、职业、滴眼天数、干预方法等因素相关关系进行比较分析。结果:年龄、性别、干预方法等因素对结膜囊细菌培养阳性率有显著性关联,职业、眼别、术前滴眼天数对结膜囊细菌培养结果影响不大。结论:影响结膜囊细菌培养因素有患者自身因素,也有外部因素,干预方法对结膜囊细菌培养阳性率影响至关重要,应引起重视。     

白内障术前滴用氧氟沙星滴眼液对结膜囊细菌培养的影响

目的:观察老年性白内障患者术前应用氧氟沙星滴眼液对结膜囊细菌培养的影响。方法:老年性白内障患者30例60眼,随机分成两组:对照组15例30眼,3g/L氧氟沙星点眼组15例30眼,平均点眼5次,l滴/次。观察点药前,点药l,2,3d,结膜囊内细菌的变化。结果:点药前,点药1,2,3d,结膜囊内细菌落积分的变化:对照组,51,51,33,42;3g/L氧氟沙星点眼组,51,30,9,0。配对t检验统计分析,点药3d,P=0.043。结膜囊内细菌检出率的变化:对照组,60%,60%,40%,50%;3g/L氧氟沙星点眼组,60%,30%,10%,0。χ2检验,点药3d,P<0.01。结论:老年性白内障患者术前应用氧氟沙星滴眼液点眼,3d可以达到结膜囊内无细菌。     

白内障手术前后结膜囊细菌学分析

目的：探讨白内障术前、术后结膜囊细菌学分布状态，为临床用药提供依据。方法：将无睑缘炎、结膜囊外观清洁、泪道冲洗通畅的白内障住院患者94例分别于入院未用抗生素眼液点眼前、手术消毒前及术后第1天拆开眼垫换药前进行结膜囊细菌培养。结果：未用抗生素眼液点眼前的结膜囊(正常结膜囊)细菌培养阳性率为56．4％，经0．3％氟哌酸眼液点眼后结膜囊细菌培养阳性率为0，但术后第1天拆开眼垫后结膜囊的细菌培养阳性率为5．3％。结论：正常结膜囊可以有各种致病菌或非致病菌存在，即使术前结膜囊细菌培养为无菌生长，但术后第1天仍然可能有结膜囊细菌存在，提示白内障术前及术后均应加强抗生素眼液点眼，以减少眼内炎的发生。     

白内障术前结膜囊菌群分布和药敏试验研究

目的 探讨白内障术前结膜囊细菌种类和药物敏感情况,为临床用药提供依据.方法 对白内障术前205例(205眼)结膜囊采集标本进行细菌培养,观察培养阳性的细菌对常用抗菌药物的敏感性变化.结果 细菌培养阳性26例(26眼),阳性率为12.68％.白内障患者术前结膜囊主要细菌构成为革兰阳性球菌(96.15％),其中以表皮葡萄球菌为主(69.23％),其次为溶血性葡萄球菌、产色葡萄球菌、腐生葡萄球菌;革兰阴性杆菌为洋葱假单胞菌.大多数细菌对万古霉素、阿米卡星、替考拉宁、克林霉素、莫匹罗星、呋喃妥因、吗啉唑酮敏感,耐药性小于20％,普遍对氨苄西林、四环素、头孢西丁、苯唑西林、红霉素明显耐药(68.0％以上).结论 表皮葡萄球菌是白内障术前结膜囊存在的最常见条件致病菌,预防感染或抗感染可以选用阿米卡星、克林霉素、呋喃妥因等常用抗菌药物.     

老年人内眼手术前结膜囊细菌培养的分析

目的 了解老年人内眼手术前的结膜囊细菌情况。方法 对老年患者279例(350眼)术前进行结膜囊细菌培养，并对阳性者作药敏试验。结果 术前结膜囊细菌培养阳性率为17．43％。药敏试验结果：敏感药物为氧氟沙星、先锋霉素、庆大霉素等。结论 老年人内眼手术前用敏感抗生素滴眼，并常规行结膜囊细菌培养及药敏试验是必要的。     

正常结膜囊细菌培养397例分析

目的:调查不同人群正常结膜囊带菌情况及其对常用抗生素的敏感情况.方法:对4wk内未使用滴眼液和抗生素的397名受调查者,常规眼科检查排除泪囊、眼表、前节疾病后,进行结膜囊细菌培养和药物敏感试验.结果:＜12岁人群、＞60岁人群结膜囊带菌率明显高于12～60岁人群,农村高于城市.细菌培养阳性率为21.2%,共培养出13个菌种,84个菌株.葡萄球菌属最多,共54株(64.3%),其中表皮葡萄球菌43株(51.2%),金黄色葡萄球菌10株(11.9%).革兰阳性细菌对万古霉素、呋喃坦啶、利福平敏感;大部分革兰阴性菌对复达欣、亚胺硫霉素、丁胺卡那霉素、妥布霉素敏感;对β-内酰胺类和喹诺酮类耐药菌株增多.结论:正常结膜囊可能带有细菌,并可致眼部感染.术前滴敏感抗生素眼液可减少结膜囊细菌,以防止眼部感染.     

正常眼和白内障手术前后结膜囊细菌菌谱及抗生素应用的对比研究

目的检查正常眼的结膜囊存在的细菌种类,并进行药敏分析,对目前临床常用的抗生素滴眼液药效进行对比。方法207例(207眼)正常眼及200例(200眼)白内障的结膜囊标本进行细菌培养,200例白内障分4组给予林可霉素,妥布霉素,氧氟沙星,左氧氟沙星滴眼后术前及手术后再次培养,并将所有培养为阳性的标本进行药敏分析。结果407眼的结膜囊细菌培养阳性率31.45%,其中70岁以上者阳性率最高为42.05%(37/88)。革兰氏阳性球菌阳性率达到80.47%,革兰氏阴性杆菌为16.40%。4种抗生素结膜囊细菌的清除率分别为70.59%、89.47%、94.74%、100.00%;所有白内障眼术前使用抗生素后细菌阳性率为4.00%,手术后1 d拆开眼垫后细菌培养阳性率为6.00%。结论正常眼的结膜囊可有多种细菌存在,高龄者检出率高。其中以表皮葡萄球菌多见,其次为洛菲不动杆菌和金黄葡萄球菌;目前常用的4种抗生素滴眼液的效果强弱不同,提示在临床进行白内障等内眼手术时应根据结膜囊细菌培养的情况选用敏感抗生素,术后也应进行局部抗生素滴眼液的应用。     

白内障术前清洁结膜囊方法的现况研究

白内障是我国主要的致盲眼病,白内障摘除联合人工晶状体植入术是白内障患者复明的主要有效手段,细菌性眼内炎是其最严重的并发症。目前,预防眼内炎主要依赖于抗生素的使用,而结膜囊的术前准备也受到越来越多术者的重视。本文就白内障术前结膜囊的准备现况进行总结分析,主要有以下两点：（1）术前结膜囊抗生素眼液的应用;（2）术前结膜囊的消毒、冲洗;在此,结膜囊冲洗液中提出使用温热生理盐水的观点。另外,已有术者提出术前睑板腺处理的必要性。     

Pathogenic conjunctival bacteria associated with systemic co-morbidities of patients undergoing cataract surgery

Purpose

To identify the risk of patients undergoing cataract surgery of having pathogenic conjunctival bacteria associated with their systemic co-morbidities.

Methods

Retrospective study of consecutive patients undergoing their first cataract operation from July 2005 to April 2010. Their preoperative conjunctival bacteria were cultured, identified, and classified in bacterial groups. Their co-morbidities were defined from their clinical data and the answers to systematic questions asked in the anaesthetic evaluation. The Microsoft Access databases of the two data sets were merged for carrying out the statistical analysis. Univariate association of each bacterial group with each co-morbidity was studied by using χ²-test for categorical data and Student''s t-test for continuous variables. Also, logistic regression models were used adjusting for age and sex. SPSS statistic programme, version 18 was used for all these analyses. Endophthalmitis cases in this surgical series were searched.

Results

In the 8333 selected patients, age was associated with increased conjunctival bacteria in all groups except for Streptococcus pneumoniae and Propionibacteriae. However, male sex was associated with these two groups and also with coagulase-negative Staphylococci, Corynebacterium xerosis, Staphylococcus aureus, and Gram-negative rods. After adjusting for age and sex, S. aureus was associated with diabetes, lung diseases, and renal and heart insufficiency; Gram-negative rods with smoking habit; Enterococci with diabetes; Streptococcus pneumoniae with kyphoscoliosis; and other Streptococci with diabetes and handicapped patients.

Conclusion

The more pathogenic conjunctival bacteria were more likely associated with patients'' co-morbidities, such as diabetes, lung diseases, renal and heart insufficiency, kyphoscoliosis, and smoking habit, than the less pathogenic ones.     

Eyelid skin disinfecting and conjunctival bacteria in cataract surgery

Purpose: To evaluate the effect on conjunctival micro‐organisms of chlorhexidine alcohol 0.5% eyelid wash in cataract patients. Methods: In this single‐centre experimental study, 120 patients scheduled to undergo cataract operation were cultured in the conjunctiva before the operation and after the insertion of the intraocular lens. Bacterial samples for aerobic and anaerobic cultures were taken with a polyvinyl alcohol pad and transported in peptone water to the microbiological laboratory where they were analysed in a blinded fashion. Half of the patients received a standardized eyelid scrub with chlorhexidine alcohol 0.5%, while the rest did not. The conjunctiva of all patients was rinsed preoperatively with chlorhexidine solution 0.05%. Results: In all the between‐group comparisons, the treated eyelid group had slightly lower bacterial counts than the control group on the postoperative samples, but differences were far from statistically significant. Within‐group comparisons revealed statistically significant reduction in colonies and species between the preoperative and postoperative sampling. Conclusion: In this experimental culture study, no evidence was found to suggest that preoperative eyelid chlorhexidine alcohol wash is effective in further reducing bacterial counts in the conjunctiva when the conjunctiva itself is rinsed preoperatively with chlorhexidine solution. The present results, however, do not contradict that the wash may be of some marginal help in reducing bacterial contamination of the operation field. Consequently, this part of the prophylactic protocol is still in practice in our institution.     

新疆哈萨克族白内障患者术前结膜囊细菌培养及药敏试验分析

目的：了解哈萨克族白内障患者结膜囊带菌和药敏情况。

方法：收集538例哈萨克族白内障患者的结膜囊分泌物进行细菌培养、鉴定和药敏试验。

结果：538份标本细菌培养阳性214例,阳性率39.8%。病原菌的种类以革兰氏阳性球菌为主(88.3%),其中表皮葡萄球菌最常见(66.4%),其次是微球菌(9.8%)。性别对哈萨克族白内障患者结膜囊带菌率无影响,而年龄、居住地对带菌率有影响(≥60岁人群结膜囊带菌率明显高于40～59岁人群,农牧区人群结膜囊带菌率明显高于城市人群)。分离出的革兰氏阳性球菌对青霉素、红霉素、四环素和氯霉素的敏感性较差,耐药率>70%; 而对万古霉素、替考拉宁、利福平、妥布霉互和阿米卡星较敏感,耐药率<20%。

结论：革兰氏阳性球菌是哈萨克族白内障患者结膜囊最常见的菌种,尤其是表皮葡萄球菌; 结膜囊带菌情况与受检者的年龄和居住地域相关。临床上应严格掌握抗菌药物使用的适应证,以减少细菌耐药的发生。