优化术前护理措施对白内障手术后急性眼内炎的影响

目的 评估优化术前护理措施对白内障手术后急性眼内炎的影响。方法 回顾分析优化术前护理措施后白内障超声乳化手术后眼内炎变化情况,优化护理措施包括术前用氯霉素滴眼液冲洗结膜囊,手术时用聚维酮碘消毒结膜囊,在手术器械进入眼前房前用BSS彻底冲洗结膜囊。结果 在优化护理措施前的1221眼白内障超声乳化手术,发生手术后急性眼内炎4眼,发生率为3.28‰ 均为表皮葡萄球菌感染,为对氯霉素敏感。优化护理措施后1018眼白内障超声乳化手术,术后急性眼内炎1例,发生率为0.99‰,细菌培养为金葡萄球菌感染。结论 通过优化术前护理措施,可以有效的降低白内障超声乳化手术后急性眼内炎的发生。     

正常成人结膜囊细菌培养198例分析

目的 调查正常成人结膜囊内细菌情况.方法 对4周内未使用任何滴眼液的198例正常人,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.结果 正常成人结膜囊细菌培养阳性率为29.29%,共培养出8个菌种,56个菌株.葡萄球菌属最多共30株(53.57%),其中表皮葡萄球菌18株(32.14%),金黄色葡萄球菌12株(21.43%).结论 正常成人结膜囊可带有细菌,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.     

围术期护理预防白内障术后感染的效果观察

目的:探讨围术期护理预防白内障患者术后感染的效果。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,给予患者合理的围术期护理干预。结果:本组细菌培养阳性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25例(96.15%),其中以表皮葡萄球菌为主18例(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。本组无一例发生术后感染。结论:超声乳化白内障摘除加人工晶体植入术围术期护理可有效预防术后感染的发生。     

1896份眼结膜囊分泌物病原菌及耐药性分析

目的依据病原菌及其药敏结果,合理应用抗菌药物,提高治疗效果。方法对陕西省咸阳市第一人民医院眼科中心1 896份结膜囊分泌物进行细菌培养,分离病原菌,鉴定并做药敏试验。结果 1 896份结膜囊分泌物标本,检出病原菌384株,阳性率20.25%。其中革兰阳性菌286株,占74.48%;革兰氏阴性菌89株,占23.18%;真菌9株,占2.34%。分离前5位病原菌分别是表皮葡萄球菌(35.95%)、金黄色葡萄球菌(11.08%)、肺炎链球菌(8.65%)、溶血葡萄球菌(4.86%)和铜绿假单胞菌(4.05%)。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林表皮葡萄球菌检出率分别为25.00%和76.07%,金黄色葡萄球菌对眼科常用药物喹诺酮类(环丙沙星、左氧氟沙星)和氨基糖苷类耐药率不到20.00%和35.00%,表皮葡萄球菌和溶血葡萄球菌稍高。氯霉素、氧氟沙星、左氧氟沙星对肺炎链球菌有较高的抗菌活性,耐药率为25.00%、25.00%和16.67%。肺炎链球菌对青霉素耐药率达66.67%。结论细菌性结膜炎病原菌分布存在地区及国家间的差异,表皮葡萄球菌为该院眼科中心细菌性结膜炎首要病原菌,应重视结膜囊病原菌培养,依据药敏试验结果合理使用抗菌药物,提高治疗效果。     

婴幼儿慢性泪囊炎结膜囊细菌培养pH值测定及药敏结果分析

目的对婴幼儿慢性泪囊炎菌群种类进行分析,为临床药物使用提供有价值的参考依据。方法对132例144只眼患慢性泪囊炎的患儿进行眼部分泌物采集,分别作细菌培养、药敏试验及结膜囊pH值测定。结果 132例标本中,24h未找到细菌11例,占8.3%。致病细菌种类主要为革兰阳性球菌81例,占61.36%,检查出金黄色葡萄球菌37例,占30.57%。药敏试验结果显示多数细菌对左氧氟沙星、妥布霉素敏感。结膜囊pH值测定结果呈弱碱性。结论对致病菌种类培养及药敏结果分析显示,金黄色葡萄球菌敏感抗生素药物首选左氧氟沙星,对副流感嗜血杆菌等革兰阴性杆菌敏感抗生素药物首选利福平。冲洗液首选生理盐水。     

特应性皮炎患者结膜囊细菌分布及药敏分析

目的分析特应性皮炎(atopic dermatitis,AD)患者结膜囊细菌分布特征,并进行药敏分析,为AD患者行内眼手术围手术期眼内炎预防措施提供依据。方法研究采集30例AD患者结膜囊拭子标本,进行细菌培养鉴定,并进行药物敏感试验,另外采集30例正常患者标本作为对照。结果结膜囊菌培养,对照组结膜囊细菌阳性检出率为56.67%,AD组为86.67%(χ~2=6.538,P=0.110);对照组金黄色葡萄球菌检出率为10.00%,AD组为70.00%,两组比较差异有统计学意义(χ~2=22.125,P0.001);对照组耐甲氧西林金黄色葡萄球菌(methicillin resistant staphylococcus aureus,MRSA)检出率为3.33%,AD组为40.00%,两组比较差异有统计学意义(χ~2=11.684,P=0.001)。药敏分析中,除两组革兰染色阳性球菌对万古霉素敏感率都为100%外,AD组革兰染色阳性球菌对左氧氟沙星、庆大霉素和头孢唑啉的敏感率均低于对照组,两组比较差异均有统计学意义(χ~2=4.367,6.440,4.063;P=0.037,0.011,0.044)。结论 AD组结膜囊金黄色葡萄球菌、MRSA检查率均高于正常对照组,并且AD组革兰染色阳性球菌对一些抗菌素敏感率降低,此类患者进行内眼手术时围手术期眼内炎防控措施应加强。     

不同结膜囊冲洗液对防治白内障术后眼部感染的临床效果比较

目的比较不同结膜囊冲洗液防治白内障术后眼部感染效果。方法将收治的白内障手术患者随机分为2组,庆大霉素组术前采用生理盐水加庆大霉素冲洗,生理盐水组采用生理盐水洗眼冲洗。2组患者冲洗后,均用无菌棉拭子采集结膜囊进行细菌培养,冲洗后15、30 min观察结膜囊充血情况,比较2种冲洗液应用后眼内炎的发生率及眼部不良反应的发生率。结果 2组结膜囊冲洗前后细菌阳性率比较,差异有统计学意义(P0.05),而2组细菌阳性差异无统计学意义(P0.05);冲洗后庆大霉素结膜充血情况较好(P0.05);2组术后均无眼内炎发生,庆大霉素组眼部不良反应发生率明显较低。结论生理盐水和庆大霉素是有效的结膜囊冲洗液,但庆大霉素应用更加安全。     

白内障术后眼内感染因素的调查与防控

目的了解白内障手术后眼内感染的影响因素,采取相应的防控措施。方法采用回顾性调查和细菌培养的方法,对某医院眼科2例白内障手术后发生眼内感染的原因进行调查与分析。结果在482例白内障手术患者中,有2例发生了术后眼内感染,医院感染发病率为0.41%。患者术前用抗菌药物滴眼和生理盐水冲洗结膜囊,手术中采用低浓度碘伏消毒液消毒眼脸和眼周皮肤。从感染患者的前房水、玻璃体内和睑板腺开口处均分离培养出表皮葡萄球菌。结论该医院白内障手术患者术后眼内感染发生率高于国内平均水平,感染因素主要是术前处理不够严格,由表皮葡萄球菌引起眼内感染,应进一步研究更有效的术前消毒处理方法。     

眼内点药器的制作与应用

眼内炎是眼部手术最严重的并发症之一,往往严重影响病人的视力。近年来,随着白内障手术的大量开展,眼科医生越来越重视预防术后眼内炎的发生。眼睑和结膜囊的菌群是引起术后眼内炎病原体的主要来源[1,2]。这些细菌可以通过手术入路进入房水和玻璃体成为引起眼内炎的凶险因素。聚维酮碘被证明能有效地减少眼表菌群[3]和使眼内炎的发病率下降[4]。术前与术后结膜囊内应用5%聚维酮碘是目前被推崇的有效预防眼     

中心静脉导管相关性感染及病原学分析

目的 观察危重患者导管相关性感染的临床特点、菌群分布及药敏情况.方法 分析评定233例导管相关性感染(CRI)患者导管尖端分泌物、导管内血及对侧肢体静脉血培养结果.结果 培养出病原菌296株,其中双重感染22例.细菌培养阳性233例,其中革兰阴性杆菌181株,占61%;革兰阳性球菌52株,占18%;真菌63株,占21%.药敏结果显示最常见的革兰阴性杆菌是铜绿假单孢菌,耐药率极高,其中对亚胺培南耐药率为15%;最常见的革兰阳性菌是凝固酶阴性葡萄球菌和金黄色葡萄球菌,对万古霉素敏感率为100%.结论 临床对于导管相关性感染应以预防为主,感染发生后有效处理方式是拔除致病导管,根据病原菌培养结果选用敏感抗生素积极抗炎治疗.     

MRSA ocular infections]

Staphylococcus aureus and Staphylococcus epidermidis are organisms that frequently cause conjunctivitis, keratitis and endophthalmitis. MRSA comprised about 25% of the S. aureus isolated from ocular infections; most were from compromised host. MRSA was resistant to penicillins, cephems and macrolides but was sensitive to amikacin, netilmicin, minocycline and ofloxacin. Ofloxacin-resistant strains, however increased rapidly. Topical vancomycin, arbekacin and minocycline were used when commercially available antibiotics were inadequate.     

Treatment of Staphylococcus epidermidis endophthalmitis with intravitreal moxifloxacin in a rabbit model

Staphylococcus epidermidis is one of the most common causes of postoperative infectious endophthalmitis, which is a serious complication of ocular surgery and penetrating trauma. Moxifloxacin is a newly developed fluoroquinolone with a potent antimicrobial activity. Corticosteroids are used in endophthalmitis to suppress devastating intraocular inflammatory response. This study was designed to assess the efficacy of intravitreal moxifloxacin alone and in combination with intravitreal dexamethasone. To the best of our knowledge, there is no published report demonstrating the effect of intravitreal moxifloxacin on bacterial endophthalmitis. One eye of each rabbit (n=24) was infected by inoculation of 10(5) colony-forming units (CFU) of S. epidermidis into the vitreus cavity. Rabbits received intravitreal injection of moxifloxacin (50 microg) or a combination of moxifloxacin (50 microg) and dexamethasone (400 microg). No treatment was given to control group. Clinical and histopathological examination scores and microbiological analysis of vitreus aspirates were compared. In the treatment groups, the clinical and histopathological scores and mean CFU were significantly lower than those in the control group (p <0.05) but showed no significant difference between the treatment groups. These results suggest that intravitreal injection of moxifloxacin is effective against S. epidermidis in this experimental rabbit model. Moxifloxacin may be a promising agent in the treatment of bacterial endophthalmitis.     

1756株医院感染病原菌的菌群分布及耐药性分析

目的了解医院感染病原菌的菌群分布及其对常用抗菌药物的耐药情况,为临床合理使用抗菌药物提供依据。方法常规培养分离细菌,应用VITEK-Compact 2全自动细菌分析仪鉴定细菌。常规药敏试验采用K-B纸片法。结果从临床分离出1 756株病原菌,主要来源于痰、分泌物及中段尿,三者之和占86.0%;分离的病原菌以肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌和白色假丝酵母菌为主,占感染菌株分离率的72.5%;病原菌分离率较高的科室为神经外科、呼吸科、监护室（ICU）、心胸外科;大肠埃希菌和肺炎克雷伯菌产ESBLs的阳性率分别为64.3%和61.7%,对头孢哌酮/舒巴坦和亚胺培南的耐药率在3.4%以下;非发酵菌对孢哌酮/舒巴坦的耐药率低于15.6%;未检出耐万古霉素的阳性球菌。结论医院内感染标本的来源主要以呼吸道和泌尿生殖道为主。肠杆菌科细菌已成为医院内感染的重要病原菌,产ESBLs状况十分严重。临床对产酶菌及非发酵菌引起的重症感染应首选头孢哌酮/舒巴坦和亚胺培南,对耐甲氧西林的葡萄球菌引起的重症感染应首选万古霉素来治疗。     

Besifloxacin Ophthalmic Suspension, 0.6%: a Novel Topical Fluoroquinolone for Bacterial Conjunctivitis

Acute bacterial conjunctivitis, the most common cause of conjunctivitis, is responsible for approximately 1% of all primary-care consultations. Of the topical ophthalmic antibiotics used to treat acute bacterial conjunctivitis, fluoroquinolones are especially useful because they possess a broad antibacterial spectrum, are bactericidal in action, are generally well tolerated, and have been less prone to development of bacterial resistance. Besifloxacin, the latest advanced fluoroquinolone approved for treating bacterial conjunctivitis, is the first fluoroquinolone developed specifically for topical ophthalmic use. It has a C-8 chlorine substituent and is known as a chloro-fluoroquinolone. Besifloxacin possesses relatively balanced dual-targeting activity against bacterial topoisomerase IV and DNA gyrase (topoisomerse II), two essential enzymes involved in bacterial DNA replication, leading to increased potency and decreased likelihood of bacterial resistance developing to besifloxacin. Microbiological data suggest a relatively high potency and rapid bactericidal activity for besifloxacin against common ocular pathogens, including bacteria resistant to other fluoroquinolones, especially resistant staphylococcal species. Randomized, double-masked, controlled clinical studies demonstrated the clinical efficacy of besifloxacin ophthalmic suspension 0.6% administered three-times daily for 5 days to be superior to the vehicle alone and similar to moxifloxacin ophthalmic solution 0.5% for bacterial conjunctivitis. In addition, besifloxacin ophthalmic suspension 0.6% administered two-times daily for 3 days was clinically more effective than the vehicle alone for bacterial conjunctivitis. Besifloxacin has also been shown in preclinical animal studies to be potentially effective for the "off-label" treatment of infections following ocular surgery, prophylaxis of endophthalmitis, and the treatment of bacterial keratitis. Taken together, clinical and preclinical animal studies indicate that besifloxacin is an important new option for the treatment of ocular infections.     

Mechanisms of action of quinolones against staphylococci and relationship with their in vitro bactericidal activity

Ciprofloxacin and norfloxacin exhibited mechanism A (requires cell division as well as bacterial protein and RNA synthesis to kill bacteria) and C (active against nondividing bacteria but requires protein and RNA synthesis) against the reference strain Staphylococcus aureus ATCC 25923, yet only mechanism A was exhibited by these fluoroquinolones when tested against three clinical isolates: S. aureus Sa-215, Staphylococcus epidermidis Se-81 and Staphylococcus haemolyticus Sx-1. On the contrary, fleroxacin exerted mechanism A and C against the three clinical isolates but only mechanism A against the reference strain. Ofloxacin displayed mechanism A against S. epidermidis Se-81, mechanism A and C against S. haemolyticus and mechanism A and B (active against nondividing bacteria and does not require protein and RNA synthesis) against the two S. aureus tested. Sparfloxacin showed mechanism A and C against the four Staphylococcus species studied, and temafloxacin was the only fluoroquinolone tested that exhibited mechanism A and B against the four bacterial strains assayed. No correlation was found between the in vitro bactericidal activity (expressed as minimum inhibitory concentration and optimal bactericidal concentration) and the mechanisms of action exhibited by these fluoroquinolones.     

妥布霉素滴眼液和左氧氟沙星滴眼液治疗细菌性结膜炎的疗效观察

目的观察妥布霉素滴眼液和左氧氟沙星滴眼液治疗细菌性结膜炎的临床效果和安全性。方法回顾性分析2018年10月至2019年6月于该院门诊就诊的89例细菌性结膜炎患者的临床资料,所有患者依据就诊先后顺序分为对照组(43例)和研究组(46例)。对照组采用左氧氟沙星滴眼液治疗,研究组采用妥布霉素滴眼液治疗。比较两组临床疗效、细菌清除情况、眼表状况和不良反应发生情况。结果治疗后,研究组总有效率及细菌清除率高于对照组,差异均有统计学意义(P<0.05)。治疗前,两组泪膜破裂时间(BUT)、基础泪液分泌试验(SIt)结果比较,差异无统计学意义(P>0.05);治疗后,两组BUT、SIt结果均较治疗前下降,且对照组下降更为明显(P<0.05)。两组不良反应以眼部出现烧灼感、眼部瘙痒为主,组间不良反应发生率比较,差异无统计学意义(P>0.05)。结论妥布霉素滴眼液治疗细菌性结膜炎的效果优于左氧氟沙星滴眼液,更有利于细菌的清除,对眼表状态的影响较小,安全性更高。     

Topical fluoroquinolones for eye and ear

Topical fluoroquinolones are now available for use in the eye and ear. Their broad spectrum of activity includes the common eye and ear pathogens Staphylococcus aureus and Pseudomonas aeruginosa. For the treatment of acute otitis externa, these agents are as effective as previously available otic preparations. For the treatment of otitis media with tympanic membrane perforation, topical fluoroquinolones are effective and safe. These preparations are approved for use in children, and lack of ototoxicity permits prolonged administration when necessary. Topical fluoroquinolones are not appropriate for the treatment of uncomplicated conjunctivitis where narrower spectrum agents suffice; they represent a simplified regimen for the treatment of bacterial keratitis (corneal ulcers). When administered topically, fluoroquinolones are well tolerated and offer convenient dosing schedules. Currently, bacterial resistance appears limited.     

白内障囊外摘除术后眼内炎的临床研究

目的：分析白内障囊外摘除术后眼内炎的情况,探讨其防治措施。方法：采用单因素分析及非条件Logistic逐步回归分析方法,回顾性分析自内障囊外摘除人工晶状体植入患者9660例（10898眼）术后并发跟内炎的发生率,筛查分析其发生眼内炎的危险因素。结果：10898眼中共有27眼术后发生眼内炎（0．25％）,危险因素主要有术中玻璃体溢出、并发糖尿病、年龄较大（≥70岁）、大手术切口和手术历时较久（≥1h）等;发现眼内炎后立即行玻璃体注药联合全身给药或玻璃体手术,并行细菌学检查,27例中,16例细菌培养结果阳性,分别为表皮葡萄球菌7例,粪肠球菌（D群）4例,肺炎链球菌3例．真菌感染2例,其余11例标本培养3次均无细菌生长。治疗后7眼无光感,3眼行眼球摘除。结论：白内障囊外摘除术后并发眼内炎有诸多危险因素,采取规范的围手术期处理措旌、推广小切口巩膜隧道式手术、提高基层医生的手术技能、减少玻璃体溢出等有望降低眼内炎的发生率。     

人类β-防御素在眼表组织中的表达

背景:人类β-防御素主要定位于多种组织的表皮或上皮.在眼表中也存在防御素,但其在眼表中的分布及眼表疾病中的作用尚不十分清楚.目的:观察人类β-防御素在眼表组织中的分布,分析其在眼表疾病中的潜在作用.设计、时间及地点:以眼表组织为观察对象体外对照实验,于2006-10/2007-12在上海交通大学医学院附属新华医院中心实验室和中国科学院上海分院细胞生化所完成.材料:18个炎性结膜样本中包括6个胬肉表面球结膜、4个球结膜囊肿、4个酸烧伤结膜组织、2个热烧伤结膜组织和2个结膜肉芽肿组织;15个炎性角膜样本中包括6个病毒性角膜炎、4个霉菌性角膜炎、3个细菌性角膜炎和2个角膜穿孔伤后摘除眼球;9个尸体眼正常球结膜样本,8个尸体眼正常角膜样本.方法:RT-PCR法及免疫组织化学法检测50份样本人类β-防御素表达.主要观察指标:人类β-防御素1～3三种蛋白因子在正常及炎症眼表组织的表达和定位.结果:RT-PCR检测发现,人类β-防御素1,3在所有被检角结膜组织中均显示阳性;人类β-防御素2在大部分炎症眼表组织中显示阳性,在正常眼表组织几乎不表达.免疫组织化学结果显示,大多数炎性眼表组织中均同时表达人类β-防御素1,2,分布于上皮细胞层,以基底层为主,偶见基质细胞的浸润,仅少数无人类β-防御素2表达;正常角膜和球结膜样本中均有人类β-防御素1表达,分布于上皮细胞层,以基底层为主,仅极少数同时存在人类β-防御素2表达.结论:人类β-防御素1,3呈组成式表达于正常及炎性眼表组织上皮细胞表皮与基底上皮细胞表层和基底层,人类β-防御素2则呈诱导式表达于大多数炎性眼表组织上皮细胞表皮与基底上皮细胞表层和基底层,均以基底层居多;3种人类β-防御素在对抗眼表感染和促进眼表损伤修复中可能起重要作用.     

Antibacterial activity of the fourth-generation fluoroquinolones gatifloxacin and moxifloxacin against ocular pathogens

The ideal ophthalmic anti-infective exhibits broad-spectrum activity against gram-positive, gram-negative, and atypical bacterial species. These pathogens can cause potentially blinding infections such as keratitis and endophthalmitis, both of which are associated with ophthalmic surgery or traumatic injury. These infections often require aggressive antibacterial therapy, preferably with newer generations of antibiotics. In this study, minimal inhibitory concentration (MIC) values for gatifloxacin and moxifloxacin were determined in vitro against bacterial strains that were isolated from suspected cases of bacterial keratitis and endophthalmitis. The ocular isolates included 7 gram-positive, 4 gram-negative, and 3 atypical bacterial species. Gatifloxacin and moxifloxacin exhibited similar activity against 6 gram-positive organisms: Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Bacillus cereus, and Enterococcus faecalis. MIC90 values for the drugs against these isolates ranged from 0.08 mg/mL to 0.57 mg/mL and were comparable to previously published values against isolates from patients with systemic infections. The MIC90 for gatifloxacin against Streptococcus viridans was 0.22 mg/mL compared with 0.73 mg/mL for moxifloxacin (P = .011). Among the gram-negative isolates, the mean MIC90 for gatifloxacin against Pseudomonas aeruginosa was 1.28 mg/mL compared with 2.60 mg/ mL for moxifloxacin (P = .023). MIC90 values for gatifloxacin against Klebsiella pneumoniae and Enterobacter aerogenes were one fourth to one fifth the values for moxifloxacin. For the atypicals, the MIC90 values for gatifloxacin against Nocardia asteroides and Mycobacterium chelonae were one fourth the corresponding values for moxifloxacin. Gatifloxacin demonstrated a broad spectrum of activity against several key ocular pathogens tested in this study and was at least as effective as moxifloxacin against these pathogens.