白内障术前睑板腺特殊处理对结膜囊微生物影响分析

目的 前瞻性研究白内障术前通过眼睑热敷、按摩及清洁睑缘等睑板腺的特殊处理对结膜囊微生物状态的影响,寻求更安全的内眼手术术前准备方法.方法 将87例90只眼拟行白内障手术患者随机分为A(空白组:未做任何处理之前)、B(对照组:术前使用抗生素眼液滴眼、剪眼睫毛、生理盐水冲洗泪道及结膜囊等常规术前准备)、C(处理组:常规术前准备+睑板腺特殊处理)三组,分别为25例26只眼、29例29只眼、33例35只眼,A组于人院时,B、C两组于手术开始及术毕两个时间点分别采集结膜囊标本,送检行微生物培养.结果 (1)结膜囊微生物培养阳性率:A组为53.85％,B组与C组手术开始及术毕两个时间点的阳性率分别为10.34％、27.59％与2.86％、5.71％.C组结膜囊微生物培养阳性率明显降低,与A组、B组组间差异均有统计学意义(P＜0.05).(2)结膜囊微生物培养阳性率与术前抗生素眼液使用天数、术前睑板腺处理时间、手术持续时间长短差异均无统计学意义(P＞0.05).(3)结膜囊微生物培养菌种:共培养出阳性菌28株,5种菌属.未培养出真菌.结论 (1)正常人群中结膜囊存在一定细菌;术前使用抗生素眼液滴眼、剪眼睫毛、生理盐水冲洗泪道及结膜囊等常规术前准备可以减少结膜囊微生物培养阳性率;对睑板腺特殊处理后可以更进一步降低结膜囊微生物培养检出率.(2)白内障术前增加对睑板腺的特殊处理可以在减少局部使用抗生素眼液时间的情况下,同样达到有效清洁术野、减少结膜囊微生物的作用,从而起到降低术后眼内炎风险的作用.     

季节对结膜囊带菌状况的影响

目的观察结膜囊细菌是否受季节的影响。方法对连续住院手术的349例患者（370只眼）进行结膜囊需氧菌培养，阳性者做细菌鉴定和药物敏感性试验。结果春、夏、秋、冬4个季节的结膜囊培养阳性率分别为70．5％、67．7％．42．8％和40．4％。差别有显著的统计学意义（P〈0．01）。培养的细菌均以凝固酶阴性葡萄球菌为主，葡萄球菌多重耐药菌株的比率达42．6％。细菌种类和耐药性方面各季节没有明显的统计学差别（P〉0．05）。结论春夏季节眼科住院患者结膜囊细菌培养阳性率较高，加强这个季节术后感染的预防是必要的。     

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。     

准分子激光原位角膜磨镶术前结膜囊细菌分析

目的观察准分子激光原位角膜磨镶术(1aser in situ keratomileusis，LASIK)术前患者结膜囊细菌分布及药物敏感性。方法对LASIK术前100例患者(200只眼)结膜囊取材进行细菌培养，并观察培养阳性的细菌对10种常见抗生索的体外药物敏感性。结果在200只眼结膜囊标本中细菌培养阳性者58眼(71株)，阳性率29%，共分离鉴定出12个细菌种属；其中革兰氏阳性菌为85．9％，革兰氏阴性菌为14．1％；金黄色葡萄球菌、表皮葡萄球菌、棒状杆菌属及假单胞菌属为LASIK术前患者结膜囊存在的常见菌属。药敏结果发现所分离细菌对阿米卡星和左氧氟沙星最敏感。结论革兰氏阳性菌是LASIK术前患者结膜囊存在的最常见菌，术前预防性抗生素使用应注意选择对革兰氏阳性菌敏感的抗生素。     

甘孜州汉族中老年人结膜囊细菌状况调查

目的:了解藏区汉族中老年人结膜囊细菌状况。方法:对甘孜州康定县姑咱镇、炉城镇,九龙县呷尔镇的汉族中老年人群173例346眼刮取下睑结膜囊分泌物,接种于血平板,培养48h后进行细菌分离鉴定。结果:选取346眼中结膜囊细菌培养阳性209眼,培养阳性率60.4%。培养出菌株232株,其中表皮葡萄球菌115(49.6%);棒状杆菌60株(25.9%)。康定县姑咱镇、炉城镇的汉族中老年人结膜囊细菌阳性率分别为69.2%和65.8%,差异无统计学意义(χ2=0.1709,P>0.05)。九龙县呷尔镇中老年人结膜囊细菌阳性率为44.3%,分别低于康定姑咱镇、炉城镇的中老年人结膜囊细菌阳性率,差异有统计学意义(姑咱镇vs呷尔镇:χ2=13.2002,P<0.05;炉城镇vs呷尔镇:χ2=9.6869,P<0.05)。结论:甘孜州多数汉族中老年人结膜囊存在细菌;绝大多数细菌为革兰氏阳性菌;表皮葡萄球菌、棒状杆菌是其结膜囊的优势菌种。区域不同,结膜囊细菌阳性率不同。     

急性细菌性结膜炎最新病原学分析

目的　探讨我国最新急性细菌性结膜炎致病菌的种类。方法　对５０例（５０眼）急性细菌性结膜炎患者结膜囊分泌物进行细菌学检查,给予患者１０ｇ·Ｌ－１阿奇霉素滴眼液滴眼,每天２次,滴眼２ｄ后改为每天１次,治疗３ｄ,于第８天再次行细菌培养检查。结果　急性细菌性结膜炎结膜囊分泌物细菌培养阳性率８０．０％,革兰阳性细菌占９７．５％,表皮葡萄球菌占首位（占培养阳性总数７２．５％）,其中包括２例苯唑西林耐药表皮葡萄球菌。应用抗生素治疗后,４７例（９４．０％）患者临床症状缓解。再次行病原学检查,原致病菌全部清除率为６０．０％,部分清除率为５．０％。治疗后细菌培养仍阳性细菌主要为表皮葡萄球菌（占培养阳性总数５６．２％）。结论　表皮葡萄球菌已成为我国目前急性细菌性结膜炎的首要致病菌,在临床工作中应对其予以重视,选择针对性治疗。     

眼前节内眼手术应用5％吡咯烷酮碘两种不同用法的前瞻性随机化比较研究

目的：确定5％吡咯烷酮碘采用两种不同的方法（结膜囊滴两滴和10ml溶液穹窿结膜冲洗）对降低结膜囊菌群的功效。方法：在这项前瞻性对照实验中。将行眼前节手术的200只眼随机分为对照组和研究组。两组病例术前均给予氧氟沙星滴眼液局部点眼和5％吡咯烷酮碘眶周区域皮肤擦洗消毒。术前对照组眼结膜囊内给予2滴5％吡咯烷酮碘溶液，研究组眼用5％吡咯烷酮碘溶液冲洗穹窿结膜。分别于术前和术后4个时间点行结膜细菌培养。结果：研究组78只眼中20只眼（26％）术前结膜细菌培养阳性：对照组94只眼中40只眼（43％）为阳性（P=0．02）。手术结束时。研究组78只眼中14只眼（18％）、对照组94只眼中30只眼（32％）结膜细菌培养阳性（PP=0．05）。结论：手术时应用5％吡咯烷酮碘溶液冲洗穹窿结膜与结膜囊仅点入两滴相比。前者显著降低了结膜细菌培养阳性率。     

眼外伤236例结膜囊细菌培养及药敏试验分析

目的了解眼外伤结膜囊带菌情况及细菌耐药性。方法对236例（242眼）眼外伤者结膜囊分泌物进行细菌培养和药敏试验。结果242眼中有69眼分离出69株病原菌，其中革兰阳性球菌40株（57．97％）、革兰阳性杆菌4株（5．80％）、革兰阴性杆菌19株（27．54％）、真菌6株（8．70％）。结论根据眼外伤结膜囊病原菌及药敏试验，治疗中合理选择抗生素。     

人工晶体植入术前老年人结膜囊细菌状况

报道４组老年人人工晶体植入术前的结膜囊细菌状况。第１组术前正常结膜囊阳性率为４５．７％；第２组术日结膜囊组阳性率为１９．２％；第３组切口前结膜囊阳性率为１９．２％；第４组结膜充血组阳性率为５３．１％，与前３组比较差异显著。前三组菌株多数是葡萄球菌结膜３４例次，表皮葡萄球菌最多２２例，金黄色葡萄球菌次之９例。结膜充血组菌种多，仍然是葡萄球菌较多。多数菌株对庆大霉素、先锋霉素和氟哌酸敏感。术前结膜囊有     

准分子激光近视手术前结膜囊细菌培养的病原学分析

目的 观察准分子激光手术患者术前结膜囊细菌病原学特征及术前用药效果.方法 对230例(450只眼)LASIK、LASEK患者于术前用药前和用药后进行结膜囊细菌培养并行药敏试验.结果 450只眼用药前结膜囊细菌培养有240只眼(占53.33%)培养出细菌,其中表皮葡萄球菌138只眼(占57.5%),棒状杆菌73只眼(占30.78%),表皮葡萄球菌+棒状杆菌共20只眼(占8.33%),溶血链球菌9只眼(占3.75%).用药后341只眼中有6只眼(占1.76%)培养出细菌,为微球菌.所培养出的细菌均对左氧氟沙星敏感,术后均未感染.结论 准分子手术患者术前有必要局部滴用有效的抗生素滴眼液清洁结膜囊以预防术后感,增加手术的安全性,降低手术风险.     

Antibiotic susceptibility of preoperative normal conjunctival bacteria

PURPOSE: To determine the antibiotic susceptibility of preoperative conjunctival bacterial flora. DESIGN: In vitro study. METHODS: Antibiotic susceptibility of conjunctival bacterial strains isolated from 164 patients undergoing intraocular surgery was determined using the Kirby-Bauer disk-diffusion technique. RESULTS: Among the 162 bacteria isolated, 124 (76%) were coagulase-negative staphylococci (CNS), with 2% resistant to gatifloxacin and moxifloxacin, and none were resistant to vancomycin or minocycline. Other bacteria isolated were 19 Staphylococcus aureus (S. aureus), 8 Streptococcus Group D, and 11 gram-negative rods. Most S. aureus (>85%) were susceptible to all antibiotics except for the penicillin and macrolide groups. No streptococci were resistant to gatifloxacin, levofloxacin, moxifloxacin, mezlocillin, imipenem, or vancomycin. None of the gram-negative rods were resistant to the fluoroquinolones. Approximately one half of all bacteria were resistant to erythromycin. One in three patients harbored multi-resistant bacteria (resistant to > or = five antibiotics). CONCLUSIONS: Newer-generation fluoroquinolones provide excellent broad-spectrum coverage against conjunctival bacterial flora.     

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.     

Effect of preoperative fusidic acid on the normal eyelid and conjunctival bacterial flora.

A randomised trial comparing the topical application of 1% fusidic acid with 0.3% gentamicin solution in the reduction of the normal preoperative lid and conjunctival microbial flora was performed. Forty patients awaiting cataract surgery were randomly divided into two groups consisting of 20 patients each. The first group received a 1% microcrystalline suspension of fusidic acid, the second 0.3% gentamicin to the preoperative eye every two hours between 0600 and 2400 daily for 48 hours preoperatively. Cultures were obtained from both the lid margins and the conjunctival sac of both groups prior to antibiotic therapy and again in the operating theatre before surgery. Microbiological identification and colony counts were performed by standard laboratory methods. Staphylococcus epidermidis was the commonest micro-organism isolated. Statistical analysis revealed no significant differences in the ability of a 1% microcrystalline suspension of fusidic acid and 0.3% gentamicin in eliminating or reducing the normal preoperative conjunctival or lid flora.     

Changes in bacterial flora of conjunctival sac in patients prophylacticaly treated with antibiotic before cataract operation

PURPOSE: The aim of the study was to estimate changes in bacterial flora of conjunctival sac changes in patients prophylacticaly treated with different antibiotics (chloramphenicol, gentamycin, ofloxacin, norfloxacin) before cataract operation. MATERIAL AND METHODS: The studied group consisted of 166 patients hospitalized for cataract surgery. The control group consisted of 33 persons, neither treated topically with antimicrobial drugs nor suffering from infectious or inflammatory diseases. On the first day and on the operation day conjunctival swabs were obtained and typical microbiological diagnosis was performed. During hospitalization only one antimicrobial drug was administrated topically (chloramphenicol, gentamycin, ofloxacin or norfloxacin) in the studied group. RESULTS: Prophylaxis with antibiotics before cataract surgery changes bacterial flora of conjunctival sac: quantitative changes were observed most frequently, but also hospital antibiotic resistant strains were detected. None of tested antibiotics caused total elimination of conjunctival flora in all patients. CONCLUSIONS: None of the antibiotics used in our study could cause total elimination of conjunctival flora. According to our results, the most effective antibiotics in prophylaxis before eye surgery are fluoroquinolones. Some patients before eye surgery have the pathogenetic conjunctival flora not causing the disease, yet increasing the risk of postoperative endophthalmitis.     

Bacteriological contents of conjunctival sac in patients with cataract in the early post-operative period

PURPOSE: Evaluation of conjunctival microflora in patients with cataract, during the early post-operative period. MATERIAL AND METHODS: One hundred twenty patients scheduled for cataract extraction were evaluated. In each patient, conjunctival swab was taken directly after cataract surgery and two to three days postoperatively. Following surgical procedure all patients received topical antibiotics alone or along with steroids. The agents were placed into conjunctival sac of the operated eye. Ophthalmic ointments were administered HS and eye drops QID. RESULTS: 9.2% (11 patients) of the cultures of conjunctival swabs collected right after surgical procedure were positive for growth with predominantly Gram-positive organisms, mainly Staphyloccocus spp. These, were compared with 24.2% (29 patients) of positive cultures from conjunctival swabs collected two to three days later. 4.2% of the latter were also positive when taken in the operating room, immediately after a surgical procedure. The remaining 20.0% of positive cultures swabbed two to three days after surgery were resulted from the contamination of conjunctival sac with germs during the postoperative hospitalisation. CONCLUSIONS: There is a risk of early post-operative infection in patients undergoing cataract surgery. It is caused by the appearance of microflora in the conjunctival sac.     

Identification of bacterial flora of conjunctival sac in congenital nasolacrimal duct obstruction in children

PURPOSE: The aim of the study was to evaluate the species of the microorganisms and their susceptibility to antibiotics in congenital nasolacrimal duct obstruction in children. MATERIAL AND METHODS: The pus secretion after lacrimal sac massage was obtained from 81 children with congenital nasolacrimal duct obstruction. The laboratory diagnostics was performed using typical microbiological procedures. The modification of these procedures was 24-hour pre-incubation in sugar boullion. RESULTS: The most frequently isolated bacteria were Staphylococcus epidermidis (28%) and Staphylococcus aureus (22%). The isolated staphylococci (only coagulase-negative species MRSE) were resistant to methicillin in 2 cases. Streptococci were obtained in 20% isolations: Streptococcus pneumoniae (14%), Streptococcus viridans (6%). Gram-negative bacilli Pseudomonas aeruginosa and Moraxella spp. and Candida albicans were isolated in a few cases. Negative results of the cultures were obtained in 25% cases. CONCLUSIONS: The microorganisms typically constituting physiological flora of conjunctival sac may become the pathogens in the complications of congenital nasolacrimal duct obstruction in children.     

108例干眼症之结膜囊细菌菌落

连续选取我院角膜病门诊１０８例（２１６只眼）确诊为干眼症患者、２１６例（４３２只眼）正常人分别结膜囊细菌培养，结果说明结膜囊作细菌培养阳性率干眼症患者明显高于正常人（Ｐ〈０．００１），且以致病力较强的绿脓力及金黄色葡萄球菌最多。建议干眼症患者除了给予人工泪液外还应给予预防性抗生素治疗。     

青少年角膜塑形镜配戴者结膜囊及镜盒菌群研究

目的研究配戴角膜塑形镜对青少年结膜囊菌群的影响,以及角膜塑形镜存储盒带菌情况。方法实验研究。分别对101名配戴角膜塑形镜（配戴组）和110名未配戴角膜塑形镜青少年（对照组）进行结膜囊细菌培养,并对158个角膜塑形镜存储盒进行细菌培养。所有标本置于37 ℃恒温箱中培养48 h后统计培养阳性率。数据比较采用卡方检验。结果对照组结膜囊培养菌株68株,阳性率为30.9%;配戴组结膜囊培养菌株59株,阳性率为29.4%;2组结膜囊细菌培养阳性率差异无统计学意义（χ²=0.12,P>0.05）。角膜塑形镜存储盒细菌培养菌株72株,阳性率为45.6%。2组研究对象结膜囊和镜盒菌群培养阳性率首位均为表皮葡萄球菌。结论配戴角膜塑形镜不会提高青少年结膜囊带菌率,镜片及镜盒的清洁可降低镜片污染率。     

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.     

Comparison of aerobic conjunctival bacterial flora in pregnant, reproductive-aged and postmenopausal women

AIM: To evaluate the effect of hormonal status on aerobic conjunctival flora in women. METHODS: One hundred fifty-eight women [reproductive-aged (n=55), pregnant (n=51), and postmenopausal (n=52)] who admitted to outpatient clinic of Obstetrics and Gynecology Department of Denizli State Hospital were enrolled. Age, body-mass index (BMI), obstetric history, cigarette smoking, drug usage, presence of systemic disease, and intraocular pressure (IOP) were recorded for each patient. The samples were taken from the lower fornix with two culture swabs and directly incubated in culture containing 5% sheep blood, eosin-methylene blue and chocolate agar. The other swab specimen was Gram stained. All growths and microscopic results were analyzed. RESULTS: The coagulase-negative Staphylococcus was the predominant organism isolated in the conjunctival samples in both three groups. The aerobic microorganism growth rate for all isolated aerobic organisms revealed no significant change in the three groups (P >0.05). The conjunctival culture positivity rates were similar in the three groups (49% in reproductive-aged, 57% in pregnant and 58% in postmenopausal women) (P >0.05). Age, IOP, BMI, gravidity, parity, cigarette smoking, drug usage, and presence of systemic diseases did not have an effect on culture positivity in three groups. CONCLUSION: Results of this study showed that conjunctival aerobic flora and bacterial colonization did not differ between reproductive-aged, pregnant and postmenopausal women.