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。     

增殖性糖尿病视网膜病变患者结膜囊需氧菌培养及药物敏感性分析

目的 探讨增殖性糖尿病视网膜病变患者结膜囊细菌学分布状态及药物敏感试验，为临床用药提供依据。方法 对2002年12月至2004年6月住我院眼底病科311例（其中男性112例，女性199例）388眼增殖性糖尿病视网膜病变眼疾患者，入院当天眼部未做任何处理即常规行结膜囊需氧菌培养，并对阳性者作药物敏感试验。结果388眼增殖性糖尿病视网膜病变眼疾患者培养出需氧菌172株，阳性率为44．3％。其中革兰氏阳性球菌约占83．7％。革兰氏阴性杆菌占16．3％。革兰氏阳性球菌中最常见菌为表皮葡萄球菌和金黄色葡萄球菌分别为43．6％和11．6％。革兰氏阴性杆菌中主要是大肠埃希氏菌和洛菲不动杆菌各占4．1％和3．5％。检菌率和性别存在明显相关性，女性高于男性，而和糖尿病病程以及类型无直接的关系。培养出的革兰氏阳性菌对万古霉素、利福平、庆大霉素敏感，对环丙沙星、氧氟沙星耐药性有所增加；革兰氏阴性菌对庆大霉素、环丙沙星及氧氟沙星敏感。结论 增殖性糖尿病视网膜病变患者术前点用敏感抗生素眼水，常规行结膜囊细菌培养及药物敏感试验是十分必要。     

眼结膜囊培养细菌病原学分析

目的　了解眼结膜囊分离细菌的菌属分布及变化。方法　对北京同仁医院 1989～ 1998年 10 a当中的 14 11份结膜囊细菌培养标本 ,按照培养阳性率、革兰染色分布、细菌属种分布及变化进行回顾性分析。结果　 14 11份结膜细菌培养标本中 ,细菌培养阳性的共 50 6株 ,平均培养阳性率为 3 5.9% .革兰阳性球菌占总检出菌的 63 .6% ;革兰阳性杆菌占 18.2 % ;革兰阴性球菌占 6.1% ;革兰阴性杆菌 12 .1% .凝固酶阴性葡萄球菌 (主要是表皮葡萄球菌 )为总检出菌的 3 6.2 % ;第 2位是棒状杆菌为 16.8% ;微球菌属为 12 .5% ;金黄色葡萄球菌为 10 .7% .近 5a来 ,结膜囊中分离出球菌的百分比增高 ,杆菌的百分比下降。结论　革兰阳性球菌仍然是结膜囊分离出的主要菌属 ;球菌百分比的升高及杆菌百分比的下降 ,应引起眼科临床的重视。     

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。     

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。     

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.     

正常结膜囊细菌的研究

结膜囊正常菌群因不同的环境、年龄、抗生素应用情况,尤其是不同的培养基和取样、培养方法,培养结果差异较大。结膜囊带菌率总体呈下降趋势,凝固酶阴性的表皮葡萄球菌、类白喉杆菌或棒状杆菌、金黄色葡萄球菌始终是最多的几种细菌。     

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。     

儿童眼部分离细菌的病原学分析

目的回顾分析14岁以下儿童的眼部标本培养细菌的菌属分布。方法对1989~2000年送检的798份14岁以下儿童的眼部细菌培养标本,进行革兰(G)染色分布、细菌菌属分布及随年龄变化规律进行分析。结果培养阳性的细菌250株,12年平均培养阳性率为31·3%,其中G 球菌127株,占50·8%;G 杆菌35株,占14%;G-球菌30株,占12%;G-杆菌53株,占21·2%。放线菌5株,占2%。培养阳性菌中凝固酶阴性葡萄球菌(主要为表皮葡萄球菌)的比例最高,为18·0%,其次为棒状杆菌为12·4%,肠杆菌科为11·6%,微球菌属为9·6%,假单孢菌属为9·2%,淋病奈瑟氏菌为9·2%。结论儿童结膜标本细菌G染色特点及细菌菌属分布与全体人群差异较大,儿童结膜淋病奈瑟菌阳性率远高于一般人群,应该引起临床医生重视。     

急性细菌性结膜炎致病菌和药物敏感性分析

目的 探讨急性细菌性结膜炎致病菌的种类及其对临床常用抗菌素的敏感性。方法 对200例(200只眼)急性细菌性结膜炎患者结膜囊分泌物进行细菌学检查，并对致病菌种类和药物敏感试验结果进行分析。结果 急性细菌性结膜炎结膜囊分泌物涂片革兰氏染色细菌检出率较低(7．00％)，而细菌培养阳性率比较高(146只眼，73．00％)；其中革兰氏阳性细菌有129只眼(88．36％)，以表皮葡萄球菌、腐生葡萄球菌和金黄色葡萄球菌多见，革兰氏阴性细菌17只眼(11．04％)，以大肠埃希氏菌、淋球菌、肺炎克雷伯氏菌和普通变形杆菌多见。大匆数主要致病菌对环丙沙星、氧氟沙星等敏感，而对氯霉素和利福平耐药。结论 表皮葡萄球菌等条件致病菌已成为急性结膜炎的主要致病菌，在临床工作中应有针对性选择有效抗菌素进行治疗；尽早获取结膜囊分泌物标本进行细菌培养和药物敏感试验对于病原学诊断和选择敏感抗菌素治疗有重要的临床意义。     

Aerobic bacterial conjunctival flora in diabetic patients

OBJECTIVE: To study the aerobic conjunctival flora of diabetic patients and its relation to the presence and level of diabetic retinopathy and the duration of the disease. METHODS: One hundred three patients from the diabetic retinopathy screening program of the Federal University of S?o Paulo with no evidence of ocular surface disease were included. The diabetic patient cohort was compared with 60 nondiabetic subjects. All patients underwent slit-lamp evaluation, conjunctival scrapings, and indirect ophthalmoscopy. RESULTS: The frequency of positive conjunctival cultures was significantly higher in the diabetic group (94.18%) than in the nondiabetic group (73.33%). Among diabetic patients, a significantly higher frequency of positive cultures was detected in those with diabetic retinopathy than in those without retinopathy. Neither the duration of the diabetes nor the hypoglycemic therapy correlated with the culture results. Coagulase-negative Staphylococcus was the most common microorganism isolated, and its identification was more frequent in patients with retinopathy than in those without diabetic retinopathy. CONCLUSION: Diabetic patients have a significantly higher number of positive conjunctival cultures. The presence of diabetic retinopathy was correlated with an increase in positive cultures and a higher proportion of coagulase-negative Staphylococcus.     

Comparison of preoperative conjunctival bacterial flora in patients undergoing glaucoma or cataract surgery

PURPOSE: To assess differences in conjunctival bacterial flora between patients undergoing glaucoma and cataract surgery. PATIENTS AND METHODS: A prospective study comparing conjunctival bacterial cultures obtained from 339 patients undergoing either cataract (n = 258) or glaucoma (n = 81) surgery. All cultures were acquired during the preoperative visit, approximately three to seven days prior to surgery. The culture samples were inoculated onto blood and chocolate agar, as well as blood culture broth media. All bacterial isolates were identified and statistical analyses were performed to determine if there were differences in flora between the eyes undergoing cataract versus glaucoma surgery. RESULTS: Two hundred fifteen of 258 eyes (83%) undergoing cataract surgery were found to have positive bacterial growth, compared with 62 of 81 eyes (77%) of those undergoing glaucoma surgery (P = 0.2246). Coagulase-negative Staphylococci, the most common bacterial isolate, was cultured from 167 eyes (65%) in the cataract group and 42 (52%) in the glaucoma group (P = 0.0514). Among all bacterial isolates, only Corynebacterium species was found to be statistically different between the two patient groups with 92 (36%) and 11 (14%) eyes testing positive in the cataract and glaucoma groups, respectively (P = 0.0003). CONCLUSIONS: There was no statistically significant difference in the proportion of conjunctival culture samples testing positive for bacterial growth in eyes undergoing glaucoma surgery compared with those undergoing cataract surgery. Glaucoma medications, or their preservatives, do not appear to significantly alter conjunctival flora. Techniques used for endophthalmitis prophylaxis prior to cataract surgery are likely appropriate for glaucoma surgery as well.     

Bacterial contamination of anterior chamber during IOL surgery

PURPOSE: To study the nature and frequency of bacterial contamination during cataract surgery. METHODS: The preoperative smears from the conjunctiva and anterior chamber (AC) fluid aspirates during extra-capsular cataract surgery (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in 40 eyes were analysed for aerobic and anaerobic bacteria. Any change in the bacterial strains isolated before and after cataract surgery was also studied. RESULTS: AC fluid aspirates were positive for bacteria in 15 eyes (37.5%). Coagulase-negative Staphylococcus was the most common aerobe (39.4%) and Propionibacterium acnes the most common anaerobe. Of the 15 cases with positive AC fluid cultures, 6 showed an organism in the AC aspirate different from the conjunctival smear. CONCLUSION: Clinically there was no endophthalmitis in any of the eyes. Factors such as preoperative antibiotic use, the antibacterial properties of aqueous, or low inoculum size could explain this. The preoperative conjunctival smear may not be useful in predicting the AC fluid contamination or outcome of cataract surgery.     

莫西沙星对减少结膜囊细菌效果的临床实验研究

目的 探讨术前应用0.5%莫西沙星眼药水对减少结膜囊细菌的效果.方法 对96例(98只眼)行眼前节手术的患者,随机分为A、B两组,分别于术前3 d和1 d用0.5%莫西沙星眼药水点眼,用药及手术前后取结膜囊标本做肉汤培养基培养、血平板培养及厌氧菌培养,对阳性结果行药物敏感性试验.结果 肉汤培养结果示:用药3 d或1 d后(T1)A、B两组的结膜囊细菌阳性率均低于用药前(P=0.000),术前1 h用药及聚维酮碘冲洗结膜囊后(T2),A、B两组的阳性率均低于T1(P=0.005;P=0.016),手术完成时(T3)A、B两组的阳性率与T2无差异(P=0.399;P=0.140),在各个时间点,A、B两组之间结膜囊细菌培养阳性率均差异无统计学意义(P＞0.05).血平板培养结果示:用药后(T1)两组结膜囊细菌阳性率均明显下降(P＜0.001),CFUs＞10的菌株消失.厌氧菌培养结果示:用药后(T1)两组结膜囊细菌阳性率无明显下降(P＞0.05).结论 术前1 d局部应用0.5%莫西沙星眼药水可以明显减少结膜囊需氧菌.     

Study of the resistance pattern and alteration in the conjunctival flora of patients exposed to repeated antibiotics

AIM: To investigate and analyze the changes in the conjunctival flora of patients exposed to repeated antibiotic usage. In addition, determining the effects of this repeated exposure on the resistance pattern of the conjunctival flora. METHODS: This study included 40 patients, admitted to the Retina Unit of the Research Institute of Ophthalmology. All chosen patients had a minimum of 4 consecutive, monthly intravitreal injections (IVI), some were extended to 6mo or 1y as required. The patients were randomly divided into 3 groups and each group received one kind of antibiotic which was either ofloxacin, moxifloxacin or ceftazidime. All bacterial isolates were tested for antibiotic susceptibility using Kirby-Bauer disc diffusion technique. RESULTS: In this study the conjunctival normal flora at base line culture varied from a predominance of Staphylococcus epidermidis (51.2%), followed by Staphylococcus aureus 14% to Micrococcus species 12.8% and other coagulase negative staphylococci (CONS) 13%. Our results showed an increase in the percentage of Staphylococcus epidermidis among ceftazidime treated eyes during the four visits in comparison to baseline cultures of patients randomized to ceftazidime. In contrast, there was no noticeable increase in Staphylococcus aureus percentage from baseline. In fluoroquinolone treated eyes, we also observed an increase in percentage of Staphylococcus epidermidis from base line. In contrast to ceftazidime treated eyes, the Staphylococcus aureus percentage in fluoroquinolone treated eyes showed an increase from baseline. However, the pattern of the ocular flora composition changed with the exposure to the old and newer generation of fluoroquinolones. We noticed an increase of Staphylococcus epidermidis in moxifloxacin treated eyes than that in ofloxacin treated eyes from baseline. There was no observed difference in the pattern of Staphylococcus aureus regarding exposure to older and newer generations of fluoroquinolones. CONCLUSION: Repeated use of ophthalmic antibiotics not only alters the composition of the normal ocular flora, but also selects for resistant strains.     

Effect of topical netilmicin on the reduction of bacterial flora on the human conjunctiva

PURPOSE: To investigate the effects of topical netilmicin on human conjunctival bacterial flora. METHODS: Fifty-six patients' eyes with cataract were treated three times a day with netilmicin 1 day before the surgery. The fellow eyes of the patients were not treated. After 1 day of netilmicin application cultures of the inferior palpebral conjunctiva were performed in both eyes. Bacterial evaluation is qualitative. McNemar test was used for statistical analyses. RESULTS: The number of eyes with positive culture for coagulase negative staphylococcus (CNS) in untreated eyes was 43 (76.8%) and in treated eyes it was 5 (8.93%) and the difference was statistically significant (p=0.000). In untreated eyes number of negative cultures with no bacterial growth was 8 (14.3%) and it was 47 (83.9%) in the treated eyes. The difference among groups was statistically significant (p=0.000). Netilmicin is found very effective for CNS as the percentage of positive cultures (n=43) in untreated eyes to positive cultures (n=4) in the treated fellow eye was 90.7%. Likewise, all patients with Staphylococcus aureus positive cultures in untreated eyes (n=5) had negative culture for this microorganism in their treated fellow eyes (100%). CONCLUSIONS: The Endophthalmitis Vitrectomy Study demonstrated that the most common causes of postoperative endophthalmitis are coagulase negative microorganisms, S aureus and Streptococcus species. As netilmicin was found effective to reduce the number of positive cultures for these bacteria, it can be used to lower the incidence of postoperative endophthalmitis before surgery.     

Clinicobacteriological correlates of congenital dacryocystitis

One hundred and fourteen eyes with congenital dacryocystitis have been studied clinically and bacteriologically. Gram positive cocci constituted the major bacterial isolates (57.9%) with streptococcus pneumoniae predominating (28.9%). The most effective antibiotic was cloxacillin with an overall efficacy of 77%. Normal conjunctival flora was sterile in majority (75%) of cases. Positive cases showed preponderance of gram positive cocci (21.6%) with staphylococcus albus (13.3%) being the major isolate. Normal nasal flora revealed diphtheroids (alone or in combination) to be the commonest bacteria (62.1%). A statistically significant correlation was not observed between the normal conjunctival or nasal flora and flora from the affected eyes.