感染性眼内炎的致病菌培养结果分析

目的：探讨引起感染性眼内炎的致病菌对广谱抗生素的耐药性及敏感性。

方法：对我院15例白内障术后眼内炎术中抽取玻璃体做病原学检查并对治疗结果进行回顾性分析。

结果：此15例在术中采集前房水及玻璃体做细菌培养与药物敏感试验,7例培养出致病菌,细菌培养阳性率47%(其中真菌1例,表皮葡萄球菌3例,缓慢葡萄球菌1例,凝固酶阴性葡萄球菌1例,浅绿气球菌1例),8例示无菌生长。培养阳性病例中3例表皮葡萄球菌和1例缓慢葡萄球菌的药敏试验均显示对左氧氟沙星是耐药的,MIC均>4; 另外1例凝固酶阴性葡萄球菌和1例浅绿气球菌药敏试验显示对左氧氟沙星是敏感的,MIC均<2,万古霉素与利福平均为敏感抗生素,MIC均<1。

结论：大多数医疗机构常规使用左氧氟沙星作为内眼手术预防性用药,但本文章总结后对此现象提出质疑。临床医生对致病菌经验性用药经常出现,但当未做细菌培养和药物敏感性试验同时致病菌出现耐药时经验性用药往往导致治疗效果降低或更严重的后果。因此应该及时根据细菌培养和药物敏感性试验结果合理选择抗生素,适时调整用药方案是规范治疗的首选。     

Endogenous Bacterial Endophthalmitis: A Five-Year Retrospective Review at a Tertiary Care Academic Center

ABSTRACT

Purpose

To better characterize the demographics and outcomes of endogenous bacterial endophthalmitis (EBE).     

LISTERIA MONOCYTOGENES ENDOPHTHALMITIS: A CASE REPORT

Listeria monocytogenes endophthalmitis is characterised by a progressively darkening indolent hypopyon. Gentamicin and amoxycillin, as used in this, the first reported Australian case, is the currently recommended treatment.     

Antimicrobial prophylaxis for ophthalmic surgery

Preoperative, intraoperative, and postoperative antibiotic agents have been used by ophthalmic surgeons routinely as prophylaxis for postoperative endophthalmitis. The rationale for such prophylaxis and the evidence which supports its efficacy are well founded. The optimal choice of antibiotic agent—from the standpoint of efficacy, route of delivery, adverse reactions, and cost—is far less established. This review considers these issues, as well as the role of topical disinfectants, including povidone-iodine, in preoperative prophylaxis.     

晶体源性眼内炎发病机理的实验研究——植物血凝素对晶体蛋白免疫耐受性的破坏作用

依据植物血凝素(PHA)能激活多克隆T淋巴细胞的性质,先给大鼠注射PHA,再切开晶体囊膜,大鼠发生了晶体源性眼内炎。这个结果直接证实了T淋巴细胞在晶体源性眼内炎发病过程中起始动作用。这一动物模型建立时间短,不需接种弗氏佐剂,有助于探讨该病的发生机理和寻找治疗药物。     

Amphotericin clearance in vitrectomized versus nonvitrectomized eyes

Ocular clearance of amphotericin B after direct intravitreal injection was studied in a rabbit model. Unmodified phakic eyes, Candida-infected eyes, aphakic eyes, and aphakic vitrectomized eyes were employed. Using high pressure liquid chromatography to assess drug level, the half-lives of drug disappearance after single 10-microgram (microgram) intravitreal injections were 9.1, 8.6, 4.7, and 1.4 days, respectively. The disappearance slope for vitrectomized eyes was significantly different from all nonvitrectomized eyes with P less than 0.001. The rapid disappearance of amphotericin from vitrectomized eyes must be considered in clinical management of patients with fungal endophthalmitis.     

白内障手术切口关闭形式与发生眼内炎的关系

目的:分析白内障手术切口关闭形式与眼内炎发生的关系。方法:抽取2001/2007年白内障手术5139眼,比较手术切口(巩膜隧道)大小(3.5～7.0mm)及关闭方式(自闭、一针缝合、双针缝合)与眼内炎的发生率。结果:2001/2007年白内障手术5139眼共发生眼内炎10眼,发生率为0.54%～0,均数0.28%。结论:白内障手术切口关闭形式与眼内炎的发生存在显著相关性,有效关闭手术切口就能减少或避免眼内炎的发生。     

Achromobacter xylosoxidans Endophthalmitis Diagnosed by Polymerase Chain Reaction and Gene Sequencing

Purpose: To report a patient with Achromobacter xylosoxidansendophthalmitis that was diagnosed using polymerase chain reaction and gene sequencing. Methods: Case report. A patient with culture-negative endophthalmitis underwent an anterior chamber tap. Polymerase chain reaction was performed on the aqueous sample using the 16S ribosomal DNA primer set to detect and amplify bacterial DNA. The amplified DNA was sequenced and compared to archived sequences in a gene library using the BLAST search program. Results: A 214-base pair gene sequence was amplified and matched with the gene sequence for A. xylosoxidans. Antimicrobial treatment was instituted with resolution of hypopyon, anterior chamber cells, and vitreous cells one month after treatment. Conclusions: Polymerase chain reaction of 16S rDNA combined with gene sequencing may be an alternative method of diagnosing culture-negative bacterial endophthalmitis.     

Flomoxef Sodium and Levofloxacin Concentrations in Aqueous Humor

Aims: We intravenously administered flomoxef sodium (FMOX) 120 minutes before cataract surgery, topically administered levofloxacin (LVFX) into the eyes four times at 30-minute intervals before surgery, and measured the aqueous humor concentrations of these agents to investigate their penetration into the aqueous humor and their efficacy in the prevention of postoperative endophthalmitis. Methods: Sixty-eight patients who underwent cataract surgery at the Department of Ophthalmology, Yokohama City University School of Medicine, or its affiliate, Kanazawa Hospital, Yokohama, were enrolled in this study. They received one or both of the following: 1.0 g FMOX via a 20-minute intravenous drip and LVFX ophthalmic solution applied four times at 30-minute intervals, both beginning two hours before the operation. Aqueous humor was aspirated from the anterior chamber and assayed for FMOX and LVFX concentrations using high-performance liquid chromatography (HPLC). Results: The mean intraoperative FMOX and LVFX concentrations in the patients' aqueous humor were 1.21 ± 0.63 μ g/ml and 0.69 ± 0.47 μ g/ml, respectively. These concentrations sufficiently exceeded the MIC90 values against Staphylococcus epidermidis, S. aureus, and Propionibacterium acnes. Conclusions: The FMOX and LVFX concentrations in the aqueous humor sampling were adequate to kill bacteria in vitro. These drugs may have efficacy in the prevention of postoperative endophthalmitis in patients undergoing cataract surgery.