泪小管炎主要临床特征及致病菌分析

目的：探讨泪小管炎的主要临床特征、致病菌分布及其药物敏感性特征，为临床诊治提供依据。

方法： 回顾性研究。选择2016-12/2020-10于河北省眼科医院确诊为泪小管炎的患者45例45眼，分析患者的一般资料、临床表现及治疗史、细菌培养及药物敏感性试验结果。

结果：纳入的45例患者均单眼发病，其中21眼表现为流泪、分泌物增多、内眦部结膜充血，14眼表现为内眦部红肿，6眼表现为类似眼睑囊肿，行常规术前检查时发现并诊断4眼。既往被诊断为其他眼部疾病27眼，误诊率为60.0%。细菌培养阳性率为80.0%(36/45)，以表皮葡萄球菌最为常见，其次为链球菌属； 多重耐药菌感染患者占52.8%(19/36)。细菌对氟喹诺酮类抗生素敏感率(82.9%，97/117)高于氨基糖苷类(70.1%，68/97)和头孢菌素类(68.1%，111/163)抗生素； 除万古霉素以外，利福平、左氧氟沙星、氯霉素对革兰氏阳性菌的敏感性较高。

结论：表皮葡萄球菌是泪小管炎最常见致病菌、其次为链球菌属； 左氧氟沙星、利福平可作为局部抗感染的首选抗生素，合理用药可减少多重耐药菌形成； 行泪小管切开成形术彻底清除结石，可提高治愈率。

Analysis of main clinical features and pathogenic bacteria of lacrimal tracheitis

AIM:To investigate the main clinical features, pathogen distribution and drug sensitivity of lacrimal angiitis, and to provide evidence for clinical diagnosis and treatment.

METHODS:Retrospective study. A total of 45 patients(45 eyes)diagnosed with lacrimal angiitis in Hebei Eye Hospital from December 2016 to October 2020 were selected to analyze the general information, clinical manifestations and previous treatment history, bacterial culture results, and drug sensitivity test results.

RESULTS:All 45 patients had monocular disease, including 21 eyes with tears, increased secretion, conjunctival congestion in inner canthus, 14 eyes with red and swollen inner canthus, 6 eyes similar to eyelid cyst, and 4 eyes were found and diagnosed during routine preoperative examination. 27 eyes were previously diagnosed with other eye diseases, and the misdiagnosis rate was 60.0%. The positive rate of bacterial culture was 80.0%(36/45), Staphylococcus epidermidis was the most common, followed by Streptococcus; 52.8%(19/36)of the patients were infected with multidrug-resistant bacteria. The sensitivity rate of bacteria to fluoroquinolones(82.9%, 97/117)was higher than that of aminoglycosides(70.1%, 68/97)and cephalosporins(68.1%, 111/163). Except vancomycin, rifampicin, levofloxacin and chloramphenicol were highly sensitive to Gram-positive bacteria.

CONCLUSION: Staphylococcus epidermidis is the most common pathogen of dacryocystitis, followed by Streptococcus. Levofloxacin and rifampicin can be the first choice antibiotics for local anti-infection. Rational drug use can reduce the formation of multidrug-resistant bacteria. The cure rate can be improved by complete removal of stones by incision and plasty of lacrimal canaliculus.