白内障超声乳化患者结膜囊细菌学特征和药物敏感性分析

目的比较白内障手术患者结膜囊中分离的细菌菌群对不同抗生素的耐药性,分析结膜囊细菌菌群的耐药趋势,从而指导眼部抗生素药物的合理使用。方法选取2018年2月至2019年2月行白内障超声乳化吸出及人工晶状体植入术的老年性白内障患者共1444眼为研究对象,使用无菌棉签收集下结膜穹隆标本,送实验室行细菌培养及药物敏感性试验。结果结膜囊细菌培养阳性率为24.58%,其中最常见的是表皮葡萄球菌(69.86%),其次是金黄色葡萄球菌(12.39%),革兰阴性菌仅占3.94%;细菌培养阳性率与年龄、糖尿病相关,而与性别、季节、高血压无关;耐药性方面,表皮葡萄球菌和金黄色葡萄球菌对青霉素、复方新诺明的耐药率高(>90.00%),对左氧氟沙星(>30.00%)以及红霉素和阿奇霉素(>70.00%)等耐药率稍高,而对苯唑西林、万古霉素、莫西沙星等较敏感。革兰阴性菌对复方新诺明(90.01%)、氨苄西林(80.00%)耐药率高,而对头孢哌酮、替卡西林、美罗培南、亚胺培南、阿米卡星、环丙沙星耐药率低,本次未检测出耐药菌株。结论白内障患者结膜囊细菌培养阳性率与年龄、糖尿病相关,表皮葡萄球菌和金黄色葡萄球菌是最常见的细菌,其对苯唑西林、万古霉素、莫西沙星耐药率较低,可用于指导术前合理用药。

Analysis on bacteriological characteristics of conjunctival sac and drug susceptibility in patients undergoing phacoemulsification

Objective To compare the antibiotic resistance of bacteria isolated from conjunctival sac of patients undergoing cataract surgery,so as to analyze the trend of antibiotic resistance and guide the rational use of eye antibiotics.Methods Totally 1444 eyes of senile cataract patients who received phacoemulsification with intraocular lens implantation in hospital from February 2018 to February 2019 were collected.Inferior conjunctival formix samples were collected by sterile swabs,and sent for bacterial culture and drug susceptibility test.Results The positive rate of bacterial culture in conjunctival sac was 24.58%,the most common organisms identified were staphylococcus epidermidis(69.86%),followed by staphylococcus aureus(12.39%),and gram-negative bacteria was account for 3.94%.The positive rate of bacterial culture was related to age and diabetes,and was not related to gender,season and hypertension.For drug resistance,staphylococcus epidermidis and staphylococcus aureus showed a higher resistance rate to penicillin and compound neomycin(>90.00%),slightly higher drug resistance to levofloxacin(>30.00%)、erythromycin and azithromycin(>70.00%),and highly susceptible to oxacillin,rifampicin,vancomycin and moxifloxacin.The gram-negative bacillus showed a high resistance rate to compound neomycin(90.01%)and ampicillin(80.00%),low resistance rate to cefoperazone,ticacillin,meropenem,imipenem,amikacin and ciprofloxacin,and there was no drug-resistant strain.Conclusion The positive rate of bacterial culture in conjunctival sac of cataract patients is related to age and diabetes.Staphylococcus epidermidis and staphylococcus aureus?are the most common bacterial isolates,and sensitive to benzacillin,vancomycin,tigecycline and moxifloxacin,therefore may be used to guide the rational use of prophylactic agents before operation.