影响外源性眼内炎患者眼内液细菌培养阳性率的相关因素与药敏分析

目的 探究外源性感染性眼内炎患者眼内液中细菌培养阳性率的影响因素、病原菌构成及耐药情况，为外源性眼内炎提供有效的诊疗依据，指导临床合理用药。方法 回顾性收集并分析2011年5月至2021年5月在浙江省人民医院确诊、治疗且随访4～6个月的外源性感染性眼内炎患者的眼内液标本，共收集69眼的105例标本。记录性别、年龄、病程、发病季节、病因、入院视力、标本来源、手术次数、眼内异物状态、玻璃体内抗生素注射史、全身抗生素使用史、基础疾病等，并用二元logistic回归模型对细菌培养阳性率的相关影响因素进行分析。对获取的细菌培养及药敏试验结果进行统计分析。结果 培养阳性者眼内液标本种类、眼内异物状态、内眼手术后眼内炎、玻璃体内抗生素注射史、全身抗生素使用史的患者比例均高于培养阴性者(均为P<0.05)。二元logistic回归分析结果显示，玻璃体内标本(P<0.001)、眼内异物状态(P=0.020)、玻璃体内抗生素注射史(P=0.007)是眼内液细菌培养阳性的相关影响因素。36株外源性眼内炎致病菌中，革兰阳性菌占75.0%(27株),其中凝固酶阴性葡萄球菌占66.7%(18株)。未检...

Analysis of related factors and drug sensitivity affecting the positive rate of bacterial culture in intraocular fluid of exogenous endophthalmitis

Objective　To investigate the influencing factors of bacterial culture positive rate, pathogens composition and drug resistance in the intraocular fluid of exogenous endophthalmitis to provide an effective basis for diagnosis and treatment of exogenous endophthalmitis and guide clinical rational drug use. Methods　A total of 105 intraocular fluid samples from 69 eyes of patients who were diagnosed with exogenous endophthalmitis, treated, and followed up for 4-6 months in Zhejiang Provincial People’s Hospital from May 2011 to May 2021 were retrospectively enrolled and analyzed in this study. The influencing factors of the bacterial culture positive rate were recorded and analyzed by a binary logistic regression model, including gender, age, course of the disease, onset season, etiology, visual acuity on admission, sample source, surgery frequency, intraocular foreign body status, history of intravitreal injection of antibiotics, history of systemic antibiotic use, and basic diseases. Statistical analysis was made on the results of bacterial culture and drug sensitivity. Results　The intraocular fluid sample type, the intraocular foreign body status, endophthalmitis secondary to intraocular surgery, the history of intravitreal injection of antibiotics, and the history of systemic antibiotic use in positive culture were higher than those in negative culture (all P<0.05). The binary logistic regression results showed that intraocular fluid sample (P<0.001), intraocular foreign body status (P=0.020), and intravitreal injections of antibiotics (P=0.007) were influencing factors of positive bacterial culture in the intraocular fluid. Among the 36 pathogens of exogenous endophthalmitis, Gram-positive bacteria accounted for 75.0% (27 strains), in which, coagulase negative staphylococcus accounted for 66.7% (18 strains). Gram-positive bacteria resistant to vancomycin, dalfopristin, tigecycline and linezolid were not detected. Conclusion　Intraocular fluid sample, intraocular foreign body status, and intravitreal injections of antibiotics are the independent influencing factors of positive bacterial culture in the intraocular fluid. Coagulase negative staphylococcus is the main pathogen of exogenous endophthalmitis. Multiple pathogens should be considered in the clinical use of antibiotics.