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。

Analysis of bacterial culture in normal and cataract conjunctival sacs with contrasting study on antibiotic use

Objective To analyze the results of bacterial culture and drug susceptibility tests in normal conjunctival sacs,and compare the drug effects of common local antibiotics,which applies references to clinic medication. Methods Samples of conjunctival sacs in 207 mormal eyes and 200 cataract eyes were collected for bacterial culture.All the cataract patients were devided into four groups,respectively treating with Lincomycin,Tobramicin,Ofloxacin and Levofloxacin eye drops.All samples were cultured for bacteria before and after surgery,and drug susceptibility tests were carried out on the positive specimens. Results The positive rate of bacterial culture in conjunctival sacs was 31.45%(128/407 subjects),which was highest among the subjects above 70 years old.Among the positive cases,80.47% were Gram-positive cocci(G C),while 16.40% were Gram-negative bacilli(G-B).The bacterial clearance rates of four kinds of antibiotic eye drops,respectively,were 70.59%,89.47%,94.74% and 100%.Of all the cataract patients with antibiotic eye drops medication,the positive rate of bacterial culture was 4% before surgery and 6% one day after surgery. Conclusion Different kinds of bacteria can exist in the normal conjunctival sacs.With the increased age,the germ-carrying rate was elevated.Staphylococcus epidermidis was most common,follwed by Acinetobacter lwoffii and Staphylococcus aureus.At present,four common antibiotic eye drops varied in the effects of sterilizing bacteria,which indicated that the use of antibiotics should be enhanced before and after cataract surgery to avoid endophthalmitis.