Nine-Year Analysis of Isolated Pathogens and Antibiotic Susceptibilities of Infectious Endophthalmitis from a Large Referral Eye Center in Southern China
Nine-Year Analysis of Isolated Pathogens and Antibiotic Susceptibilities of Infectious Endophthalmitis from a Large Referral Eye Center in Southern China
复制标题
中国南方大型转诊眼科中心传染性眼内炎分离病原体和抗生素敏感性的九年分析
DOI：
10.2147/idr.s235954
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发表时间：
2020-01-01
影响因子：
3.9
通讯作者：
Lin, Xiaofeng
中科院分区：
文献类型：
--
作者：
Lin, Lixia;Duan, Fang;Lin, Xiaofeng
目的分析中国南方某大型眼科转诊中心9年来感染性眼内炎的病原菌谱及药敏趋势。方法回顾性收集2010年1月至2018年12月中山眼科中心所有临床诊断为感染性眼内炎并进行微生物学评价的住院患者的资料，根据不同的临床病因进行分析。结果共收集816例患者。外伤致眼内炎473例（57.97%），感染性角膜炎后眼内炎70例（8.58%），术后眼内炎156例（19.12%），内源性眼内炎117例（14.34%）。在309例培养阳性的病例中，术后和外伤后眼内炎的主要病原菌均为革兰阳性球菌（分别占59.52%和49.72%）。角膜炎相关性眼内炎的病原菌以丝状真菌（57.58%）和革兰阴性杆菌（30.30%）为主。内源性眼内炎的病原菌几乎均匀分布于革兰阳性球菌、革兰阴性杆菌和真菌中。85例（10.42%）患者接受了眼内容摘除术，其中42例继发于角膜炎相关眼内炎。角膜炎相关性眼内炎眼内容物剜出的发生率明显高于眼内炎总人群（χ2 =123.61，P<0.001）。细菌对氟喹诺酮类药物的敏感率为75.36-100.00%。革兰阳性球菌对头孢菌素的敏感性明显高于革兰阴性杆菌（85.11- 92.59%vs25.42 -35.72%）。对于敏感性时间趋势分析的五种一线抗生素，从2010-2014年到2015-2018年，四种抗生素的敏感性显著降低。结论2010 - 2018年中山市眼科中心收治的眼内炎中，外伤性眼内炎是最常见的类型。致病病原体根据不同的临床环境而变化。尽管总体抗生素敏感性相当高，但我们观察到大多数一线抗生素的敏感性大幅下降。
Purpose To analyze the pathogen spectrum of isolated pathogens and antibiotic susceptibility trends of infectious endophthalmitis over 9 years from a large referral eye center in southern China. Methods Data from all inpatients who were clinically diagnosed with infectious endophthalmitis and underwent microbiological evaluation at the Zhongshan Ophthalmic Center from January 2010 to December 2018 were collected retrospectively and analyzed according to different clinical etiologies. Results A total of 816 cases were collected in the study. Open-globe injuries had caused 473 (57.97%) cases, 70 (8.58%) cases presented endophthalmitis after infectious keratitis, 156 (19.12%) cases were postoperative, and endogenous causes accounted for 117 (14.34%) cases. Among the 309 culture-positive cases, the predominant pathogen for both postoperative and posttraumatic endophthalmitis was gram-positive cocci (59.52% and 49.72%, respectively). Regarding keratitis-related endophthalmitis, the main pathogens were filamentous fungi (57.58%) and gram-negative bacilli (30.30%). The pathogens of endogenous endophthalmitis were almost evenly distributed among gram-positive cocci, gram-negative bacilli, and fungi. Eighty-five (10.42%) cases underwent evisceration/enucleation, including 42 cases secondary to keratitis-related endophthalmitis. The incidence of evisceration/enucleation was much higher in keratitis-related endophthalmitis than the total endophthalmitis population (χ2 =123.61, P<0.001). Overall bacteria showed high susceptibility to fluoroquinolones (75.36–100.00%). Gram-positive cocci showed much higher sensitivity to cephalosporins compared to gram-negative bacilli (85.11–92.59% vs 25.42–35.72%). For the five first-line antibiotics analyzed for time trend of susceptibility, four exhibited a significant decrease of susceptibility from 2010–2014 to 2015–2018. Conclusion Between 2010 and 2018, posttraumatic endophthalmitis was the most common form of the treated endophthalmitis in Zhongshan Ophthalmic Center. The causative pathogens varied according to different clinical settings. Even though the overall antibiotic susceptibilities were fairly high, we observed a substantial decrease of susceptibility for most first-line antibiotics.