Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal.
Demography, Risk Factors, and Clinical and Microbiological Features of Microbial Keratitis at a Tertiary Eye Hospital in Nepal.
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DOI：
10.2147/opth.s266218
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Dhakhwa K
中科院分区：
文献类型：
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作者：
Bajracharya L;Bade AR;Gurung R;Dhakhwa K
感染性角膜炎是发展中国家最常见的角膜病理。它的控制和适当管理需要更新的知识。纳入了2013年10月至2015年3月18个月期间出现的所有疑似细菌性角膜炎病例。收集的数据包括人口统计资料、危险因素、临床特征、分离的微生物及其敏感性。共有602例细菌性角膜炎被纳入研究。598例患者平均年龄47.9岁，男性53.8%。64.1%从事农业工作。38.3%的患者有外伤史，其次是疱疹性眼病史（17.9%）和外用类固醇史（14.2%）。总共有473人被转诊，平均症状出现21.5天。14.9% （n=90）的病例在就诊时已经穿孔或即将穿孔。69.6%可见轴部浸润。516例（85.7%）接受了诊断性角膜培养。256个（49.6%）得到了肯定的结果。纯细菌111例（43.4%），纯真菌138例（53.9%），混合微生物7例（2.7%）。121株细菌中革兰氏阳性95.0%。最常见的分离细菌是肺炎链球菌（45.5%,n=55），其次是金黄色葡萄球菌（20.6%,n=25）。145株真菌分离株中，曲霉菌和镰刀菌数量相等（n=41，各28.3%）。研究中分离的革兰氏阳性菌中有85%以上对万古霉素、头孢唑林、莫西沙星和加替沙星敏感。超过80%的革兰氏阴性菌对庆大霉素、妥布霉素和阿米卡星敏感。在农民中发生的微生物角膜炎和相关危险因素表明缺乏认识和预防方案。在获得三级保健方面的延误导致了复杂的病例。对当地卫生工作者进行预防培训，更新角膜炎治疗指南，及时转诊到更高一级的中心，对于降低微生物角膜炎的发病率都很重要。
Infective keratitis is the most common corneal pathology in developing countries. Updated knowledge is needed for its control and proper management. All cases of presumed microbial keratitis that presented in an 18-month period from October 2013 to March 2015 were enrolled. Data collected were demographic profile, risk factors, clinical features, and organisms isolated and their sensitivities. A total of 602 cases of microbial keratitis were enrolled. Mean age of subjects (598 patients) was 47.9 years with 53.8% male. 64.1% worked in agriculture. 38.3% gave history of trauma followed by history of herpetic eye diseases (17.9%) and topical steroid use (14.2%). A total of 473 who were referred came at an average of 21.5 days of symptoms. 14.9% (n=90) of cases were either perforated or impending to perforate at presentation. 69.6% had infiltrate in the visual axis. A total of 516 (85.7%) underwent diagnostic corneal culture. A total of 256 (49.6%) yielded a positive result. Pure bacterial growth was seen in 111 (43.4%), pure fungal growth in 138 (53.9%), and mixed microbial growth was present in 7 (2.7%) cases. Out of 121 bacterial isolates, 95.0% were Gram positive. Streptococcus pneumoniae (45.5%, n=55) was the most common bacterial isolate followed by Staphylococcus aureus (20.6%, n=25). Out of 145 fungal isolates, Aspergillus and Fusarium species were found in equal numbers (n=41, 28.3% each). Over 85% of Gram-positive organisms isolated in the study were sensitive to vancomycin, cefazolin, moxifloxacin, and gatifloxacin. Over 80% of Gram-negative organisms were sensitive to gentamicin, tobramycin, and amikacin. Microbial keratitis and associated risk factors occurring in farmers implies a lack of awareness and prevention programs. Delay in reaching tertiary care is resulting in complicated cases. Training of local health workers for prophylaxis, updated guidelines for treating keratitis, and timely referral to higher centers are all important in a chain to decrease the incidence of microbial keratitis.