Risk factors and causative organisms in microbial keratitis
Risk factors and causative organisms in microbial keratitis
复制标题
DOI：
10.1097/ico.0b013e318156caf2
复制
发表时间：
2008-01-01
期刊：
影响因子：
2.8
通讯作者：
Stapleton, Fiona
中科院分区：
文献类型：
--
作者：
Green, Matthew;Apel, Andrew;Stapleton, Fiona
目的：建立的风险因素，致病微生物，抗生素耐药性，患者的人口统计学，临床表现，和临床结果的微生物角膜炎在三级医院在Australia.Methods：患者角膜刮培养超过5年的时间内确定通过当地的微生物学数据库，并进行了回顾性审计他们的医疗记录。临床信息从医疗记录中收集，涂片、培养和抗生素耐药性结果来自微生物学数据库。根据上皮缺损和前房反应的程度以及病变的位置计算每个患者的疾病严重程度指数。角膜炎的危险因素和变量，如患者的人口统计学，病原体和抗生素耐药性，疾病的严重程度，和结果之间的关联进行了分析，通过方差分析和卡方检验，适当的校正多重comparing.Results：231例253例微生物性角膜炎。60%的患者为男性，并且在表现年龄上呈双峰分布。角膜炎的常见风险因素为接触透镜配戴（53例; 22%）、眼表疾病（45例; 18%）、眼外伤（41例; 16%）和既往眼部手术（28例; 11%）。革兰染色阳性率为33%，敏感性为53%，特异性为89%。65%的病例角膜刮片培养为阳性，铜绿假单胞菌（44; 17%）、凝固酶阴性葡萄球菌（22; 9%）、金黄色葡萄球菌（19; 8%）和真菌（7; 3%）通常被回收。在隐形眼镜相关病例中，铜绿假单胞菌比其他培养结果更常见（55%比0%-23%; P < 0.001），而S.在眼科手术相关病例中，金黄色葡萄球菌比其他培养结果更常见（29%比0%-21%; P < 0.001）。与先前眼表疾病相关的角膜炎患者在刮擦时角膜炎更严重（P = 0.037）。镰刀菌、铜绿假单胞菌和其他革兰氏阴性菌培养阳性患者在刮擦时角膜炎的严重程度在统计学上显著更高，而培养阴性患者的角膜炎较轻（P = 0.030）。只有2%的所有细菌菌株耐环丙沙星，20%的革兰氏阳性菌耐头孢菌素，没有革兰氏阴性菌耐庆大霉素。结论：在这一系列，角膜炎最常见的危险因素是接触透镜磨损和最常见的分离的有机体是铜绿假单胞菌。
Purpose: To establish the risk factors, causative organisms, levels of antibiotic resistance, patient demographics, clinical presentations, and clinical outcomes of microbial keratitis at a tertiary hospital in Australia.Methods: Patients who had a corneal scraping for culture over a 5-year period were identified through the local microbiology database, and a retrospective audit of their medical records was carried out. Clinical information was gathered from medical records, and smear, culture, and antibiotic resistance results were from the microbiology database. An index of disease severity was calculated for each patient from scores for the magnitude of the epithelial defect and anterior-chamber reaction and the location of the lesion. Associations between risk factors for keratitis and variables such as patient demographics, causative organism and antibiotic resistance, disease severity, and outcome were analyzed by using analysis of variance and chi(2) tests with appropriate correction for multiple comparisons.Results: Two hundred fifty-three cases of microbial keratitis in 231 patients were included. Sixty percent of patients were men, and there was a bimodal distribution in the age of presentation. Common risk factors for keratitis were contact lens wear (53; 22%), ocular surface disease (45; 18%), ocular trauma (4 1; 16%), and prior ocular surgery (28; 11%). Gram stains were positive in 33%, with a sensitivity of 53% and specificity of 89%. Cultures of corneal scrapings were positive in 65% of cases, and Pseudomonas aeruginosa (44; 17%), coagulase-negative staphylococci (22; 9%), Staphylococcus aureus (19; 8%), and fungi (7; 3%) were commonly recovered. P aeruginosa was more common than other culture results in contact lens-related cases (55% vs. 0%-23%; P < 0.001), and S. aureus was more common than other culture results in ocular surgery-related cases (29%vs. 0%-21%; P < 0.001). Patients with keratitis related to prior ocular surface disease had more severe keratitis at the time of scraping (P = 0.037). Cultures positive for Fusarium, P aeruginosa, and other Gram-negative organisms had statistically significantly more severe keratitis at the time of scraping, whereas patients with negative cultures had milder keratitis (P = 0.030). Only 2% of all bacterial isolates were resistant to ciprofloxacin, 20% of Grampositive isolates were resistant to cephalothin, and no Gram-negative isolates were resistant to gentamicin.Conclusions: In this series, the most common risk factor for keratitis was contact lens wear and the most commonly isolated organism was P aeruginosa.