Microbial keratitis pathogens and antibiotic susceptibilities: a 5-year review of cases at an urban county hospital in north Texas.
Microbial keratitis pathogens and antibiotic susceptibilities: a 5-year review of cases at an urban county hospital in north Texas.
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DOI：
10.1097/01.icl.0000234002.88643.d0
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发表时间：
2007-01-01
期刊：
影响因子：
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通讯作者：
Cavanagh, H Dwight
中科院分区：
文献类型：
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作者：
Pachigolla, Gowri;Blomquist, Preston;Cavanagh, H Dwight
目的：回顾微生物性角膜炎的流行病学、危险因素、微生物谱和结果，并将德克萨斯州北部一家大型县医院在 5 年内确定致病微生物的病例与确定为无菌的病例进行比较。方法：对 2000 年 1 月至 2004 年 12 月期间帕克兰纪念医院的微生物性角膜炎病例进行回顾性图表审查。结果：在这 5 年期间在此期间，131 名患者的 132 只眼睛因推测的微生物性角膜炎而接受了 139 次角膜刮片检查，并在 73 次（52.5%）培养物中报告了微生物。包括异常的共焦显微镜结果在内，在 78 例（56.1%）病例中确定了致病微生物。 115 例 (87.1%) 病例中至少存在一种危险因素，最常见的危险因素是既往存在的眼部疾病、佩戴隐形眼镜和外伤史。近 5% 的患者报告有可卡因使用史。革兰氏染色正确鉴定了 20 例（28.6%）培养阳性病例中的微生物，铜绿假单胞菌是最常见的分离株，其次是金黄色葡萄球菌。金黄色葡萄球菌对氟喹诺酮类药物的耐药率 (15.4%) 与 20 世纪 90 年代初至中期报道的耐药率相似，但低于 90 年代末报道的耐药率。严重并发症在非无菌亚组（34.2%）中比无菌亚组（16.9%）更常见（P=0.041）。尽管非无菌亚组的急性干预率（27.4%）高于无菌亚组（20.3%），但差异无统计学意义（P=0.461）。就诊时平均 logMAR 视力为 1.451（Snellen 等效视力，20/563），最后一次随访时为 1.062（20/231）（P
PURPOSE: To review the epidemiology, risk factors, microbiologic spectrum, and outcomes of microbial keratitis and to compare cases in which a causative organism is identified to those determined to be sterile during a 5-year period at a large county hospital in north Texas.METHODS: A retrospective chart review of cases of microbial keratitis at Parkland Memorial Hospital between January 2000 and December 2004.RESULTS: During this 5-year period, 132 eyes of 131 patients underwent 139 corneal scrapings for presumed microbial keratitis and an organism was reported in 73 (52.5%) cultures. Including abnormal confocal microscopy results, a causative organism was determined in 78 (56.1%) cases. At least one risk factor was present in 115 (87.1%) cases, with the most common risk factors being preexisting ocular disease, contact lens wear, and a history of trauma. Nearly 5% of patients reported a history of cocaine use. Gram staining correctly identified the organism in 20 (28.6%) culture-positive cases, and Pseudomonas aeruginosa was the most common isolate, followed by Staphylococcus aureus. The rate of S. aureus resistance to fluoroquinolones (15.4%) was similar to rates previously reported from the early to mid 1990s, but less than those reported from the late 1990s. Severe complications were more common in the nonsterile subgroup (34.2%) than in the sterile (16.9%) subgroup (P=0.041). Although the rate of acute intervention was higher in the nonsterile subgroup (27.4%) than in the sterile subgroup (20.3%), this difference was not statistically significant (P=0.461). Mean logMAR visual acuity was 1.451 (Snellen equivalent, 20/563) at presentation and 1.062 (20/231) at the last follow-up visit (P