Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study.
Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study.
复制标题
DOI：
10.1016/s0002-9394(14)71959-2
复制
发表时间：
1996-07
影响因子：
4.2
通讯作者：
Dennis P. Han;S. Wisniewski;L. Wilson;M. Barza;A. K. Vine;B. Doft;S. Kelsey
中科院分区：
文献类型：
--
作者：
Dennis P. Han;S. Wisniewski;L. Wilson;M. Barza;A. K. Vine;B. Doft;S. Kelsey
目的了解眼内炎术后感染细菌的菌谱及药敏情况，探讨手术因素对细菌菌谱的影响。方法对白内障摘除或人工晶状体植入术后6周内出现细菌性眼内炎的患者进行分析。结果在420例患者中，291例(69.3%)眼内标本证实有微生物生长。革兰氏阳性菌274例(94.2%)，革兰阴性菌19例(6.5%)。革兰阳性凝固酶阴性微球菌226株(70.0%)，金黄色葡萄球菌32株(9.9%)，链球菌29株(9.0%)，肠球菌7株(2.2%)，其他革兰氏阳性菌10株(3.1%)，革兰阴性杆菌19株(5.9%)。所有测试的革兰氏阳性菌株对万古霉素敏感。17株革兰阴性菌(89%)同时对阿米卡星和头孢他啶敏感，2株(11%)同时对两者耐药。与后房型人工晶状体植入术(P=0.022)或一期白内障摘除术后(P=0.024)相比，前房或二期人工晶状体植入术与革兰氏阳性菌感染相关(P=0.022)，与凝固酶阴性微球菌感染相关(P=0.024)。万古霉素对所有革兰氏阳性菌株均有效。阿米卡星和头孢他啶对革兰氏阴性杆菌具有相同的抗菌活性。二期或前房人工晶状体植入可能导致光谱向革兰氏阳性细菌转移，而不是凝固酶阴性微球菌。
PurposeTo determine the microbiologie spectrum and antibiotic susceptibilities of infecting organisms in postoperative endophthalmitis and to evaluate the effects of operative factors on the microbiologie spectrum.MethodPatients with bacterial endophthalmitis presenting within six weeks of cataract extraction or secondary intraocular lens implantation (IOL) were evaluated. Cultures and Gram stains were performed on intraocular specimens and susceptibility tests on the isolates.ResultsConfirmed microbiologie growth was demonstrated from intraocular specimens from 291 of 420 patients (69.3%). Gram-positive bacteria were isolated from 274 patients (94.2%) with confirmed growth and gram-negative bacteria from 19 (6.5%). Two hundred twenty-six of the 323 isolates obtained (70.0%) were gram-positive, coagulase-negative micrococci, 32 (9.9%) Stapfiylococcus aureus, 29 (9.0%) Streptococcus species, seven (2.2%) Enterococcus species, ten (3.1%) miscellaneous gram-positive species, and 19 (5.9%) gram-negative species. All gram-positive isolates tested were susceptible to vancomycin. Seventeen gram-negative isolates (89%) were susceptible to both amikacin and ceftazidime and two (11%) were resistant to both. Anterior chamber or secondary IOL implantations were associated with higher rates of infection with gram-positives other than coagulase-negative micrococci than were posterior chamber IOL implantations (P = .022) or primary cataract extractions (P = .024).ConclusionGram-positive, coagulasenegative micrococci predominated in this series. Vancomycin was active against all gram-positive isolates tested. Amikacin and ceftazidime showed equivalent activity against gram-negative isolates. Secondary or anterior chamber lens implantations were associated with a possible spectrum shift toward gram-positive organisms other than the coagulase-negative micrococci.