Evaluation of microbiological diagnostic techniques in postoperative endophthalmitis in the endophthalmitis vitrectomy study
Evaluation of microbiological diagnostic techniques in postoperative endophthalmitis in the endophthalmitis vitrectomy study
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DOI：
10.1001/archopht.1997.01100160312008
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发表时间：
1997-09-01
影响因子：
--
通讯作者：
Kelsey, SF
中科院分区：
文献类型：
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作者：
Barza, M;Pavan, PR;Kelsey, SF
目的：为了分析的文化和革兰氏染色的数据前瞻性收集的方案在眼内炎玻璃体切除术Study.Design：培养的水性，未稀释的玻璃体，和（谁接受玻璃体切除术的患者）玻璃体切除术盒流体从420例患者制备巧克力琼脂，巯基乙酸肉汤，和沙氏葡萄糖琼脂;革兰氏染色的水性和未稀释的玻璃体。标准的设计，以区分真正的病原体（确认阳性文化）从contamination.Setting：私人和大学为基础的视网膜玻璃体的做法和相应的微生物laborators.Results：与水相比，未稀释的玻璃体产生了更高的百分比确认阳性文化和巧克力琼脂上的菌落计数更高，更频繁地从眼睛的阳性文化的唯一来源。然而，分别有4.2%和8.9%的眼房水和玻璃体切除术盒液是眼内阳性培养物的唯一来源。巧克力琼脂和巯基乙酸盐肉汤的总产率相似。来自水性或未稀释玻璃体的阳性革兰氏染色高度预测来自眼睛的阳性培养物，但阴性革兰氏染色对培养结果几乎没有预测价值。实验室确认的感染的总体率在玻璃体切除术组没有统计学显着高于在水龙头或活检group.Conclusions：玻璃体是一个更丰富的来源，阳性培养物和高菌落计数比水，无论是因为它是更支持细菌的生长，或者是因为一个更大的接种物的玻璃体比水可以获得。革兰染色结果不应作为眼内炎治疗中抗生素药物选择的依据。玻璃体切除术，玻璃体切除术盒液体培养，并没有产生比水龙头或活检材料明显更多的阳性培养物，不应进行该手术以提高微生物产量。
Objective: To analyze the data for cultures and Gram stains prospectively collected by protocol in the Endophthalmitis Vitrectomy Study.Design: Cultures of aqueous, undiluted vitreous, and (for patients who underwent vitrectomy) vitrectomy cassette fluid obtained from 420 patients were prepared on chocolate agar, in thioglycolate broth, and on Sabouraud dextrose agar; Gram stains of the aqueous and undiluted vitreous were made. Criteria were devised to distinguish true pathogens (confirmed positive cultures) from contaminants.Setting: Private and university-based retina-vitreous practices and corresponding microbiology laboratories.Results: Compared with the aqueous, undiluted vitreous produced a higher percentage of confirmed positive cultures and higher colony counts on chocolate agar and was more frequently the only source of a positive culture from the eye. Nevertheless, the aqueous and vitrectomy cassette fluid were the only source of a positive culture from the eye in 4.2% and 8.9% of eyes, respectively. The overall yields of chocolate agar and thioglycolate broth were similar. A positive Gram stain from the aqueous or undiluted vitreous was highly predictive of a positive culture from the eye, but a negative Gram stain had little predictive value for the culture result. The overall rate of laboratory-confirmed infection was not statistically significantly higher in the vitrectomy group than in the tap or biopsy group.Conclusions: The vitreous was a richer source of positive cultures and high colony counts than was the aqueous, either because it is more supportive of bacterial growth or because a somewhat larger inoculum of the vitreous than of aqueous could be obtained. The result of Gram stain should nor determine the choice of antibiotic drugs in the treatment of endophthalmitis. Vitrectomy, with culture of the vitrectomy cassette fluid, did not produce significantly more positive cultures than tap or biopsy material, and the procedure should not be performed to improve the microbiological yield.