Management of bacterial keratitis: beyond exorcism towards consideration of organism and host factors
Management of bacterial keratitis: beyond exorcism towards consideration of organism and host factors
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DOI：
10.1038/sj.eye.6700635
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发表时间：
2003-11-01
期刊：
影响因子：
3.9
通讯作者：
O'Brien, TP
中科院分区：
文献类型：
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作者：
O'Brien, TP
微生物性角膜炎是一种常见的、可能威胁视力的眼部感染，可能由细菌、真菌、病毒或寄生虫引起。1眼科医生面临的挑战是在临床上区分微生物性角膜炎与其他非感染性角膜炎性疾病，这些疾病是由创伤、超敏反应和其他免疫介导的反应引起的。另一个挑战是临床上怀疑是细菌性角膜炎而不是其他潜在的感染性原因。没有绝对特异的临床体征可以证实感染或提示明确的细菌性原因，但临床医生应根据上皮状态评估和定义独特的角膜体征在一个实施方案中，所述方法包括确定基质炎症的类型（完整或溃疡）、基质炎症的类型（化脓性或非化脓性）和基质炎症的部位（局灶性、弥漫性、多灶性或边缘性）。当临床检查有足够证据怀疑可能存在感染性病原体时，需要进行实验室研究以确定具体的致病微生物。根据临床环境和风险因素、临床检查特征、实验室调查结果以及对潜在角膜病原体的了解，启动治疗计划。2随后根据临床反应、体外药敏测定结果和抗菌药物耐受性修改治疗计划。3与
Microbial keratitis is a common, potentially sight threatening ocular infection that may be caused by bacteria, fungi, viruses, or parasites. 1 The challenge for the ophthalmologist is to distinguish clinically microbial keratitis from other noninfectious inflammatory conditions of the cornea resulting from trauma, hypersensitivity, and other immune-mediated reactions. A further challenge is to develop a clinical suspicion for a bacterial keratitis as opposed to the other potential infectious causes.There are no absolutely specific clinical signs that confirm infection or suggest definite bacterial cause, yet the clinician should assess and define the distinctive corneal signs based on the status of the epithelium (intact or ulcerated), type of stromal inflammation (suppurative or nonsuppurative), and the site of the stromal inflammation (focal, diffuse, multifocal, or marginal). When there is sufficient evidence based on clinical examination to raise the suspicion for a possible infectious etiology, laboratory studies are required to establish the specific causative organism. Based on the clinical setting and risk factors, features of clinical examination, results from laboratory investigation, and knowledge of the potential corneal pathogens, a therapeutic plan is initiated. 2 Modification of the therapeutic plan is subsequently based on clinical response, results of in vitro susceptibility determination, and tolerance of the antimicrobial agents. 3 With