Delayed-onset bleb-associated endophthalmitis: presentation and outcome by culture result
Delayed-onset bleb-associated endophthalmitis: presentation and outcome by culture result
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DOI：
10.2147/opth.s17975
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发表时间：
2011-01-01
影响因子：
2.2
通讯作者：
Gedde, Steven J.
中科院分区：
文献类型：
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作者：
Jacobs, David J.;Leng, Theodore;Gedde, Steven J.
目的：为了确定如何培养结果与迟发性滤过泡相关性眼内炎（BAE）的临床表现和结局相关，方法：回顾性连续病例系列的BAE在巴斯科姆帕尔默眼科研究所1996年1月1日至2009年12月31日。所有患者均既往接受过青光眼滤过手术。BAE定义为眼内感染伴玻璃体受累，接受玻璃体内抗生素治疗。视力（VA）的结果和其他临床数据进行了分组的文化结果和比较使用双侧Student's t-test.Main结果的措施：平均logMAR的变化，在3个月后的治疗（3个月logMAR Delta）。两只眼睛基本上被挖出来了。53只（63%）眼睛培养阳性，有以下微生物：链球菌，21只（25%）;凝固酶阴性葡萄球菌，9只（11%）;肠球菌，6只（7%）;革兰氏阴性菌，15只（18%）;莫拉氏菌，8只（10%）;假单胞菌，3只（4%）;沙雷氏菌，3只（4%）。显示logMAR VA：培养阳性病例比培养阴性病例差（2.45 vs 2.19，P = 0.05）。眼压：培养阳性组高于培养阴性组（24 mmHg vs 14 mmHg，P = 0.002）。眼底表现差：链球菌比凝固酶阴性葡萄球菌差（90%比44%，P = 0.006），假单胞菌和沙雷菌比莫拉菌差（100%比50%，P = 0.04）。3个月logMAR Delta：培养阳性病例比培养阴性病例差（1.03vs0.43，P = 0.02），链球菌比凝固酶阴性葡萄球菌更严重假单胞菌属和沙雷氏菌属的感染率分别为1.44和0.31，P = 0.004假单胞菌属和沙雷氏菌属的感染率高于莫拉氏菌属（2.41 vs 0.31，P = 0.001）。链球菌或沙雷氏菌的培养结果存在于6的7眼，接受了额外的治疗眼球摘除或眼内容摘除（P = 0.01）。结论：培养阳性的情况下，更差的VA，更高的眼压，更差的VA结果比培养阴性的情况下。链球菌属、假单胞菌属和沙雷氏菌属病例的眼底表现较差，VA结局比凝固酶阴性葡萄球菌属和莫拉氏菌属病例差。
Purpose: To determine how culture results are associated with clinical presentations and outcomes in delayed-onset bleb-associated endophthalmitis (BAE).Methods: Retrospective consecutive case series of BAE at Bascom Palmer Eye Institute between January 1, 1996 and December 31, 2009. All patients had prior glaucoma filtering surgery. BAE was defined as intraocular infection with vitreous involvement receiving treatment with intravitreal antibiotics. Visual acuity (VA) outcomes and other clinical data were grouped by culture result and compared using the 2-sided Student's t-test.Main outcome measure: Mean logMAR change at 3 months after treatment (3-month logMAR Delta).Results: Eighty-six eyes of 85 patients were identified. Two eyes were primarily eviscerated. Fifty-three (63%) eyes were culture-positive with the following organisms: Streptococcus, 21 (25%); coagulase-negative Staphylococcus, 9 (11%); Enterococcus, 6 (7%); Gram-negative, 15 (18%); Moraxella, 8 (10%); Pseudomonas, 3 (4%); and Serratia, 3 (4%). Presenting logMAR VA: culture-positive worse than culture-negative cases (2.45 vs 2.19, P = 0.05). Presenting intraocular pressure (IOP): culture-positive higher than culture-negative cases (24 mmHg vs 14 mmHg, P = 0.002). Poor presenting view of the fundus: Streptococcus worse than coagulase-negative Staphylococcus cases (90% vs 44%, P = 0.006), Pseudomonas and Serratia worse than Moraxella cases (100% vs 50%, P = 0.04). Three month logMAR Delta: culture-positive worse than culture-negative cases (1.03 vs 0.43, P = 0.02), Streptococcus worse than coagulase-negative Staphylococcus cases (1.44 vs 0.31, P = 0.004), Pseudomonas and Serratia worse than coagulase-negative Staphylococcus cases (2.41 vs 0.31, P = 0.001), Pseudomonas and Serratia worse than Moraxella cases (2.41 vs 0.04, P = 0.001). A culture result of Streptococcus or Serratia was present in 6 of 7 eyes that received an additional treatment of enucleation or evisceration (P = 0.01).Conclusion: Culture-positive cases were associated with worse presenting VA, higher presenting IOP, and worse VA outcomes than culture-negative cases. Streptococcus, Pseudomonas, and Serratia cases were associated with poor presenting view of the fundus and worse VA outcomes than coagulase-negative Staphylococcus and Moraxella cases.