Laboratory Results, Epidemiologic Features, and Outcome Analyses of Microbial Keratitis: A 15-Year Review From St. Louis.
Laboratory Results, Epidemiologic Features, and Outcome Analyses of Microbial Keratitis: A 15-Year Review From St. Louis.
复制标题
DOI：
10.1016/j.ajo.2018.09.032
复制
发表时间：
2019-03
影响因子：
4.2
通讯作者：
Edelstein SL
中科院分区：
文献类型：
--
作者：
Hsu HY;Ernst B;Schmidt EJ;Parihar R;Horwood C;Edelstein SL
评估圣路易斯大学15年以上细菌性角膜炎患者的实验室结果和不良临床结局的预后因素。回顾队列和趋势研究。回顾了1999-2013年圣路易斯大学培养阳性病例的微生物学和临床信息。统计分析用于确定微生物和抗生素敏感性趋势。临床预后不良的预后因素从文献中被用来建立多元回归模型来描述我们的队列。革兰氏阳性菌占主导地位(48%)，其次是革兰氏阴性菌(34%)和真菌(16%)。最常见的分离菌为铜绿假单胞菌(21%)。对苯唑西林耐药率金黄色葡萄球菌为45%，凝固酶阴性葡萄球菌为43%。只有假单胞菌的比例随着时间的推移发生了显著变化(p=0.02)。随着时间的推移，唯一发现无效的抗生素是庆大霉素(p=0.005)，用于革兰氏阳性菌。多因素Logistic回归分析显示，主要并发症与大型溃疡(P<；0.006)、真菌病例(P<；0.001)和合并眼部疾病(P<；0.001)有关。愈合不良与大型溃疡(P<；0.001)和真菌病例(P<；0.001)有关。最后，视力不良与大面积溃疡(P<；0.01)和年龄&60岁(P<；0.02)有关。在圣路易斯地区，耐苯唑西林细菌、铜绿假单胞菌和真菌通常从微生物角膜炎病例中恢复，发病率高得不成比例。因此，经验性的抗生素选择应该反映这些趋势。需要对大面积溃疡和真菌感染的患者以及合并眼部疾病的老年患者采取特别护理，因为这些患者的临床结果较差。
To evaluate the laboratory results and prognostic factors of poor clinical outcomes in microbial keratitis cases over 15 years at Saint Louis University. Retrospective cohort and trend study. Microbiological and clinical information from culture-positive cases seen at Saint Louis University from 1999–2013 were reviewed retrospectively. Statistical analyses were used to determine microbiological and antibiotic susceptibility trends. Prognostic factors of poor clinical outcome from the literature were used to create multivariate regression models to describe our cohort. Gram-positive organisms predominated (48%), followed by Gram-negative organisms (34%) and fungi (16%). The most commonly isolated organism was Pseudomonas aeruginosa (21%). Oxacillin-resistant rates of Staphylococcus aureus and Coagulase-negative Staphylococci were 45% and 43%, respectively. Only the proportion of Pseudomonas changed significantly over time (p=0.02). The only antibiotic found to lose efficacy over time was gentamicin for Gram-positive organisms (p=0.005). Multivariate logistic regression analyses revealed that major complications were associated with large ulcers (p<0.006), fungal cases (p<0.001), and co-morbid ophthalmic conditions (p<0.001). Poor healing was associated with large ulcers (p<0.001) and fungal cases (p<0.001). Lastly, poor visual outcome was associated with large ulcers (p<0.01) and age > 60 years (p<0.02). In the Saint Louis area, oxacillin-resistant organisms, Pseudomonas aeruginosa, and fungi are commonly recovered from microbial keratitis cases with a disproportionally high incidence. Hence, empiric antibiotic choice should reflect these trends. Special care needs to be taken for patients with large ulcers and fungal infections as well as elderly patients with co- morbid ophthalmic conditions, as these patients have worse clinical outcomes.
登录
查看更多内容
影响因子：
4.2
作者：
MCDONNELL, PJ;NOBE, J;TROUSDALE, M
通讯作者：
TROUSDALE, M
影响因子：
2.8
作者：
Hernandez-Camarena, Julio C.;Graue-Hernandez, Enrique O.;Bautista-de Lucio, Victor M.
通讯作者：
Bautista-de Lucio, Victor M.
DOI：
10.1097/icl.0000000000000334
发表时间：
2018-09-01
影响因子：
2.3
作者：
Truong, David T.;Minh-Thuy Bui;Cavanagh, H. Dwight
通讯作者：
Cavanagh, H. Dwight
影响因子：
4.1
作者：
Morlet, N;Minassian, D;Butcher, J
通讯作者：
Butcher, J
DOI：
10.1097/icl.0b013e3181e3ef45
发表时间：
2010-07-01
影响因子：
2.3
作者：
Hsu, Hugo Y.;Nacke, Randall;Israel, Heidi A.
通讯作者：
Israel, Heidi A.