Polymicrobial endophthalmitis: prevalence, causative organisms, and visual outcomes
Polymicrobial endophthalmitis: prevalence, causative organisms, and visual outcomes
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DOI：
10.1186/1869-5760-3-6
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发表时间：
2013-01-01
影响因子：
2.9
通讯作者：
Flynn, Harry W., Jr.
中科院分区：
文献类型：
--
作者：
Jindal, Animesh;Moreker, Mayur R.;Flynn, Harry W., Jr.
背景资料：本研究的目的是评估细菌培养证实的多菌性眼内炎患者的患病率、致病微生物和视力结果。本研究采用回顾性分析2000年至2010年诊断为多菌性眼内炎的患者的非比较性连续病例系列。结果：1107例患者中43例（3.88%）被确定为多菌性眼内炎。42名患者有2个分离株，1名患者生长了3个分离株，共产生87个分离株。革兰氏阳性球菌是最常见的分离株（n = 53; 60.9%），包括表皮葡萄球菌（n = 14/53; 16.1%）和肺炎链球菌（n = 13/53; 13.8%）。病因包括创伤后（n = 31/43; 72.1%）和术后（n = 9/43; 20.9%）眼内炎。革兰阳性菌对万古霉素和氯霉素的耐药率分别为100%和96%。革兰阴性菌对环丙沙星和氧氟沙星的敏感率分别为86.4%和81.2%。创伤性病例（38.7%）和革兰氏阴性菌和真菌合并感染病例（66.7%）的二次干预次数最多。视力（VA）< 20/200在创伤后病例中（n = 27/31; 87.1%）比术后病例（n = 4/9; 44.4%）更常见。在43名患者中，只有9名患者（20.9%）在最终随访时实现了VA >= 20/200。12例患者中有4例（33.3%）的VA >= 20/200，真菌是其中之一。结论：虽然眼内炎中的多种微生物感染并不常见，但它通常与视力不良有关，尤其是在开放性眼球损伤的眼中。革兰氏阴性菌或真菌的合并感染与最不利的视力结果相关。
Background: The purpose of the present study is to evaluate the prevalence, causative organisms, and visual acuity outcome in patients with culture-proven polymicrobial endophthalmitis. The method used in this study is the noncomparative, consecutive case series using a retrospective analysis of patients diagnosed with polymicrobial endophthalmitis for the period 2000 to 2010.Results: Polymicrobial endophthalmitis was identified in 43/1,107 (3.88%) patients. Forty-two patients had two isolates, and one patient had grown three isolates, yielding a total of 87 isolates. Gram-positive cocci were the most common isolate (n = 53; 60.9%) including Staphylococcus epidermidis (n = 14/53; 16.1%) and Streptococcus pneumoniae (n = 13/53; 13.8%). The etiologies included posttraumatic (n = 31/43; 72.1%) and postoperative (n = 9/43; 20.9%) endophthalmitis. Antibiotic susceptibilities among Gram-positive bacteria were vancomycin (100%) and chloramphenicol (96%). Susceptibilities among Gram-negative bacteria were ciprofloxacin (86.4%) and ofloxacin (81.2%). A maximum number of secondary interventions were done in traumatic cases (38.7%) and cases having coinfection with Gram-negative bacteria and fungus (66.7%). Visual acuity (VA) < 20/200 was more frequently observed in posttraumatic cases (n = 27/31; 87.1%) as compared with postoperative cases (n = 4/9; 44.4%). Of the 43 patients, only 9 patients (20.9%) achieved a VA >= 20/200 on final follow-up. Four out of twelve patients (33.3%), with fungus as one of the isolates, had a VA >= 20/200.Conclusions: Although polymicrobial infection in endophthalmitis is uncommon, it is generally associated with poor visual acuity outcomes especially in eyes with open-globe injuries. Coinfection with Gram-negative bacteria or fungi was associated with most unfavorable visual outcome.