论文部分内容阅读
目的:探讨眼内炎病原菌药物敏感性及临床用药选择情况,为临床合理用药提供依据。方法:对2012年1月至2016年12月北京同仁医院393例诊断为感染性眼内炎的病例资料进行回顾性分析。结果:393例眼内炎中外源性眼内炎占78.1%(307/393)、内源性眼内炎16.8%(66/393),其他5.1%(20/393),249例给予房水/玻璃体标本病原菌培养,培养阳性66例,阳性率26.5%,病原菌中革兰阳性球菌、革兰阴性杆菌、革兰阳性杆菌、厌氧菌和真菌分别占51.5%、28.7%、4.6%、4.6%和10.6%,其中革兰阳性球菌以表皮葡萄球菌为主(19.7%),革兰阴性杆菌以肺炎克雷伯菌为主(12.1%),革兰阳性球菌对万古霉素、利奈唑胺敏感率最高,均为100.0%,革兰阴性杆菌对亚胺培南、哌拉西林/三唑巴坦敏感率较高,分别为94.7%、89.5%。用药选择中全身用药前5位的分别为头孢曲松(34.1%)、左氧氟沙星(27.2%)、头孢呋辛(20.9%)、万古霉素(14.2%)和头孢克洛(10.9%),局部滴眼前3位分别为妥布霉素(77.3%)、左氧氟沙星(18.8%)和加替沙星(10.4%),局部注射前3位分别为妥布霉素(23.7%)、万古霉素(8.6%)和两性霉素B(2.5%),治疗后视力大于0.05占12.5%。结论:感染性眼内炎以外源性为主,其致病菌谱较广,应及早检测致病菌菌种及药物敏感性,对于病原菌不明确的细菌性眼内炎,提倡早期联合用药。
Objective: To investigate the drug susceptibility of endophthalmitis pathogens and the choice of clinical medication for clinical rational use of drugs provide the basis. Methods: The data of 393 cases diagnosed as endophthalmitis in Beijing Tongren Hospital from January 2012 to December 2016 were analyzed retrospectively. Results: 393 cases of endophthalmitis accounted for 78.1% (307/393) of exogenous endophthalmitis, endogenous endophthalmitis was 16.8% (66/393), the other 5.1% (20/393), 249 cases were given aqueous humor / Gram-positive specimens were cultured and cultured in 66 cases with the positive rate of 26.5%. Gram-positive cocci, gram-negative bacilli, gram-positive bacilli, anaerobic bacteria and fungi accounted for 51.5%, 28.7%, 4.6% % And 10.6%, respectively. Among them, Gram-positive cocci were mainly Staphylococcus epidermidis (19.7%), Klebsiella pneumoniae was the major gram-negative bacterium (12.1%), Gram- The highest sensitivity was 100.0%. The sensitivity of Gram-negative bacilli to imipenem and piperacillin / tazobactam was higher, 94.7% and 89.5% respectively. Medication in the top five drugs were ceftriaxone (34.1%), levofloxacin (27.2%), cefuroxime (20.9%), vancomycin (14.2%) and cefaclor (10.9% The top three instillation were tobramycin (77.3%), levofloxacin (18.8%) and gatifloxacin (10.4%) respectively. The top three injections were tobramycin (23.7%), vancomycin 8.6%) and amphotericin B (2.5%) after treatment, visual acuity greater than 0.05 accounted for 12.5%. CONCLUSION: Infectious endophthalmitis is mainly exogenous and its pathogenic spectrum is relatively broad. Pathogenic bacteria and drug susceptibility should be detected as early as possible. Early bacterial combination endophthalmitis should be recommended for early detection of bacterial endophthalmitis.