感染性角膜炎病原菌分布特征及耐药性分析

摘要

Objective To analyze the distribution and shifting trends of pathogens causing bacterial or fungal keratitis and their resistance to commonly used antibiotics in Zhongshan ophthalmic center.Methods Two thousend and forty-six specimens from patients with infective keratitis from January 2004 to December 2010 were collected.Bacterial and fungal culture-positive rate,the genus distribution of isolates and resistance regularity to antibiotics were analyzed retrospectively.Results Out of 2046 specimens,1022 were positive cultures,showing a positive rate of 49.9％.Of those individuals with positive cultures,463 had pure bacterial infection ( including 11 specimens with two bacterial growth),500 had pure fungal infection and 59 had mixed growth.The predominant bacterial pathogens isolated were Gram-positive cocci ( 336 of 533,63.0％ ) and Gram-negative bacilli ( 163 of 533,30.6％ ),in which Staphylococcus epi(257 of 533,48.2％ )was the most common pathogen,followed by Pseudomonas aeruginosa(84 of 533,15.76％ ).The predominant fungal pathogens isolated was Fusarium.Spp.( 180 of 559,32.2％ ),followed by Aspergillus Spp.(139 of 559,24.9％ )and Helminthosporium( 110 of 559,19.7％ ).The distribution of pathogens causing bacterial keratitis had no significant change.However,there has been an increase in Helminthosporium and a decrease in Aspergillus Spp.Overall,aminoglycosides showed better sensitivity to Staphylococcus epi,and fluoroquinolones had a better sensitivity to Pseudomonas aeruginosa.Conclusions In the area of Guangdong,the most common pathogens of bacterial keratitis was Staphylococcus epi,which showing highest sensitivity to neomycin,and Fusarium Spp are the predominant pathogens of fungal keratitis.The increased recovery of Helminthosporium and decreased recovery of Aspergillus Spp.from keratitis isolates presents an important challenge to the ophthalmology.%目的 了解我中心感染性角膜炎细菌及真菌分布、变迁及耐药情况,为临床合理治疗提供依据.方法 收集中山眼科中心2004年至2010年2046例角膜感染患者微生物实验室检查资料,对细菌和真菌培养的阳性率、菌属的分布及耐药性进行回顾性分析.结果 2046份标本中,培养阳性的标本1022份,阳性率为49.9％,其中只有细菌的标本463份(包括11份培养出2种细菌的标本),只有真菌的标本500份,同时有细菌及真菌的标本59份.细菌以革兰阳性球菌为主,336株(占63.0％),其次为革兰阴性杆菌,163株(占30.6％),其中表皮葡萄球菌最多,257株(占48.2％),其次为铜绿假单胞菌,84株(占15.8％)；真菌以镰刀菌属最多,180株(占32.2％),其次为曲霉菌属和蠕孢菌属,分别为139株(占24.9％)和110株(占19.7％).细菌分布近7年变化不明显,真菌中蠕孢菌属近7年有明显上升趋势,而曲霉菌属总体呈下降趋势.主要致病细菌表皮葡萄球菌对氨基糖苷类抗菌药的敏感性相对较好,而铜绿假单胞菌则对喹诺酮类相对较敏感.结论 广东地区角膜感染主要致病细菌为表皮葡萄球菌,对新霉素较敏感,主要致病真菌为镰刀菌属,蠕孢菌属检出的升高及曲霉菌属的下降趋势应引起临床的关注.