摘要
目的分析儿童感染性角膜炎的病原学特征。方法回顾性研究。纳入2007至2016年在首都医科大学附属北京同仁医院眼科拟诊为细菌性、真菌性、棘阿米巴性角膜炎的14岁及以下639例(649只眼)患者的资料,其中男性361例,女性278例,年龄(5.6±4.4)岁。按年龄≤3岁、4~7岁、>7岁分别进行分析。收集患眼角膜病灶组织标本649份进行病原学检查及药物敏感试验。定性资料的比较采用χ^(2)检验。结果在649份标本中140份培养结果为阳性,阳性率21.6%。细菌培养标本共368份,其中培养阳性114份(占培养阳性标本总数的81.4%),阳性率31.0%;细菌菌群分布主要为革兰阳性球菌,其次是革兰阴性杆菌。链球菌属(34.2%)居首位,其次是葡萄球菌属(27.2%)和假单胞菌属(7.9%),≤7岁患儿的标本中肺炎链球菌最常见,8~14岁者表皮葡萄球菌最常见。革兰阳性球菌均对万古霉素敏感;大多数细菌对氟喹诺酮类药物敏感性较高,对头孢类和氨基甙类抗菌药敏感性较低,耐甲氧西林葡萄球菌检出率为68%(17/25)。细菌对各种喹诺酮类抗菌药的敏感率为59.0%~84.4%,其中加替沙星最高,但与莫西沙星、左旋氧氟沙星、氧氟沙星相比差异无统计学意义(χ^(2)=0.836,0.358,1.490;P=0.361,0.550,0.222)。真菌培养标本共254份,其中培养阳性22份(占培养阳性标本总数的15.7%),阳性率8.7%。2007至2011年真菌培养阳性率为9.2%(11/119),2012至2016年为8.1%(11/135),差异无统计学意义(χ^(2)=0.096,P=0.757)。真菌感染的菌群分布主要为镰刀菌属(34.8%,8/22)、曲霉菌属(26.1%,6/22)和念珠菌属(13.0%,3/22)。镰刀菌属对特比萘芬敏感率较高,对氟康唑和伊曲康唑不敏感;曲霉属对特比萘芬和伏立康唑敏感率高,两性霉素次之;念珠菌属对两性霉素、氟康唑、伊曲康唑和伏立康唑敏感率高。棘阿米巴送检标本27份,培养阳性4份(占培养阳性标本总数的2.9%),阳性率14.8%,危险因素包括�
Objective To analyze the etiological changes of children with infectious keratitis.Methods Retrospective study.Data of patients diagnosed as bacterial,fungal,and amoebic keratitis from 2007 to 2016,aged no more than 14 years old,were collected in the Department of Ophthalmology,Beijing Tongren Hospital.A total of 649 samples were obtained for routine laboratory culture identification and drug sensitivity tests.There were 361 males and 278 females,aged(5.6±4.4)years.The data were analyzed according to age≤3 years,4 to 7 years and>7 years.The qualitative data were analyzed by the Chi-square test.Results Among 649 samples,140 were culture positive,and the positive rate was 21.6%.Bacteria were the main pathogens,accounting for 81.4%.The positive rate was 31.0%among bacterial samples(114/368),and the bacterial flora was mainly Gram-positive cocci,followed by Gram-negative bacilli.Streptococcus(34.2%)ranked first,followed by Staphylococcus(27.2%)and Pseudomonas(7.9%).For children no more than 7 years old,Streptococcus pneumoniae was the most common bacterial species,while Staphylococcus epidermidis was most common in those aged 8-14 years.Gram-positive cocci were sensitive to vancomycin.Most bacteria were more sensitive to fluoroquinolones and less sensitive to cephalosporins and aminoguanidine.The detection rate of methicillin-resistant Staphylococcus was 68%(17/25).Gatifloxacin had the highest sensitivity,while the difference between gatifloxacin and moxifloxacin,levofloxacin,ofloxacin were not statistically significant(χ^(2)=0.836,0.358,1.490;P=0.361,0.550,0.222).A total of 254 specimens were cultured for fungi,of which 22 were positive,and the positive rate was 8.7%.The isolated fungi included Fusarium(34.8%,8/22),Aspergillus(26.1%,6/22)and Candida(13.0%,3/22).The positive rate of fungal culture was 9.2%(11/119)from 2007 to 2011,and 8.1%(11/135)from 2012 to 2016,no significant difference was found between two period(χ^(2)=0.096,P=0.757).Fusarium showed a relatively high sensitivity to terbinafine,but it was no
作者
王智群
张阳
孙旭光
Wang Zhiqun;Zhang Yang;Sun Xuguang(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Ophthalmology&Visual Sciences,Beijing 100730,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2022年第6期433-440,共8页
Chinese Journal of Ophthalmology
关键词
角膜炎
眼感染
儿童
回顾性研究
Keratitis
Eye Infections
Child
Retrospective studies
