摘要
目的探讨眼前节不同部位分离出的耐药葡萄球菌对左氧氟沙星、妥布霉素、头孢唑啉钠、夫西地酸、克林霉素的敏感性。方法横断面研究。收集2018年1月至2019年5月河南省立眼科医院微生物室从67例(67只眼)眼前节感染患者的结膜囊、角膜、睑缘及泪囊采集的标本中分离出的67株耐药葡萄球菌的资料进行研究。患者中男性37例,女性30例;年龄(35.18±24.69)岁;结膜炎33例、细菌性角膜炎6例、睑缘炎7例、新生儿泪囊炎9例、成人泪囊炎1例、其他感染性眼病11例。通过细菌测定系统随机体外诊断试剂板(DL-STAPH葡萄球菌)对菌株的耐药机制类型[耐甲氧西林(MRS)株和(或)产β内酰胺酶(β-Lac)]进行鉴定,依据美国临床和实验室标准化研究所的M100标准,对微量液基法测出的最小抑菌浓度进行敏感和耐药的判定。采用卡方或Fisher确切检验对数据进行统计学分析。结果67株耐药葡萄球菌中MRS株35株、产β-Lac株30株、产β-Lac MRS株2株。泪囊、角膜、睑缘和结膜囊的MRS株分别有3、9、4、19株,占各部位分离出总菌株数的3/4、9/12、4/8、19/43(44.2%);产β-Lac株分别有1、3、3、23株,占各部位分离出总菌株数的1/4、3/12、3/8和23/43(53.5%)。结膜囊分离出的产β-Lac株中来自诊断为结膜炎的患者有17株,占比最高(25.3%);角膜和泪囊分离出的MRS株中来自诊断为细菌性角膜炎和新生儿泪囊炎患者的分别为5(7.5%)和3株(4.5%);睑缘分离出的MRS株、产β-Lac株来自睑缘炎患者的均为3株(4.5%)。睑缘和结膜囊分离出的菌株中以耐药表皮葡萄球菌为主,泪囊和角膜分离出的菌株以耐药金黄色葡萄球菌为主。35株MRS株中,分别有25、24、12、12、11株对头孢唑啉钠、夫西地酸、左氧氟沙星、克啉霉素和妥布霉素敏感,敏感率分别为71.4%、68.6%、34.3%、34.3%和31.4%,差异有统计学意义(χ^(2)=22.756,P<0.01),且4个眼前节部位分离出的MRS株对左氧氟沙星、妥布霉素、头孢唑啉钠、夫西地酸及克林霉素的敏感性差异均有统计学意义(χ^(2)=18.493,11.594,8.906,9.841,16.059;均P<0.05),角膜的MRS株对5种抗生素的敏感性差异有统计学意义(χ^(2)=33.080,P<0.001)。30株产β-Lac株中,分别有27、22、19、16、8株对头孢唑啉钠、夫西地酸、左氧氟沙星、妥布霉素和克林霉素敏感,敏感率分别为90.0%、73.3%、63.3%、53.3%和26.7%,差异有统计学意义(χ^(2)=28.280,P<0.001)。4个眼前节部位分离出的产β-Lac株对5种抗生素的敏感性差异均有统计学意义(χ^(2)=50.971,24.543,48.147,44.899,18.676;均P<0.01);结膜囊分离出的产β-Lac株对5种抗生素敏感性的差异有统计学意义(χ^(2)=23.383,P<0.01)。产β-Lac株对头孢唑啉钠和夫西地酸的敏感性高于MRS株。结论头孢唑啉钠和夫西地酸可能是治疗眼前节结膜囊、角膜、睑缘及泪囊4个部位耐药葡萄球菌感染的较优选择,尤其是产β-Lac耐药葡萄球菌的感染。
Objectie To investigate the susceptibility of drug-resistant staphylococci isolated from different parts of the anterior segment to levofloxacin,tobramycin,cefazolin sodium,fusidic acid and clindamycin.Methods Experimental Study.A total of 67 patients with anterior segment infection(33 cases of conjunctivitis,6 cases of bacterial keratitis,7 cases of blepharitis,9 cases of neonatal dacryocystitis,9 cases of neonatal dacryocystitis,1 case of adult dacryocystitis and 11 cases of other infectious eye diseases)were collected from the conjunctival sac,cornea,eyelid margin and lacrimal sac.Minimum inhibitory concentration(MIC)determination of methicillin-resistant Staphylococcus(MRS)strains andβ-lactamase-producing(β-Lac)strains by a micro-liquid-based method,according to the M100 standard of the American Institute for Clinical and Laboratory Standardization Susceptibility and resistance determinations were made.Data were statistically analyzed using Chi-square or Fisher′s exact test.Results Thirty-five MRS,30β-Lac and 2β-Lac MRS isolates were identified from 67 multidrug-resistant Staphylococcus.There were 3,9,4,and 19 MRS isolates isolated from the lacrimal sac,cornea,eyelid margin and conjunctival sac,accounting for 3/4,9/12,4/8,19/43(44.2%)of the isolated sites respectively.There were 1,3,3,and 23β-Lac isolates,accounting for 1/4,3/12,3/8 and 23/43(53.5%)of the isolated sites,respectively.The highest proportion ofβ-Lac isolates isolated from patients with a diagnosis of conjunctivitis was 17(25.3%)from the conjunctival sac.Among the MRS strains isolated from the cornea and lacrimal sac,5(7.5%)and 3(4.5%)were from patients diagnosed with bacterial keratitis and neonatal tear,respectively.The number of MRS strains andβ-Lac isolates isolated from patients with a diagnosis of blepharitis were both 3(4.5%)from the lid margin.Among the strains isolated from the eyelid margin and the conjunctival sac,drug-resistant Staphylococcus epidermidis was the main strain,the drug-resistant Staphylococcus aureus was the major isolates in lacrimal sac and cornea.Among the 35 MRS isoaltes,25,24,12,12,and 11 were sensitive to cefazolin sodium,fusidic acid,levofloxacin,clindamycin and tobramycin,and the sensitivity rates were 71.4%,68.6%,34.3%,34.3%and 31.4%,the difference was statistically significant(χ^(2)=22.756,P<0.001),The sensitivity rates of levofloxacin,tobramycin,cefazolin sodium,fusidic acid and clindamycin against MRS isolates from the anterior segment were both statistically significant differences(χ^(2)=18.493,11.594,8.906,9.841,16.059;all P<0.05).The susceptibility rates of MRS isolates against five antibiotics was statistically significant differences(χ^(2)=33.080,P<0.001).Among the 30β-Lac isolates,27,22,19,16,and 8 were sensitive to cefazolin sodium,fusidic acid,levofloxacin,tobramycin and clindamycin,and the sensitivity rates were 90.0%,73.3%,63.3%,53.3%and 26.7%,the difference was statistically significant(χ^(2)=28.280,P<0.001).The sensitivity rates of five antibiotics againstβ-Lac isolates from the anterior segment were both statistically significant differences(χ^(2)=50.971,24.543,48.147,44.899,18.676;all P<0.001).The susceptibility rates ofβ-Lac isolates against five antibiotics was statistically significant differences(χ^(2)=23.383,P<0.001).The sensitivity of cefazolin sodium and fusidic acid againstβ-Lac isolates were higher than MRS isolates.Conclusions Cefazolin sodium and fusidic acid may be the best choice for the treatment of drug-resistant Staphylococcus isolated from anterior conjunctival sac,cornea,eyelid margin and lacrimal sac,especially forβ-Lac-producing drug-resistant Staphylococcus infection.
作者
岳娟
王春梅
吕奇学
简守珺
牛月月
刘素素
孙声桃
韩雷
张红敏
Yue Juan;Wang Chunmei;Lyu Qixue;Jian Shoujun;Niu Yueyue;Liu Susu;Sun Shengtao;Han Lei;Zhang Hongmin(Department of Ophthalmology,Henan Provincial People′s Hospital of Ophthalmology,Henan Eye Hospital,Henan Eye Institute,School of Clinical Medicine,Ophthalmology Department of Henan University,People′s Hospital of Zhengzhou University,Henan Provincial Key Laboratory of Ophthalmology and Visual Science,Zhengzhou 450003,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2022年第8期598-605,共8页
Chinese Journal of Ophthalmology
基金
国家自然科学基金(81770902)
河南省立眼科医院基础研究重点专项(21JCZD003)。
关键词
眼前半段
眼感染
细菌性
葡萄球菌感染
抗菌药
抗药性
多种
细菌
微生物敏感性试验
Anterior eye segment
Eye infections,bacterial
Staphylococcal infections
Anti-bacterial agents
Drug resistance,multiple,bacterial
Microbial sensitivity tests
作者简介
通信作者:张红敏,Email:zhm0906@163.com。
