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周丹, 王远芳, 邓劲, 等. 某三甲医院2012–2021年眼部细菌感染病原菌分布及耐药性分析[J]. 四川大学学报(医学版), 2024, 55(1): 204-209. DOI: 10.12182/20240160103
引用本文: 周丹, 王远芳, 邓劲, 等. 某三甲医院2012–2021年眼部细菌感染病原菌分布及耐药性分析[J]. 四川大学学报(医学版), 2024, 55(1): 204-209. DOI: 10.12182/20240160103
ZHOU Dan, WANG Yuanfang, DENG Jin, et al. Distribution and Antibiotic Resistance Analysis of Ocular Bacterial Pathogens at a Tertiary Hospital From 2012 to 2021[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(1): 204-209. DOI: 10.12182/20240160103
Citation: ZHOU Dan, WANG Yuanfang, DENG Jin, et al. Distribution and Antibiotic Resistance Analysis of Ocular Bacterial Pathogens at a Tertiary Hospital From 2012 to 2021[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(1): 204-209. DOI: 10.12182/20240160103

某三甲医院2012–2021年眼部细菌感染病原菌分布及耐药性分析

Distribution and Antibiotic Resistance Analysis of Ocular Bacterial Pathogens at a Tertiary Hospital From 2012 to 2021

  • 摘要:
    目的 分析某三甲医院眼部细菌感染病原菌分布及耐药情况,为抗生素的合理使用提供参考。
    方法 对某三甲医院2012–2021年眼科送检样本分离出的细菌进行回顾性分析;对分离到的可疑菌株采用自动微生物鉴定及药敏分析系统及基质辅助激光解吸电离飞行时间质谱仪进行鉴定;采用VITEK 2 Compact全自动微生物药敏分析系统进行药敏试验。
    结果 共收集眼科送检细菌培养样本1556份,其中574份检出细菌生长,总阳性率为36.89%。所分离到的细菌中,革兰阳性球菌、革兰阳性杆菌、革兰阴性杆菌、革兰阴性球菌分别占比63.15%(377/597)、18.76%(112/597)、17.09%(102/597)、1.00%(6/597)。十年间不同年份分离的细菌中,革兰阳性球菌一直为眼部感染主要的致病菌。73.47%(277/377)的革兰阳性球菌分离自眼内炎患者,以表皮葡萄球菌为主,其次为草绿色链球菌,26.53%(100/377)的革兰阳性球菌分离自外眼感染患者,主要分离菌种为表皮葡萄球菌、草绿色链球菌、金黄色葡萄球菌。眼内炎和外眼感染耐甲氧西林表皮葡萄球菌分离率均超过70%。未检出对万古霉素、利奈唑胺和替加环素耐药的菌株。外眼感染患者分离到的表皮葡萄球菌对左氧氟沙星的耐药率(2/27,7.41%)较低,而眼内炎感染患者分离到的表皮葡萄球菌对左氧氟沙星具有较高的耐药率(43/127,33.86%),两者间耐药率差异有统计学意义(P<0.05)。
    结论 某三甲医院眼部感染细菌以革兰阳性球菌为主,表皮葡萄球菌是最常见菌种,其对苯唑西林有较高的耐药率,对万古霉素、利奈唑胺和替加环素保持高度敏感性。该医院表皮葡萄球菌导致的眼内炎可考虑采用万古霉素进行经验性治疗,再根据药敏结果调整治疗方案。但药敏试验折点的建立主要是基于血流感染的模型,眼部感染的治疗参考价值有限,需通过加大剂量或局部给药的方式才能在感染部位达到需要的药物分布浓度。

     

    Abstract:
    Objective To analyze the distribution of ocular bacterial pathogens and their antibiotic resistance status at a tertiary-care hospital and to provide a reference for the appropriate use of antibiotics.
    Methods Retrospective analysis was conducted with bacteria isolated from the ophthalmic samples sent for lab analysis at a tertiary-care hospital from 2012 to 2021. The suspected bacterial strains were identified with automated systems for microbial identification and susceptibility analysis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometer. VITEK 2 Compact, an automated microbial identification and antibiotic susceptibility analysis system, was used for antimicrobial susceptibility testing.
    Results A total of 1556 ophthalmology bacteria culture samples were collected, 574 of which showed bacterial growth, presenting an overall positive rate of 36.89%. Of the isolated bacteria, Gram-positive cocci, Gram-positive bacilli, Gram-negative bacilli, and Gram-negative cocci accounted for 63.15% (377/597), 18.76% (112/597), 17.09% (102/597), and 1.00% (6/597), respectively. Among the bacteria isolated in different years over the course of a decade, Gram-positive cocci always turned out to be the main cause of eye infections. Of the Gram-positive cocci, 73.47% (277/377) were isolated from patients with endophthalmitis, with the most important species being Staphylococcus epidermidis, which was followed by Streptococcus viridans. The rest, or 26.53% (100/377), of the Gram-positive cocci were isolated from patients with external eye infections, with the main isolated strains being Staphylococcus epidermidis, Streptococcus viridans, and Staphylococcus aureus. More than 70% of Staphylococcus epidermidis isolated from both endophthalmitis and external eye infections were resistant to methicillin. No strains resistant to vancomycin, linezolid, or tigecycline were detected. Staphylococcus epidermidis isolated from patients with external eye infections had a low rate of resistance to levofloxacin (2/27 or 7.41%), whereas those isolated from patients with endophthalmitis had a higher resistance rate (43/127 or 33.86%). The difference in drug resistance rate between the two groups was statistically significant (P<0.05).
    Conclusion The chief ocular bacterial pathogens identified in a tertiary-care hospital were Gram-positive cocci, among which, Staphylococcus epidermidis was the most common species. The Staphylococcus epidermidis identified in the hospital had a high rate of resistance to oxacillin, but remained highly sensitive to vancomycin, linezolid, and tigecycline. The endophthalmitis caused by Staphylococcus epidermidis in the hospital can be treated empirically with vancomycin and then the treatment plan can be further adjusted according to the results of the drug susceptibility test. However, the establishment of the breakpoint of drug susceptibility test is mainly based on the model of bloodstream infection and has limited reference value for the treatment of eye infection. The required drug distribution concentration at the infection site can be achieved by dose increase or local administration.

     

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