山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (1): 7-14.doi: 10.6040/j.issn.1671-7554.0.2023.0807
• 临床医学 • 上一篇
于淑娟1,王世富2,3,4,杨尚敏2,3,4,刘国华1,4
YU Shujuan1, WANG Shifu2,3,4, YANG Shangmin2,3,4, LIU Guohua1,4
摘要： 目的 分析山东省不同人群眼部分离病原菌的构成及耐药情况,为临床抗微生物药物选择提供参考依据。 方法 本研究为回顾性分析,收集山东省儿童微生物组学研究中心儿童细菌&真菌耐药监测研究协作网成员单位(52家三级医院,7家二级医院)于2017年1月至2022年12月上报的731株来自眼部感染患者的病原菌,来源部位包括结膜囊分泌物、睑缘分泌物、泪囊分泌物、角膜刮片及玻璃体穿刺,采用质谱系统、全自动微生物鉴定系统、API系统等对分离菌种进行鉴定,美国临床和实验室标准化协会推荐的药敏试验方法进行药敏试验及药敏结果判读,利用WHONET 5.6软件对数据进行整理分析,SPSS 21.0软件对细菌耐药性差异进行统计分析。 结果 (1)分离病原菌以革兰阳性菌为主(70.2%),其中葡萄球菌属居于首位,儿童以金黄色葡萄球菌感染为主,成年人和老年人以表皮葡萄球菌为主;革兰阴性菌以铜绿假单胞菌为主。真菌感染主要发生于成年男性,以镰刀菌属为主;(2)革兰阳性菌对万古霉素、利奈唑胺耐药率为0,利福平2.0%,氯霉素4.3%,庆大霉素9.2%,莫西沙星10.6%,左氧氟沙星33.2%,红霉素77.6%。葡萄球菌对青霉素G耐药率高于链球菌,表皮葡萄球菌对利福平、奎奴普丁/达福普汀、莫西沙星、四环素、环丙沙星、左氧氟沙星、复方新诺明耐药率高于金黄色葡萄球菌;缓症链球菌对左氧氟沙星耐药率高于肺炎链球菌;(3)革兰阴性菌对阿米卡星耐药率1.7%,妥布霉素8.0%,左氧氟沙星11.1%,庆大霉素11.2%,氯霉素18.2%,铜绿假单胞菌耐药率普遍偏低。 结论 (1)葡萄球菌是感染性眼病主要致病菌;(2)革兰阳性菌对红霉素、青霉素普遍耐药;革兰阴性菌耐药率控制良好。临床对于眼部革兰阳性菌感染,除了考虑万古霉素等终极药物外,也可使用利福平治疗;对于革兰阴性菌感染,可考虑使用阿米卡星治疗;(3)要重视并监测不同年龄段人群眼部病原菌种类的分布及变化趋势,根据药物敏感结果规范合理使用抗生素,并重新评价眼科临床已较少使用的抗生素价值。
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