CAJ | 학술논문

对1998～2007年临床确诊的新生儿急性细菌性结膜炎的细菌培养结果进行分析,探讨其致病菌10年的变迁,为临床治疗、合理用药提供依据.方法对325例(466只眼)经临床诊断为新生儿急性细菌性结膜炎患儿的结膜囊分泌物标本进行细菌培养,同时对培养阳性的菌株进行鉴定分析.结果新生儿急性细菌性结膜炎的细菌平均检出率为80%.不同年分的细菌检出率变化无明显差异(x2=0.83,P＞0.05).10年来,新生儿急性细菌性结膜炎的致病菌中革兰阳性细菌有逐渐减少、革兰阴性细菌有逐渐增加的趋势.在革兰阳性细菌中,条件致病菌(表皮葡萄球菌和腐生匍萄球菌)所占的百分比有逐年增加的趋势,金黄色葡萄球菌和溶血性链球菌所占的百分比则有逐年减少的趋势.在革兰阴性菌中,淋球菌为主要致病菌.10年来,表皮葡萄球菌、腐生葡萄球菌和淋球菌在新生儿急性细菌性结膜炎的致病菌中有逐渐增加的趋势.结论对新生儿急性细菌性结膜炎患儿的结膜囊分泌物标本进行细菌培养、药物敏感试验既助于提高临床治疗,又可防止临床滥用抗生素、造成耐药菌株的增加.对于严重的新生儿急性细菌性结膜炎,早期可慎片喹诺酮类抗生素滴眼液治疗,待细菌培养和药物敏感试验结果报告后再结合治疗情况修改治疗方案.
대1998～2007년림상학진적신생인급성세균성결막염적세균배양결과진행분석,탐토기치병균10년적변천,위림상치료、합리용약제공의거.방법 대325례(466지안)경림상진단위신생인급성세균성결막염환인적결막낭분비물표본진행세균배양,동시대배양양성적균주진행감정분석.결과 신생인급성세균성결막염적세균평균검출솔위80%.불동년분적세균검출솔변화무명현차이(x2=0.83,P＞0.05).10년래,신생인급성세균성결막염적치병균중혁란양성세균유축점감소、혁란음성세균유축점증가적추세.재혁란양성세균중,조건치병균(표피포도구균화부생포도구균)소점적백분비유축년증가적추세,금황색포도구균화용혈성련구균소점적백분비칙유축년감소적추세.재혁란음성균중,림구균위주요치병균.10년래,표피포도구균、부생포도구균화림구균재신생인급성세균성결막염적치병균중유축점증가적추세.결론 대신생인급성세균성결막염환인적결막낭분비물표본진행세균배양、약물민감시험기조우제고림상치료,우가방지림상람용항생소、조성내약균주적증가.대우엄중적신생인급성세균성결막염,조기가신편규낙동류항생소적안액치료,대세균배양화약물민감시험결과보고후재결합치료정황수개치료방안.
Objective To study the results of bacterial culture from the inferior palpebral conjunctival surface of neonate with acute bacterial conjunctivitis and research the transition of bacterial pathogens in recent 10 years for sensitive antibiotics for its treatment,and to provide the basis for rational drug use for clinical treatment.Methods Secretion specimens were taken from 466 eyes of 325 cases with clinically diagnosed acute bacterial neonatal conjunctivitis for bacterial culture,and drug sensitivity test was carried out for specimens with positive culture results.Results Bacterial positive rate was 80% with insignificant changes among the different years.The past 10 years,neonatal conjunctivitis of acute bacterial pathogens,Gram-positive bacteria had a gradual downward trend;Gram-negative bacteria had a gradual upward trend.In Gram-positive bacteria,the percentage of opportunistic pathogen (Staphylococcus epidermidis and Staphylococcus saprophytic) was a rising trend,the percentage of Staphylococcus anreus and hemolytic streptococcus was a decreasing trend.In the Gram-negative bacteria,the main pathogenic bacteria were Neisseria gonorrhoeae.Staphylococcus epidermidis,Staphylococcus saprophytic and Neisseria gonorrhoeae in neonatal pathogens of acute bacterial conjunctivitis had a gradual upward trend in recent 10 years.Conclusions Bacterial culture combined with drug sensitivity test of secretion specimens of the acute bacterial neonatal conjunctivitis are beneficial not only for clinical treatment,but also to guide clinical practice in preventing antibiotics misuse and causing an increase in resistant strains.For serious neonatal acute bacterial conjunctivitis,the early quinolone antibiotic eye drops can be used with caution.After the results of bacterial culture and drug sensitivity test,the treatment programs should be modified.