CAJ | 학술논문

目的了解白内障患者术前结膜囊细菌分布,为感染预防提供参考.方法选择老年性白内障患者135例(135眼),随机分为3组,每组45例,术前分别滴用3种抗菌滴眼液(0.5%左氧氟沙星、0.3%左氧氟沙星、0.3%妥布霉素).各组再随机分为滴药1 d组30例和3 d组15例,所有患者术前15 min均采用2.5%聚维酬碘消毒液(PVI)洗眼.在各项处理措施前后行结膜囊细菌培养及药敏试验.结果术前结膜囊细菌培养阳性率为66.7%,其中G+球菌占87%;3种滴眼液滴眼后,细菌清除率:1 d组分别为72.7%、72.7%和61.1%(P=0.667),3 d组分别为70.0%、70.0%和55.5%(P=0.751),两组之间差异无统计学意义(P0.05);经PVI洗眼后细菌清除率:1 d组分别上升至86.4%、77.3%和88.9%(P=0.564),3 d组分别上升至90.0%、80.0%和66.7%(P=0.749),两组之间差异无统计学意义(P0.05).MIC结果显示:G+球菌对左氧氟沙星、妥布霉素的敏感率分别为94.8%、74.1%(P=0.000);G-杆菌分别为94.4%、83.3%(P=0.289).结论白内障患者术前结膜囊细菌以G+球菌为主,术前1 d滴眼和3 d滴眼的抗菌效果差异无统计学意义.G+球菌和G-杆菌对左氧氟沙星均有较高敏感性.聚维碘酮清洗结膜囊可提高细菌清除率.
목적 료해백내장환자술전결막낭세균분포,위감염예방제공삼고.방법 선택노년성백내장환자135례(135안),수궤분위3조,매조45례,술전분별적용3충항균적안액(0.5%좌양불사성、0.3%좌양불사성、0.3%타포매소).각조재수궤분위적약1 d조30례화3 d조15례,소유환자술전15 min균채용2.5%취유수전소독액(PVI)세안.재각항처리조시전후행결막낭세균배양급약민시험.결과 술전결막낭세균배양양성솔위66.7%,기중G+구균점87%;3충적안액적안후,세균청제솔:1 d조분별위72.7%、72.7%화61.1%(P=0.667),3 d조분별위70.0%、70.0%화55.5%(P=0.751),량조지간차이무통계학의의(P0.05);경PVI세안후세균청제솔:1 d조분별상승지86.4%、77.3%화88.9%(P=0.564),3 d조분별상승지90.0%、80.0%화66.7%(P=0.749),량조지간차이무통계학의의(P0.05).MIC결과 현시:G+구균대좌양불사성、타포매소적민감솔분별위94.8%、74.1%(P=0.000);G-간균분별위94.4%、83.3%(P=0.289).결론 백내장환자술전결막낭세균이G+구균위주,술전1 d적안화3 d적안적항균효과차이무통계학의의.G+구균화G-간균대좌양불사성균유교고민감성.취유전동청세결막낭가제고세균청제솔.
Objective To study the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and determine the efficacy of reducing conjunctival bacteria with different methods. Methods A total of 135 eyes of 135 patients scheduled to undergo cataract surgery were randomized into 3 groups (45 each). They received topical prophylactic treatment with three different kinds of antibiotics (0.5% levofloxacin, 0.3% levofloxacin and 0.3% tobramycin). Each group was randomized into one-day group and three-day group. All the eyes underwent irrigation of fornices with 2.5% povidone-iedine (PVI) before surgery. Conjunctival cultures were obtained at various time points. Results The total positive rate of conjunctival cultures was 66. 7%. The eliminating rate of conjunctival bacteria in one-day groups were 72.7%, 72.7% and 61.1% (P = 0.667) while 70.0%, 70.0% and 55.5% in the three-day groups respectively (P = 0.751). Immediately after PVI irrigation, the eliminating rate in one-day groups added up to 86.4%, 77.3% and 88.9% (P = 0.564) as compared with 90.0%, 80.0% and 66.7% in the three-day groups respectively(P = 0.749). And there was no statistically significant difference between one-day groups and three-day groups in the eliminating rate of conjunctival bacterial after the topical antibiotic application.The MIC test revealed that the antibiotic sensitivity of Gram-positive cocci (G + C) to levofloxacin was 94.8% versus 74.1% to tobramycin (P =0.000) while the antibiotic sensitivity of Gram-negative bacillus (G-B) to levofloxacin was 94.4% versus 83.3% to tobramycin (P =0.289). Conclusion G + C accounts for the most among the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and there is no statistically significant difference in the efficacy of reducing conjunctival bacteria between the application of topical antibiotic for one day and for three days. Both G + C and G - B retain a high sensitivity to levofloxacin. Topical antibiotic in combination with 2.5% PVI irrigation further reduces conjunctival bacteria.