糖尿病和非糖尿病白内障患者结膜囊菌群及耐药性的比较

Comparison of species of bacteria and antibiotic susceptibility in the conjunctival sac between diabetic and non-diabetic cataract patients

摘要:

目的：研究糖尿病和非糖尿病白内障患者结膜囊的细菌种类及其药物敏感性，指导糖尿病患者和非糖尿病患者抗生素滴眼液的应用和术前消毒，降低感染性眼内炎的发生率。

方法：将2013-11/2017-01在本院行白内障超声乳化手术的患者124例124眼按照有无2型糖尿病分为非糖尿病组(87例87眼)和糖尿病组(37例37眼)，观察术眼消毒前(T0)、术眼消毒后(T1)、手术结束时(T2)结膜囊的细菌培养结果和细菌药物敏感性检测结果。

结果：糖尿病组患者结膜囊细菌检出率在T0、T1和T2时均明显高于非糖尿病组患者。多数菌株对万古霉素、左氧氟沙星、妥布霉素的敏感性较好，对青霉素、阿奇霉素和四环素的耐药性较强。

结论：糖尿病患者由于眼表微环境的改变，结膜囊细菌检出率明显升高。表皮葡萄球菌和丙酸痤疮杆菌是两种主要的结膜囊检出菌。左氧氟沙星和妥布霉素对结膜囊检出菌的药物敏感性较好，可作为术前常规使用的抗生素滴眼液。

Abstract:

AIM: To analyzed the species of bacteria and antibiotic susceptibility in the conjunctival sac of non- diabetic patients and diabetic patients, to decrease the rate of postoperative endophthalmitis through the proper use of antibiotic drop and preoperative disinfection.

METHODS: Totally 124 patients(124 eyes)underwent cataract operation in Yangsi Hospital during November 2013 to January 2017 were divided into two groups: diabetic group(37 patients 37 eyes)and control group(87 patients 87 eyes). Bacterial culture in the conjunctival sac and antibiotic susceptibility test was operated in three time-points: before preoperative disinfection(T0), after preoperative disinfection(T1)and after operation(T2).

RESULTS: The bacterial culture rate in the conjunctival sac of diabetic patients was significantly higher than that in non-diabetic patients. Most of strains of bacteria were sensitive to vancomycin, levofloxacin and tobramycin. For penicillin, azithromycin and tetracycline, the rate of antibiotic resistance was much higher than other antibiotic.

CONCLUSION: Due to the change of the microenvironment of ocular surface, the bacterial culture rate of the conjunctival sac was significantly increased in diabetic patients. The main cultured bacteria in conjunctival sac were staphylococcus epidermidis and acnes propionate. Most of cultured bacteria in conjunctival sac were sensitive to levofloxacin and tobramycin. Levofloxacin and tobramycin can be used as preoperative antibiotic eye drop.