目的：总结分析婴幼儿急性泪囊炎患者的病原菌分布及治疗体会，为该临床急症探索一种切实有效的治疗方法。

方法：回顾性研究。收集2015年1月至2023年10月在河北省眼科医院就诊的婴幼儿急性泪囊炎患者，接诊后抽取泪囊脓液样本做细菌培养并使用抗生素滴眼液行泪囊内注药灌洗泪囊，选用抗生素种类根据药敏试验结果加以调整，急性炎症控制后满3月龄患者即行泪道探通术，<3月龄患者待其满3月龄后行泪道探通术。

结果：纳入急性泪囊炎婴幼儿34例34眼，其中男18例，女16例，平均年龄38.1±4.4 d。致病菌检出率为88%(30例)，主要致病菌为革兰阳性球菌23例(77%)，其中金黄色葡萄球菌12例(40%)、肺炎链球菌4例(13%)、A群链球菌3例(10%)、表皮葡萄球菌2例(7%)、溶血葡萄球菌2例(7%)； 革兰阴性杆菌检出7例(23%)，其中大肠埃希菌4例(13%)、弗氏柠檬酸杆菌2例(7%)、嗜麦芽窄食单胞菌1例(3%)。革兰阳性球菌对万古霉素、利福平、左氧氟沙星、阿米卡星较敏感； 革兰阴性杆菌对左氧氟沙星、妥布霉素、氨曲南、阿米卡星较敏感。34例患者平均注药灌洗治疗1-4次，急性炎症均得到良好控制，后期行泪道探通治愈33例，1例患者未能探通。

结论：革兰阳性球菌构成婴幼儿急性泪囊炎的主要致病菌，左氧氟沙星、阿米卡星眼用制剂均可作为婴幼儿急性泪囊炎早期经验用药治疗，敏感抗生素滴眼液行泪囊注药灌洗可有效控制急性炎症为后期泪道探通做准备。

METHODS: Retrospective study. Infants with acute dacryocystitis who were treated at Hebei Eye Hospital from January 2015 to October 2023 were enrolled.Post-diagnosis,dacryocystic pus specimens were collected for bacterial culture,and antibiotic eye drops were administered for dacryocystic instillation and irrigation. The selection of antibiotics was adjusted based on antimicrobial susceptibility testing results.For patients aged ≥3 mo after acute inflammation control,dacryocystorhinostomy was performed. For patients <3 mo, dacryocystorhinostomy was performed after reaching 3 mo of age.

RESULTS: Thirty-four infants(34 eyes)with acute dacryocystitis were included in the study, comprising 18 males and 16 females, with an average age of 38.1±4.4 d. The pathogen detection rate was 88%(30 cases), with gram-positive cocci being the primary pathogens in 23 cases(77%), including Staphylococcus aureus in 12 cases(40%), Streptococcus pneumoniae in 4 cases(13%), Group A Streptococcus in 3 cases(10%), Staphylococcus epidermidis in 2 cases(7%), and Staphylococcus haemolyticus in 2 cases(7%). Gram-negative bacilli were detected in 7 cases(23%), including Escherichiacoli in 4 cases(13%), Citrobacter freundii in 2 cases(7%), and Stenotrophomonas maltophilia in 1 case(3%). Gram-positive cocci were more sensitive to vancomycin, rifampin, levofloxacin, and amikacin; Gram-negative bacilli were more sensitive to levofloxacin, tobramycin, aztreonam, and amikacin. Among the 34 patients, an average of 1-4 drug irrigation treatments were administered, with acute inflammation well controlled. Subsequent dacryocystoplasty successfully treated 33 cases, while 1 patient failed to achieve patency.

CONCLUSION: Gram-positive cocci constitute the primary causative agents of acute dacryocystitis in infants and young children. Levofloxacin and amikacin ophthalmic preparations can be used as empirical treatment for early-stage acute dacryocystitis in infants and young children. Sensitivity antibiotic eye drops administered via dacryocyst instillation and irrigation can effectively control acute inflammation, preparing for subsequent lacrimal duct probing.