真菌性角膜炎致病菌分布、耐药性及预后不良因素分析
投稿时间:2016-01-12  修订日期:2016-01-18  点此下载全文
引用本文:李正平,陈萍,张露文,孔俐,余飞,王凤.真菌性角膜炎致病菌分布、耐药性及预后不良因素分析[J].医学研究杂志,2016,45(9):156-159
DOI: 10.11969/j.issn.1673-548X.2016.09.041
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作者单位E-mail
李正平 401220 重庆市长寿区人民医院眼科 lizhengpingcq01@163.com 
陈萍 401220 重庆市长寿区人民医院眼科  
张露文 401220 重庆市长寿区人民医院眼科  
孔俐 401220 重庆市长寿区人民医院眼科  
余飞 401220 重庆市长寿区人民医院眼科  
王凤 401220 重庆市长寿区人民医院眼科  
中文摘要:目的 分析真菌性角膜炎病原菌分布、耐药性特点,同时探讨影响其患者预后的主要因素,从而为真菌性角膜炎的防治提供临床依据。方法 回顾性分析2010年6月~2015年6月在笔者医院诊治的195例真菌性角膜炎患者临床资料,分析其病原菌分布、耐药性特点及相关影响预后的主要危险因素。结果 195例眼部标本中,真菌培养阳性152例(77.9%)。主要的致病真菌属为镰刀菌属75例(49.3%),曲霉属35例(23.0%),链格孢属23例(15.1%)。常见真菌对那他霉素敏感度最高,总敏感度达到89.5%,对氟康唑敏感度最低,总敏感度62.4%。Logistic回归分析显示,白蛋白水平<35g/L、患病天数≥14天、病灶情况分级为Ⅲ~Ⅳ级及上皮修复时间≥21天为影响真菌性角膜炎患者预后的独立危险因素。结论 镰刀菌属是本地区主要的真菌性角膜炎致病菌属,其对两性霉素B敏感度最高,临床上应根据病原菌分布、药敏试验结果及影响预后的相关危险因素,合理选用抗生素,同时积极采取综合防治措施,改善患者的临床疗效及预后。
中文关键词:真菌性角膜炎  病原菌  药物敏感度  预后
 
Change of Pathogens and Risk Factors Affecting the Prognosis for Fungal Keratitis
Abstract:Objective To analyze the pathogens distribution, drug sensitivity of fungal keratitis, and explore main factors affecting the prognosis of patients, thus, providing basis for the prevention of fungal keratitis. Methods The clinical data of total 195 patients with fungal keratitis in our hospital from June 2010 to June 2015 were retropectively analyzed, including the pathogens distribution, drug sensitivity and main factors affecting the prognosis. Results 152 specimens were positive for fungal culture in 195 specimens (77.9%). The main pathogenic fungi was Fusarium spp (75 cases, 49.3%), Aspergillus (35 cases, 23.0%) and Alternaria genus (23 cases, 15.1%). The main fungi's sensitivity to Natamycin was highest (89.5%), and to Fluconazole was lowest (62.4%). The logistic regression analysis showed albumin levels<35 g/L, times of the disease≥14, the lesion classified as grade Ⅲ-Ⅳ, and epithelial healing time ≥21 days were independent risk factors for affecting the prognosis of patients with fungal keratitis. Conslusion Fusarium species is the main fungal pathogen in the region, which has the highest sensitivity to Amphotericin B. Based on distribution of pathogens, drug resistance results and related risk factors, the antibiotics should be rational used, and the measures were taken to improve the clinical efficacy and prognosis.
keywords:Fungal keratitis  Pathogens  Durg sensitivity  Prognosis
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