背景:先前尚未在亚历山大市研究过微生物角膜炎的抗菌素耐药性。我们的目标是通过确定病因来推荐有效的治疗方法,抗菌敏感性的测定,并比较经验性局部抗菌药物的结果。
方法:在亚历山大大学主要医院角膜诊所进行的2022年前瞻性队列中,检测了从角膜刮片中分离出的微生物的抗菌敏感性,并开发了抗菌谱。细菌(BK),真菌(FK),或混合真菌/细菌性角膜炎(MFBK)的经验性治疗方案的患者的溃疡愈合进行比较,上皮形成的时间,最佳矫正视力,干预措施,和并发症。
结果:93个阳性培养物中普遍存在的微生物是凝固酶阴性葡萄球菌(CoNS,30.1%),铜绿假单胞菌(14%),和曲霉属。(12.9%)。CoNS对万古霉素敏感(VAN,100%)和莫西沙星(MOX,90.9%)。革兰阴性菌对加替沙星(90.9%)的敏感性高于MOX(57.1%),和庆大霉素(GEN,44.4%)比头孢他啶(CAZ,11.8%)。革兰阳性菌对甲氧西林耐药率达到23.9%。真菌对伏立康唑(VRC)表现出10%的抗性。使用GEN+VAN的49例BK患者的溃疡愈合百分比,CAZ+VAN和MOX占85.7%,44.4%,和64.5%,分别(p=0.259)。他们的中位上皮形成时间达到21、30和30天,分别(对数秩p=0.020)。在51名FK患者中,与VRC(39.1%)或NT(52.6%)相比,纳他霉素(NT)+VRC联合治疗更多溃疡(88.9%)(p=0.036)。他们的中位上皮形成时间为65、60和22天,分别(对数秩p<0.001)。VRC组比NT+VRC治疗组(11.1%)需要更多的干预措施(60.9%)(p=0.018)。在23例MFBK患者中,没有使用NT+CAZ+VAN治愈,而50%的患者使用VRC+CAZ+VAN治愈(p=0.052)。方案具有相当的视觉结果和并发症。
结论:基于检测到的更高的易感性,我们建议在疑似革兰氏阳性BK中使用经验性MOX,加替沙星在革兰氏阴性BK中,和GEN+VAN在严重的BK。由于更好的结果,我们建议在严重的FK中使用NT+VRC。
背景:ClinicalTrials.gov标识符,NCT05655689。注册2022年12月19日-回顾性注册,https://clinicaltrials.gov/ct2/show/NCT05655689?cond=NCT05655689。&draw=2&rank=1。
BACKGROUND: Antimicrobial resistance in microbial keratitis has not been previously explored in Alexandria. We aim to recommend effective therapies through identification of etiological agents, determination of antimicrobial susceptibilities, and comparing outcomes of empiric topical antimicrobials.
METHODS: In this 2022 prospective cohort conducted in Alexandria Main University Hospital cornea clinic, antimicrobial susceptibilities of isolated microorganisms from corneal scrapings were detected and antibiograms were developed. Bacterial (BK), fungal (FK), or mixed fungal/bacterial keratitis (MFBK) patients on empiric regimens were compared for ulcer healing, time-to-epithelialization, best-corrected visual acuity, interventions, and complications.
RESULTS: The prevalent microorganisms in 93 positive-cultures were coagulase-negative staphylococci (CoNS, 30.1%), Pseudomonas aeruginosa (14%), and Aspergillus spp. (12.9%). CoNS were susceptible to vancomycin (VAN, 100%) and moxifloxacin (MOX, 90.9%). Gram-negative bacteria showed more susceptibility to gatifloxacin (90.9%) than MOX (57.1%), and to gentamicin (GEN, 44.4%) than ceftazidime (CAZ, 11.8%). Methicillin-resistance reached 23.9% among Gram-positive bacteria. Fungi exhibited 10% resistance to voriconazole (VRC). Percentages of healed ulcers in 49 BK patients using GEN + VAN, CAZ + VAN and MOX were 85.7%, 44.4%, and 64.5%, respectively (p = 0.259). Their median time-to-epithelialization reached 21, 30, and 30 days, respectively (log-rank p = 0.020). In 51 FK patients, more ulcers (88.9%) healed with natamycin (NT) + VRC combination compared to VRC (39.1%) or NT (52.6%) (p = 0.036). Their median time-to-epithelialization was 65, 60, and 22 days, respectively (log-rank p < 0.001). The VRC group required more interventions (60.9%) than NT + VRC-treated group (11.1%) (p = 0.018). In 23 MFBK patients, none healed using NT + CAZ + VAN, while 50% healed using VRC + CAZ + VAN (p = 0.052). Regimens had comparable visual outcomes and complications.
CONCLUSIONS: Based on the higher detected susceptibility, we recommend empiric MOX in suspected Gram-positive BK, gatifloxacin in Gram-negative BK, and GEN + VAN in severe BK. Due to better outcomes, we recommend NT + VRC in severe FK.
BACKGROUND: ClinicalTrials.gov identifier, NCT05655689. Registered December 19, 2022- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05655689?cond=NCT05655689.&draw=2&rank=1.