背景:为了报告微生物分离株,病因学,并发症,抗生素敏感性,在位于中国北方的一家著名的三级眼科教学和转诊医院中,泪囊炎和泪小管炎的临床缓解,并为预防和制定药物治疗策略提供适当的建议。
方法:这项前瞻性研究共招募了477名被诊断患有泪囊炎或泪小管炎的参与者。该队列包括307例慢性泪囊炎患者,111例急性泪囊炎,和59例泪小管炎患者。使用无菌拭子收集泪管的脓性分泌物,并立即进行微生物培养。按照既定的方案进行抗微生物药敏试验。所有参与者都安排在接受抗生素治疗后14天内进行随访。
结果:目前的研究结果表明,女性表现出更高的易感性,男性中发生了367例,而男性中发生了110例。在477名患者中,在59个人中确定了明确的原因,占患者的12.4%。此外,132例患者报告了眼部并发症,占总数的27.7%。在大多数情况下观察到单眼受累,477名患者中有402人(84.3%)受影响,而75例患者(15.7%)存在双眼受累。总的来说,从552只眼中回收微生物菌株506株,表皮葡萄球菌(16.4%)是最常见的微生物。其他主要分离株包括麦基利棒状杆菌(9.1%),金黄色葡萄球菌(5.1%),肺炎链球菌(4.9%),嗜血杆菌(4.4%),痤疮丙酸杆菌(3.5%),和Eikenella确证(3.1%)。在12种分离的真菌中,近平滑念珠菌占66.7%。观察到革兰氏阴性杆菌(79.5%)对抗菌药物的敏感性高于厌氧菌(76.7%)和革兰氏阳性球菌(55.4%)。通过药物治疗,发现急性泪囊炎的缓解率(72.7%)高于泪小管炎(53.3%)和慢性泪囊炎(42.3%)。
结论:这项研究突出了泪囊炎和泪小管炎的微生物谱,尤其是C.macginleyi,大肠杆菌和拟态梭菌,它们也更经常被隔离。万古霉素和亚胺培南可能是更有效的治疗选择。大多数病例病因不明,和基本的预防措施包括眼和鼻手术后的泪道的术后清洁,以及积极治疗鼻炎。
BACKGROUND: To report the microbiological isolates, aetiology, complications, antibiotic susceptibilities, and clinical remission of dacryocystitis and
canaliculitis in a prominent tertiary ophthalmic teaching and referral hospital located in northern China and to offer appropriate recommendations for preventing and formulating drug treatment strategies.
METHODS: This prospective study recruited a total of 477 participants who had been diagnosed with either dacryocystitis or
canaliculitis. The cohort comprised 307 patients with chronic dacryocystitis, 111 patients with acute dacryocystitis, and 59 patients with
canaliculitis. Purulent discharge from the lacrimal duct was collected using a sterile swab and immediately subjected to microbial culture. Antimicrobial susceptibility testing was conducted following established protocols. All participants were scheduled for follow-up visits within 14 days after receiving antibiotic therapy.
RESULTS: The present findings indicated that women exhibited a higher susceptibility to the condition, as evidenced by the occurrence of 367 cases in comparison to 110 cases among men. Among the 477 patients, definitive causes were established in 59 individuals, accounting for 12.4% of the patients. Additionally, ocular complications were reported by 132 patients, representing 27.7% of the total. Monocular involvement was observed in the majority of cases, with 402 out of 477 patients (84.3%) affected, while binocular involvement was present in 75 patients (15.7%). In total, 506 microbiological strains were recovered from 552 eyes, with Staphylococcus epidermidis (16.4%) being the most prevalent microorganism. Other predominant isolates included Corynebacterium macginleyi (9.1%), Staphylococcus aureus (5.1%), Streptococcus pneumoniae (4.9%), Haemophilus (4.4%), Propionibacterium acnes (3.5%), and Eikenella corrodens (3.1%). Among the 12 isolated fungi, Candida parapsilosis accounted for 66.7%. The susceptibility to antimicrobial agents tested in gram-negative bacilli (79.5%) was observed to be higher than that of anaerobic bacteria (76.7%) and gram-positive cocci (55.4%). With pharmacological therapy, the remission rate of acute dacryocystitis (72.7%) was found to be higher than that of
canaliculitis (53.3%) and chronic dacryocystitis (42.3%).
CONCLUSIONS: This study highlights the microbial spectrum of dacryocystitis and
canaliculitis, particularly C.macginleyi, E.corrodens and C.parapsilosis, which are also more frequently isolated. Vancomycin and imipenem may be more effective treatment options. Most cases have an unknown aetiology, and essential preventive measures involve postoperative cleansing of the lacrimal passage following eye and nasal surgeries, as well as the proactive management of rhinitis.