感染性眼內炎的病因診斷－六年回顧

Etiological Diagnosis of Infectious Endophthalmitis-A Six-Year Review

謝靜茹(Ching-Ju Hsieh) ； 黃正賢(Jen-Shang Huang) ； 林昌平(Chang-Ping Lin) ； 楊長豪(Chang-Hao Yang) ； 何子昌(Tzyy-Chang Ho) ； 楊中美(Chung-May Yang) ； 陳慕師(Muh-Shy Chen)

《中華民國眼科醫學會雜誌》 42卷3期 (2003/09) Pp. 195-202

https://doi.org/10.30048/ACTASOS.200309.0004

摘要

目的：探討感染性眼內炎的病因診斷。
材料與方法：回溯性研究報告，病歷回顧近六年來（自民國86年l月l日至91年12月31日）臺大醫院感染性眼內炎，分為下列三組：術後性、創傷性及內因性眼內炎，統計分析眼內檢體培養的結果。結果：本研究總共186例，陽性培養有81例（陽性培養率44.5%)。132例(71%)術後性眼內炎，19例(10%)創傷性眼內炎，35例(19%)內因性眼內炎。術後性眼內炎：21例(42%)格蘭性陽性菌，22例(44%)格蘭性陰性菌，6例(12%)黴菌。常見有19例(38%)綠膿稈菌、9例(18%)葡萄球菌、5例(10%)鏈球菌。創傷性眼內炎：3例葡萄球菌及2例黴菌。內因性眼內炎：最常見為22例(84%)肺炎克雷伯氏菌感染肝膽系統，轉移至眼睛而引起感染性眼內炎。另外3例(12%)自體免疫性疾病患者有黴血菌而引起感染性眼內炎。
結論：感染性眼內炎唯一可靠的診斷與治療方法為眼內檢體的培養，正確適當的眼內檢體採樣，檢體迅速的傳送，可以提高陽性培養率。本研究發現近幾年術後性眼內炎的病因與過去或國外文獻報告有所不同，格蘭性陰性菌有增加的趨勢，尤其綠膿桿菌佔大多數，而格蘭性陽性菌如葡萄球菌日漸減少的趨勢。東方人內因性眼內炎最常見的病因為肺炎克雷伯氏菌(84%)，有別於西方人，以葡萄球菌或鏈球菌為主。

並列摘要

Purpose: To investigate the etiological diagnosis of infectious endophthalmitis.
Materials and Methods: The medical records of all patients with infectious endophthalmitis at National Taiwan University Hospital between January 1, 1997, and December 31, 2002 were reviewed. The infectious endophthalmitis falls into three groups; postoperative, post-traumatic and endogenous. Intraocular culture results were obtained and analyzed.
Results: 81 (44.5%) of 186 eyes were culture- positive. The postoperative group included 132(71%) eyes, the post-traumatic group 19(10%) eyes, and the endogenous group 35(19%) eyes. The common microorganism isolates were 19 (38%) Pseudomonas aeruginous, 9(18%) Staphylococci, 5(10%) Streptococci in postoperative group, 3 Staphylococci, 2 fungi in post- traumatic group, and 22(84%) Klebsiellla peumoniae originating from hepatobilliary infection, 3(12%) fungi from immunocompromised patients in endogenous group.
Conclusions: Biopsy of intraocular fluid/tissue is the only method that permits reliable diagnosis and treatment. Optimal sampling and rapidly transporting samples is crucial to increase the positive cultures. An increase in gram-negative bacteria in the postoperative group over the last 20 years was also observed in this study as well as in the literature. The most common microorganism isolates in the endogenous group were Klebsiellla peumoniae.

並列關鍵字

Postoperative ； post-traumatic and endogenous endophthalmitis