分析山东省感染性眼内炎的病原菌谱分布及药物敏感性特征。

回顾性分析2013年1月至2020年12月于山东第一医科大学附属眼科医院(山东省眼科医院)诊断为疑似感染性眼内炎350例(350只眼)患者的病例资料。其中，男性272例(272只眼)，女性78例(78只眼)；年龄1~87岁，平均年龄(44.4±20.0)岁。均为单眼发病。抽取所有患者的房水和(或)玻璃体(统称眼内液)进行涂片和体外培养实验。使用全自动微生物分析仪进行鉴定分离到的细菌和念珠菌，并行药物敏感性试验。采用WHONET5.6软件分析眼内炎患者的临床特点、病原菌分布以及主要病原菌的耐药性情况。感染性眼内炎病原菌分布和致病因素分布采用例数和百分比表示。

疑似感染性眼内炎350例患者中外源性眼内炎者和内源性眼内炎者分别为317例和33例，分别占90.6%和9.4%。房水和玻璃体均采集者269例，只采集房水者81例。涂片阳性者99例，阳性率为28.3%。涂片检出菌中革兰氏阳性球菌者、革兰氏阴性菌者、革兰氏阳性杆菌及真菌者分别为67例、8例、8例及16例，分别占67.7%、8.1%、8.1%及16.1%。病原微生物培养标本中病原菌阳性者135例，阳性率为38.6%，共分离得到病原菌144株。其中，革兰氏阳性球菌者、革兰氏阳性杆菌者、革兰氏阴性杆菌者及真菌者分别为87例、12例、15例及30例，分别占60.4%、8.3%、10.5%及20.8%。以眼内液涂片和(或)病原菌培养阳性为感染性眼内炎诊断的金标准，在350例全部疑似患者中，有211例患者眼内液涂片和(或)病原菌培养阳性，最终确诊为感染性眼内炎，感染阳性率为60.3%。病原菌中以凝固酶阴性的葡萄球菌居首位，其次为链球菌。真菌中主要以镰刀菌和曲霉菌为主。分离菌株对左氧氟沙星的敏感性最高达39.3%~84.6%。

2013年至2020年间，眼外伤是山东地区感染性眼内炎的主要致病因素，革兰氏阳性球菌尤其凝固酶阴性的葡萄球菌是感染性眼内炎的主要病原菌。

The aim of this study was to investigate the etiological spectrum of infectious endophthalmitis and analyze the drug susceptibility characteristics of etiological organism in Shandong Province.

A total of 350 patients (350 eyes) were collected from Eye Hospital of Shandong First Medical University (Shandong Eye Hospital) from 2013 to 2020 who were clinically diagnosed with suspected infectious endophthalmitis and received aqueous fluid and (or) vitreous samples for smear test, bacterial culture and fungal culture before examination and retrospectively analyzed. Isolated bacteria and candida were identified and drug sensitive test by Vitek 2 Compact automatic microbiological analysis system. The drug sensitivity data were analyzed by WHONET5.6 and expressed as cases and percentage.

Among 350 cases of suspected infectious endophthalmitis, there were 317 cases with exogenous endophthalmitis and 33 cases with endogenous endophthalmitis, accounting for 90.6% and 9.4%, respectively. There were 269 cases with both aqueous humor and vitreous fluid collected, 81 cases with aqueous humor collected. There were 67 cases with Gram-positive cocci, 8 cases with gram-negative bacteria, 8 cases with Gram-positive bacilli and 16 cases with fungi detected by smear, accounting for 28.3%, 67.7%, 8.1%, 8.1% and 16.1%, respectively. For culture in vitro, 135 cases were positive, a positive rate of 38.6%. There were 144 strains of isolated pathogenic organism, including 87 cases with Gram-positive cocci, 12 cases with Gram-positive bacilli, 15 cases with Gram-negative bacilli, and 30 cases with fungi, accounting for 60.4%, 8.3%, 10.5% and 20.8%, respectively. According to intraocular fluid smear and (or) culture positive as the gold standard for the diagnosis of infectious endophthalmitis, there were 211 patients of them with positive intraocular fluid smear and (or) in vitro culture, who were finally diagnosed as infectious endophthalmitis, an positive rate of 60.3%. Among of pathogens, Staphylococcus with negative coagulase was the top1, followed by Streptococcus. The main fungi were Fusarium and Aspergillus. The sensitivity of the isolated strains to levofloxacin ranged from 39.3% to 84.6%, which was higher than that of other drugs.

From 2013 to 2020, the ocular trauma was the main pathogenic factor of infectious endophthalmitis in Shandong. Gram-positive coccus, especially Staphylococcus with negative coagulase, were the main pathogenic bacteria of infectious endophthalmitis.