探讨眼科手术后感染性眼内炎影响因素及其病原学。

选取2014年1月至2023年12月于山西省眼科医院收治的眼科手术后感染性眼内炎患者65例(65只眼)和同期相同术式非眼内炎患者195例(195只眼)作为研究对象。其中，男性156例(156只眼)，女性104例(104只眼)；年龄4～88岁，平均年龄(65.2±10.0)岁。收集患者的基础资料、术前检查结果、感染后检查结果、术后用药情况、病原菌、治疗方法及预后等资料。平均年龄、住院时间、身体质量指数及感染症状出现时间符合正态分布以±s表示，组间比较采用独立样本t检验；吸烟史、饮酒史、合并糖尿病、合并高血压、合并高血脂、严重疾病史、术前血红蛋白低、术前血清白蛋白低、术前未按规范使用抗菌滴眼液、日间手术、急诊手术、全身麻醉手术、术前有身体其他感染病灶、术后眼污染史及术后未规范使用抗菌滴眼液等计数资料，以例数和百分比表示。不同病原菌患者预后视力不符合正态分布采用中位数和四分位间距[M(IQR)]描述。眼内炎感染的危险因素分析采用多因素Logistic回归分析。

65例(65只眼)感染性眼内炎患者中男性39例(39只眼)，女性26例(26只眼)；左眼28例(28只眼)，右眼37例(37只眼)；手术类型白内障手术51例(51只眼)，玻璃体切割术2例(2只眼)，玻璃体切割联合白内障手术6例(6只眼)，青光眼联合白内障手术4例(4只眼)，玻璃体腔药物注射2例(2只眼)；手术三级医院24例(24只眼)，二级医院31例(31只眼)，民营医院10例(10只眼)；超急性眼内炎40例(40只眼)，亚急性眼内炎25例(25只眼)，无慢性眼内炎。感染性眼内炎患者的平均年龄、住院时间及身体质量指数分别为(66.4±14.7)岁、(3.29±1.45)d及(24.41±2.09)kg/m²；非感染性眼内炎者分别为(64.8±7.8)岁、(3.06±0.97)d及(24.00±2.24)kg/m²，其差异无统计学意义(t＝1.171，1.154，0.261；P>0.05)。感染性眼内炎患者的吸烟史、饮酒史、合并糖尿病、合并高血压、合并高血脂、严重疾病史、术前血红蛋白低、术前血清白蛋白低、术前未按规范使用抗菌滴眼液、日间手术、急诊手术、全身麻醉手术、术前有身体其他感染病灶、术后眼污染史及术后未规范使用抗菌滴眼液分别有28例(28只眼)、19例(19只眼)、42例(42只眼)、29例(29只眼)、23例(23只眼)、21例(21只眼)、12例(12只眼)、20例(20只眼)、5例(5只眼)、28例(28只眼)、3例(3只眼)、2例(2只眼)、6例(6只眼)、10例(10只眼)及4例(4只眼)，分别占43.08%、29.23%、64.62%、44.62%、35.38%、32.31%、18.46%、30.77%、7.69%、43.08%、4.62%、3.08%、9.23%、15.38%及6.15%；非感染性眼内炎者分别有101例(101只眼)、62例(62只眼)、79例(79只眼)、58例(58只眼)、63例(63只眼)、22例(22只眼)、30例(30只眼)、19例(19只眼)、8例(8只眼)、93例(93只眼)、11例(11只眼)、4例(4只眼)、9例(9只眼)、12例(12只眼)及9例(9只眼)，分别占51.79%、31.79%、40.51%、29.74%、32.31%、11.28%、15.38%、9.74%、4.10%、47.69%、5.64%、2.05%、4.62%、6.15%及4.62%。经多元Logistic回归分析，合并糖尿病、术前血清白蛋白低、严重疾病史及术后眼污染史是患者术后发生感染性眼内炎的危险因素(OR＝2.039，3.021，2.803，3.095；P<0.05)。65例(65只眼)感染患者中标本检出病原菌41株，无真菌感染病例，检出率为63.08%。其中，G＋杆菌1株、G＋球菌26株及G－杆菌14株，分别占2.44%、63.41%及34.15%。65例(65只眼)患者术后感染症状出现时间为(4.48±4.46)d。其中，眼结膜充血、眼痛、异物感及伴视力模糊者53例(53只眼)、55例(55只眼)、35例(35只眼)及62例(62只眼)，分别占81.53%、84.62%、53.85%及95.38%。G＋菌、G－菌及无菌生长患者的感染症状出现时间分别为(3.56±1.71)d、(1.85±1.21)d及(4.87±3.75)d。65例(65只眼)患者中行玻璃体腔注射、前房灌洗联合玻璃体腔注射、玻璃体切除术及眼球摘除患者分别有4例(4只眼)、分别占15.38%、6.15%、75.38%及3.08%。G＋菌、G－菌及无菌生长患者的预后视力分别为3.00(1.65)、1.00(1.50)及3.30(2.40)。

糖尿病、术前血清白蛋白低、严重疾病史及术后眼污染史均可能增加眼科手术部位感染风险，不同致病菌对术后感染症状出现时间和视力预后有影响。

The aim of this study is to investigate the influential factors of infectious endophthalmitis and its pathogenic bacteria after ophthalmic surgery.

A total of 65 patients (65 eyes) with infectious endophthalmitis after ophthalmic surgery and 195 postoperative non-infected patients (195 eyes) were selected as the study objects from January 2014 to December 2023. Among them, there were 156 males (156 eyes) and 104 females (104 eyes) with mean age of (65.2±10.0) years old (ranging from 4 to 88 years old). The basic data, preoperative examination results, post-infection examination results, postoperative medication, pathogenic bacteria, treatment methods and recovery of patients were collected. The average age, length of hospital stay, body mass index, and time of onset of infection symptoms follow a normal distribution expressed as ±s and compared by independent sample t-test for inter group comparison. The counting data of smoking history, drinking history, diabetes, hypertension, hyperlipidemia, serious disease history, preoperative low hemoglobin, preoperative low serum albumin, preoperative failure to use antibacterial eye drops as required, daytime surgery, emergency surgery, general anesthesia surgery, preoperative presence of other infectious lesions, postoperative eye pollution history, and postoperative failure to use antibacterial eye drops as required were described by cases and percentages. The prognosis of visual acuity in patients with different pathogens did not follow a normal distribution and was described using median and interquartile intervals [M(IQR)]. The risk factors of endophthalmitis infection was calculated by multiple Logistic regression analysis.

Among of 65 cases (65 eyes) of infectious endophthalmitis after ophthalmic surgery, there were 39 males (39 eyes) and 26 females (26 eyes). There were 28 (28 eyes)cases of left eye and 37 cases (37 eyes)of right eye. There were 1 case (1 eye) with cataract surgery, 2 cases (2 eyes) with vitrectomy, 6 cases (6 eyes) with vitrectomy combined with cataract surgery, 4 cases (4 eyes) with glaucoma combined with cataract surgery, 2 cases (2 eyes) with intravitreal drug injection. There were 24 cases (24 eyes) in tertiary hospitals, 31 cases (31 eyes) in secondary hospitals and 10 (10 eyes)cases in private hospitals. There were 40 cases (40 eyes) with hyperacute endophthalmitis, 25 cases (25 eyes) with subacute endophthalmitis, and without chronic endophthalmitis. The mean age of patients with infectious endophthalmitis, length of hospital stay, body mass index were (66.4±14.7) years old, (3.29±1.45) d, (24.41±2.09) kg/m². The patients with non-infectious endophthalmitis were (64.8±7.8 )years old, (3.06±0.97) d, (24.00±2.24) kg/m². The difference was not statistically significant in the mean age length of hospital stay, body mass index between patients with infectious endophthalmitis and non-infectious endophthalmitis after ophthalmic surgery (t=1.171, 1.154, 0.261; P>0.05). The number patient of infectious endophthalmitis with smoking history, drinking history, diabetes mellitus, hypertension, hyperlipidemia, history of serious disease, preoperative low hemoglobin, preoperative low serum albumin, wrong use of antibacterial eye drops, day surgery, emergency surgery, general anesthesia surgery, other body infections before surgery, and postoperative history of eye contamination were 28 cases (28 eyes), 19 cases (19 eyes), 42 cases (42 eyes), 29 cases (29 eyes), 23 cases (23 eyes), 21 cases (21 eyes), 12 cases (12 eyes), 20 cases (20 eyes), 5 cases (5 eyes), 28 cases (28 eyes), 3 cases (3 eyes), 2 cases (2 eyes), 6 cases (6 eyes), 10 cases (10 eyes) and 4 cases (4 eyes), respectively, acctounting for 43.08%, 29.23%, 64.62%, 44.62%, 35.38%, 32.31%, 18.46%, 30.77%, 7.69%, 43.08%, 4.62%, 3.08%, 9.23%, 15.38% and 6.15%. The number patient of non-infectious endophthalmitis with those were 101 cases (101 eyes), 62cases (62 eyes), 79 cases (79 eyes), 58 cases (58 eyes), 63 cases (63 eyes), 22 cases (22 eyes), 30 cases (30 eyes), 19 cases (19 eyes), 8 cases (8 eyes), 93 cases (9 eyes), 11 cases (11 eyes), 4 cases (4 eyes), 9 cases (9 eyes), 12 cases (12 eyes) and 9 cases (9 eyes), respectively, acctounting for 51.79%, 31.79%, 40.51%, 29.74%, 32.31%, 11.28%, 15.38%, 9.74%, 4.10%, 47.69%, 5.64%, 2.05%, 4.62%, 6.15% and4.62%. Multivariate Logistic regression analysis showed that diabetes mellitus, low serum albumin before surgery and history of disease and, dirt getting into the eye after surgery were risk factors for infectious endophthalmitis after ophthalmic surgery (OR=2.039, 3.021, 2.803, 3.095; P<0.05). There were 41 strains of pathogenic bacteria, and no fungal infection cases were detected, the detection rate was 63.08%. Among them, there were 1 strain with G+ bacillus, 26 strains with G+ coccus and 14 strains with G-bacillus, accounting for 2.44%, 63.41% and 34.15%, respectively. The occurrence time of postoperative infection symptoms of 65 patients (65 eyes) of infectious endophthalmitis after ophthalmic surgery was (4.48±4.46) days. Among them, there were 53 cases (53 eyes), 55 cases (55 eyes), 35 cases (35 eyes), and 62 cases (62 eyes) with conjunctival congestion, eye pain, foreign body sensation, and blurred vision, accounting for 81.53%, 84.62%, 53.85%, and 95.38%, respectively. The onset time of infection symptoms in patients with G+ bacteria, G-bacteria, and sterile growth is (3.56±1.71) d, (1.85±1.21) d, and (4.87±3.75) d, respectively. Among 65 patients (65 eyes), 4 cases (4 eyes), 10 cases (10 eyes), 49 cases (49 eyes), and 2 cases (2 eyes) underwent intravitreal injection, anterior chamber lavage combined with intravitreal injection, vitrectomy, and enucleation, respectively, accounting for 15.38%, 6.15%, 75.38%, and 3.08%, respectively. The prognostic visual acuity of patients with G+ bacteria, G-bacteria, and sterile growth were 3.00 (1.65), 1.00 (1.50), and 3.30 (2.40), respectively.

Diabetes mellitus, low serum albumin before surgery, a history of ease, and dirt getting into the eye after surgery may increase the risk of surgical site infection in ophthalmology surgery. Different pathogenic bacteria had different effects on the onset time of postoperative infection symptoms and the recovery of vision.