目的

探讨山西省感染性眼内炎的病原菌分布及预后的影响因素。

方法

选取2011年至2024年于山西省眼科医院角膜科收治确诊感染性眼内炎患者412例（412只眼）的临床资料。其中，男性318例（318只眼），女性94例（94只眼）；年龄1～86岁，平均年龄（52.1±19.4）岁。外周血白细胞计数（WBC）、中性粒细胞绝对值（NEUT＃）等计量资料不符合正态分布，采用中位数和上下四分位数描述，组间比较采用非参数检验Mann-Whitney U检验；细菌株数、致病因素分布、病原菌耐药率、眼别、有无异物残留、视网膜脱离、有无外伤及就诊时间等计数资料以例数和百分比表示，组间比较使用Pearson卡方检验。

结果

1～≤14岁、＞14～≤65岁及＞65～86岁感染者分别为43例（43只眼）、296例（296只眼）及73例（73只眼），分别占10.4%、71.8%及17.7%，主要病原菌分别以链球菌属、表皮葡萄球菌及表皮葡萄球菌。412例（412只眼）感染性眼内炎患者中外伤性眼内炎者283例（283只眼），内眼手术感染患者126例（126只眼），分别占68.7%和30.6%。治愈后视力≥0.1者151例（151只眼），治愈后视力＜0.1者261例（261只眼），分别占36.6%和63.4% 。感染性眼内炎患者中革兰阳性菌、阴性菌及真菌分别为331株、78株及3株，分别占80.3%、18.9%及0.7%。其中，革兰阳性菌以表皮葡萄球菌和链球菌属为主，分别占47.3%和22.2%；革兰阴性菌以铜绿假单胞菌为主，占17.9%。外伤性眼内炎主要感染致病菌以表皮葡萄球菌为主，占49.1%。治愈后视力≥0.1者WBC、NEUT＃、NLR的中位数和四分位数分别为6.77（6.19，7.76）×10⁹/L、5.11（3.24，5.49）×10⁹/L及3.75（3.13，4.49）×10⁹/L；治愈后视力＜0.1者分别为9.21（7.83，9.93）×10⁹/L、5.52（5.01，6.01）×10⁹/L及4.29（3.88，4.88）×10⁹/L。经Mann-Whitney U检验，差异有统计学意义（Z＝-11.563，-6.562，-5.323；P＜0.05）。治愈后视力≥0.1者右眼、就诊时间≥24 h、有外伤、初始视力＜0.1、有异物残留及有视网膜脱离者分别为77例（77只眼）、92例（92只眼）、88例（88只眼）、141例（141只眼）、5例（5只眼）及11例（11只眼），分别占51.0%、60.9%、58.3%、93.4%、3.3%及7.3%；治愈后视力＜0.1者分别为136例（136只眼）、192例（192只眼）、195例（195只眼）、255例（255只眼）、13例（13只眼）及50例（50只眼），分别占52.1%、73.6%、74.7%、97.7%、5.0%及19.2%。经χ²检验，初始视力、就诊时间、有无视网膜脱离及有无外伤组间比较差异有统计学意义（χ²＝0.029，0.008，0.001，0.001；P＜0.05）。

结论

山西省感染性眼内炎主要以外伤性眼内炎为主，病原菌以表皮葡萄球菌为主。眼球破裂伤后感染性眼内炎发生率较高，WBC、NEUT＃、NLR、初始视力、就诊时间、有无视网膜脱离及有无外伤是视力预后的影响因素。

Objective

The aim of this study is to investigate the distribution of pathogenic bacteria and the influencing factors of prognosis of infectious endophthalmitis in Shanxi Province.

Methods

The clinical data of 412 patients（412 eyes）with infectious endophthalmitis diagnosed at Department of Keratology of Shanxi Eye Hospital from 2011 to 2024 were selected.Among them，there were 318 males（318 eyes）and 94 females（94 eyes）with an average age of（52.1±19.4）years（ranging from 1 to 86 years）.Peripheral blood white blood cell count（WBC），neutrophil absolute value（NEUT＃）and peripheral blood neutrophil absolute value-lymphocyte absolute value（NLR）were described by median and upper and lower quartiles when the measurement data did not conform to the normal distribution.Non-parametric test Mann-Whitney U test was used for comparison between groups.The data on number of bacterial strains and cause of disease，the distribution，and the drug resistance rate of pathogenic bacteria，strabismus，presence of foreign bodies，residual conditions，retinal detachment，presence of trauma，and time of visit were expressed as the number of cases and percentages and compared using chi-square test between groups.

Results

There were 43 cases（43 eyes），296 cases（296 eyes）and 73 cases（73 eyes）in 1 to≤14 years old，＞14 to≤65 years old and ＞65 to 86 years old，accounting for 10.4%，71.8% and 17.7%，respectively.The main pathogens were Streptococcus，Staphylococcus epidermidis and Staphylococcus epidermidis.Among 412 cases（412 eyes）with infectious endophthalmitis，283 cases（283 eyes）were traumatic endophthalmitis，and 126 cases（126 eyes）were infected by intraocular surgery，accounting for 68.7% and 30.6%，respectively.Prognostic visual acuity was≥0.1 in 151 cases（151 eyes）and＜0.1 in 261 cases（261 eyes），accounting for 36.6%，63.4%.Among the patients with infectious endophthalmitis，there were 331 strains of gram-positive bacteria，78 strains of gram-negative bacteria and 3 strains of fungi，respectively，accounting for 80.3%，18.9% and 0.7%，respectively.Among them，Staphylococcus epidermidis and Streptococcus were the main gram-positive bacteria，accounting for 47.3%and 22.2%，respectively；gram-negative bacteria were mainly Pseudomonas aeruginosa，accounting for 17.9%.The main pathogenic bacteria of traumatic endophthalmitis was Staphylococcus epidermidis，accounting for 49.1%.The median and quartile of WBC，NEUT＃and NLRin patients with visual acuity≥0.1 were 6.77（6.19，7.76）×10⁹/L，5.11（3.24，5.49）×10⁹/L and 3.75（3.13，4.49）×10⁹/L，respectively；those of patients with prognostic visual acuity＜0.1 were 9.21（7.83，9.93）×10⁹/L，5.52（5.01，6.01）×10⁹/L and 4.29（3.88，4.88）×10⁹/L.There was a statistically significant difference between them（Z＝-11.563，-6.562，-5.323；P＜0.05）.There were 77 cases（77 eyes）with prognostic visual acuity≥0.1 in the right eye，92 cases（92 eyes）with visiting time≥24 h，88 cases（88 eyes）with trauma and 141 cases（141 eyes）with initial visual acuity ＜0.1，5 cases（5 eyes）with residual foreign body and 11 cases（11 eyes）with retinal detachment，accouting for 51.0%，60.9%，58.3%，93.4%，3.3% and 7.3%；the prognosis of patients with visual acuity＜0.1 were 136 cases（136 eyes），192 cases（192 eyes），195 cases（195 eyes），255 cases（255 eyes），13 cases（13 eyes）and 50 cases（50 eyes），respectively，accouting for 52.1%，73.6%，74.7%，97.7%，5.0% and 19.2%.There were significant differences in the initial visual acuity，treatment time，retinal detachment and trauma between the groups（χ²＝0.029，0.008，0.001，0.001；P＜0.05）.

Conclusions

Infectious endophthalmitis in Shanxi Province is mainly traumatic endophthalmitis，and the pathogenic bacteria are mainly Staphylococcus epidermidis.The incidence of infectious endophthalmitis after ocular rupture is high.WBC，NEUT＃，NLR，initial visual acuity，visiting time，retinal detachment and trauma were the influencing factors of visual prognosis.