白内障超声乳化术中灌注液加入头孢呋辛对房水细菌污染的控制作用
|
摘要
目的评估白内障超声乳化术中灌注液加入头孢呋辛对房水细菌污染的控制作用。方法选取2017年5月至8月在青岛眼科医院接受白内障超声乳化手术治疗的患者为研究对象,根据术中灌注液的不同分为两组,对照组99例(102眼)使用平衡盐溶液灌注液;试验组93例(100眼)使用含头孢呋辛(1.5 g·L~(-1))的平衡盐溶液灌注液。两组患者分别于入院时(未局部应用抗菌药物前)、术前(聚维酮碘冲洗结膜囊后)行结膜囊细菌培养,于手术结束时行房水细菌培养,并对两组患者结膜囊及房水细菌培养结果进行比较。结果入院时,对照组与试验组结膜囊细菌培养阳性率为50.00%和51.00%,差异无统计学意义(χ~2=0.020,P=0.887);术前,对照组与试验组结膜囊细菌培养阳性率为25.5%和27.0%,差异无统计学意义(χ~2=0.059,P=0.807);手术结束时,对照组与试验组房水细菌培养阳性率为5.9%和0,差异有统计学意义(F=6.062,P=0.029)。结论使用含头孢呋辛(1.5 g·L~(-1))的灌注液能减少白内障超声乳化术的房水细菌污染。
Objective To assess the effect of intraoperative cefuroxime in irrigating solutions on contamination of anterior chamber(AC) aspirates during phacoemulsification.Methods Patients undergoing phacoemulsification of cataract in the Qingdao eye hospital during May 2017 and August 2017 were enrolled in this study,and were divided into two groups according to different irrigation used during the operation.In the control group,99 patients(102 eyes) received balanced salt perfusion solution,while in the experimental group,93 patients(100 eyes) received balanced salt perfusion solution with cefuroxime(1.5 g·L~(-1)).Conjunctival bacterial cultures were conducted in all patients at the time of admission(before use of topical antibiotics),and before surgery(after povidone iodine rinsing conjunctival sac);at the end of operation,aqueous humor samples were taken and sent for enrichment cultures.Bacteriological culture positive rates of conjunctival sac and AC aspirate were compared.Results At the time of admission,the positive rate of conjunctival sac culture in control group and experiment group was 50.00% and 51.00%,respectively,and there was no significant difference between two groups(χ~2=0.020,P=0.887).Before surgery,the positive rate of conjunctival sac culture was 25.5% and 27.0%,respectively,and there was no significant difference between two groups(χ~2=0.059,P=0.807).At the end of operation,the positive rate of AC aspirate culture in control group and experiment group was 5.9% and 0,respectively,and there was statistically significant difference between two groups(χ~2=6.062,P=0.029).Conclusion The use of irrigation fluid containing cefuroxime(1.5 g·L~(-1)) during phacoemulsification can reduce the microbial contamination of aqueous humor.
Objective To assess the effect of intraoperative cefuroxime in irrigating solutions on contamination of anterior chamber(AC) aspirates during phacoemulsification.Methods Patients undergoing phacoemulsification of cataract in the Qingdao eye hospital during May 2017 and August 2017 were enrolled in this study,and were divided into two groups according to different irrigation used during the operation.In the control group,99 patients(102 eyes) received balanced salt perfusion solution,while in the experimental group,93 patients(100 eyes) received balanced salt perfusion solution with cefuroxime(1.5 g·L~(-1)).Conjunctival bacterial cultures were conducted in all patients at the time of admission(before use of topical antibiotics),and before surgery(after povidone iodine rinsing conjunctival sac);at the end of operation,aqueous humor samples were taken and sent for enrichment cultures.Bacteriological culture positive rates of conjunctival sac and AC aspirate were compared.Results At the time of admission,the positive rate of conjunctival sac culture in control group and experiment group was 50.00% and 51.00%,respectively,and there was no significant difference between two groups(χ~2=0.020,P=0.887).Before surgery,the positive rate of conjunctival sac culture was 25.5% and 27.0%,respectively,and there was no significant difference between two groups(χ~2=0.059,P=0.807).At the end of operation,the positive rate of AC aspirate culture in control group and experiment group was 5.9% and 0,respectively,and there was statistically significant difference between two groups(χ~2=6.062,P=0.029).Conclusion The use of irrigation fluid containing cefuroxime(1.5 g·L~(-1)) during phacoemulsification can reduce the microbial contamination of aqueous humor.
引文
[1] YAO K,ZHU Y,ZHU Z,WU J,LIU Y,LU Y,et al.The incidence of postoperative endophthalmitis after cataract surgery in China:a multicenter investigation of 2006-2011[J].Br J Ophthalmol,2013,97(10):1312-1317.
[2] ZHU Y,CHEN X,CHEN P,WU J,HUA H,YAO K.The occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small- and medium-scale departments of ophthalmology[J].Scientific Reports,2017,7:40776.
[3] SPEAKER M G,MILCH F A,SHAH M K,EISNER W,KREISWIRTH B N.Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis[J].Ophthalmology,1991,98(5):639-650.
[4] GWON A.Topical ofloxacin compared with gentamicin in the treatment of external ocular infection.Ofloxacin Study Group[J].Br J Ophthalmol,1992,76(12):714-718.
[5] BAUSZ M,FODOR E,RESCH M D,KRISTOF K.Bacterial contamination in the anterior chamber after povidone-iodine application and the effect of the lens implantation device[J].J Cataract Refract Surg,2006,32(10):1691-1695.
[6] LEONG J K,SHAH R,MCCLUSKEY P J,BENN R A,TAYLOR R F.Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery[J].J Cataract Refract Surg,2002,28(5):826-833.
[7] SRINIVASAN R,GUPTA A,KALIAPERUMAL S,BABU R K,THIMMARAYAN S K,BELGODE H N.Efficacy of intraoperative vancomycin in irrigating solutions on aqueous contamination during phacoemulsification[J].Indian J Ophthalmol,2008,56(5):399-402.
[8] DICKEY J B,THOMPSON K D,JAY W M.Anterior chamber aspirate cultures after uncomplicated cataract surgery[J].Am J Ophthalmol,1991,112(3):278-282.
[9] CHANG D F,BRAGA-MELE R,MAMALIS N,MASKET S,MILLER K M,NICHAMIN L D,et al.Prophylaxis of postoperative endophthalmitis after cataract surgery:results of the 2007 ASCRS member survey[J].J Cataract Refract Surg,2007,33(10):1801-1805.
[10] CHANG D F,BRAGA-MELE R,HENDERSON B A,MAMALIS N,VASAVADA A.Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery:Results of the 2014 ASCRS member survey[J].J Cataract Refract Surg,2015,41(6):1300-1305.
[11] ENDOPHTHALMITIS STUDY GROUP,EUROPEAN SOCIETY OF CATARACT & REFRATIVE SURGEONS.Prophylaxis of postoperative endophthalmitis following cataract surgery:results of the ESCRS multicenter study and identification of risk factors[J].J Cataract Refract Surg,2007,33(6):978-988.
[12] RODRIGUEZ-CARAVACA G,GARCIA-SAENZ M C,VILLAR-DEL-CAMPO M C,ANDRES-ALBA Y,ARIAS-PUENTE A.Incidence of endophthalmitis and impact of prophylaxis with cefuroxime on cataract surgery[J].J Cataract Refract Surg,2013,39(9):1399-1403.
[13] HERRINTON L J,SHORSTEIN N H,PASCHAL J F,LIU L,CONTRERAS R,WINTHROP K L,et al.Comparative effectiveness of antibiotic prophylaxis in cataract surgery[J].Ophthalmology,2016,123(2):287-294.
[14] CHINESE MEDICAL ASSOCIATION OPHTHALMOLOGY BR-ANCH OF CATARACT AND INTRAOCULAR LENS GROUP.Expert consensus on prevention and treatment of infective endophthalmitis after cataract extraction in China (2017)[J].Chin J Ophthalmol,2017,53(11):810-813.中华医学会眼科学分会白内障及人工晶状体学组.我国白内障摘除手术后感染性眼内炎防治专家共识(2017年)[J].中华眼科杂志,2017,53(11):810-813.
[15] HUANG Y S,DAI Y H,SUN S Y,LAN J,XIE L X.Study of different methods in reducing conjunctival bacteria before cataract surgery[J].Chin Med J,2009,35(89):2458-2461.黄钰森,代云海,孙士营,蓝婕,谢立信.白内障患者术前结膜囊细菌的清除方法[J].中华医学杂志,2009,35(89):2458-2461.
[16] ARANTES T E,CAVALCANTI R F,DINIZMDE F,SEVERO M S,LINS NETO J,CASTRO C M.Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery[J].Arq Bras Oftalmol,2006,69(1):33-36.
[17] GENTILE R C,SHUKLA S,SHAH M,RITTERBAND D C,ENGELBERT M,DAVIS A,et al.Microbiological spectrum and antibiotic sensitivity in endophthalmitis:a 25-year review[J].Ophthalmology,2014,121(8):1634-1642.
[18] MENDIVIL SOTO A,MENDIVIL M P.The effect of topical povidone-iodine,intraocular vancomycin,or both on aqueous humor cultures at the time of cataract surgery[J].Am J Ophthalmol,2001,131(3):293-300.
[19] AXER-SIEGEL R,STIEBEL-KALISH H,ROSENBLATT I,STRAS-SMANN E,YASSUR Y,WEINBERGER D.Cystoid macular edema after cataract surgery with intraocular vancomycin[J].Ophthalmology,1999,106(9):1660-1664.
[20] WITKIN A J,SHAH A R,ENGSTROM R E,KRON-GRAY M M,BAUMAL C R,JOHNSON M W,et al.Postoperative hemorrhagic occlusive retinal vasculitis:Expanding the clinical spectrum and possible association with vancomycin[J].Ophthalmology,2015,122(7):1438-1451.
[21] Recommendations for preventing the spread of vancomycin resistance:Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)[J].Am J Infect Control,1995,23(2):87-94.
[22] CONTE J E,J R.,COHEN S N,ROE B B,ELASHOFF R M.Antibiotic prophylaxis and cardiac surgery.A prospective double-blind comparison of single-dose versus multiple-dose regimens[J].Ann Intern Med,1972,76(6):943-949.
[23] Chinese Medical Association Ophthalmology Branch of Cataract And Intraocular Lens Group.Expert advice on the standardization of perioperative infection prevention measures[J].Chin J Ophthalmol,2013,49(1):76-78.中华医学会眼科学分会白内障和人工晶状体学组.关于白内障围手术期预防感染措施规范化的专家建议(2013年)[J].中华眼科杂志,2013,49(1):76-78.
[24] MONTAN P G,WEJDE G,KORANYI G,RYLANDER M.Prop-hylactic intracameral cefuroxime.Efficacy in preventing endophthalmitis after cataract surgery[J].J Cataract Refract Surg,2002,28(6):977-981.
[25] SCOTT L J,ORMROD D,GOA K L.Cefuroxime axetil:an updated review of its use in the management of bacterial infections[J].Drugs,2001,61(10):1455-1500.
[26] OLAVI P.Ocular toxicity in cataract surgery because of inaccurate preparation and erroneous use of 50mg/ml intracameral cefuroxime[J].Acta Ophthalmol,2012,90(2):e153-154.
[27] CAKIR M,IMAMOGLU S,CEKIC O,BOZKURT E,ALAGOZ N,OKSUZ L,et al.An outbreak of early-onset endophthalmitis caused by Fusarium species following cataract surgery[J].Curr Eye Res,2009,34(11):988-995.
[28] KEATING G M.Intracameral cefuroxime:prophylaxis of pos-toperative endophthalmitis after cataract surgery[J].Drugs,2013,73(2):179-186.
[29] BARRY P,CORDOVéS L,GARDNER S.ESCRS guidelines for prevention and treatment of endophthalmitis following cataract surgery:data,dilemmas and conclusions 2013[EB/OL].(2014-03-12)[2016-12-28].http://www.escrs.org/downloads/E-ndophthalmitis Guidelines.pdf.
[30] SUZUKI T,YAMAMOTO T,TORIKAI T,OHASHI Y.Combination effect of cefuroxime and levofloxacin against bacteria isolated from the healthy conjunctival sac and endophthalmitis cases using a fractional inhibitory concentration index[J].J Ocul Pharmacol Ther,2017,33(1):19-23.
[31] MONTAN P G,WEJDE G,SETTERQUIST H,RYLANDER M,ZETTERSTROM C.Prophylactic intracameral cefuroxime.Evaluation of safety and kinetics in cataract surgery[J].J Cataract Refract Surg,2002,28(6):982-987.
[32] SHAHRAKI K,FARD M N A,SHAHRI F,POURMATIN R,MOHAMMADI T,BOROUMAND P G,et al.Effects of intracameral cefuroxime on corneal endothelial cell counts and its morphology after cataract surgery[J].Interv Med Appl Sci,2017,9(2):100-104.
[33] MOISSEIEV E,LEVINGER E.Anaphylactic reaction following intracameral cefuroxime injection during cataract surgery[J].J Cataract Refract Surg,2013,39(9):1432-1434.
[2] ZHU Y,CHEN X,CHEN P,WU J,HUA H,YAO K.The occurrence rate of acute-onset postoperative endophthalmitis after cataract surgery in Chinese small- and medium-scale departments of ophthalmology[J].Scientific Reports,2017,7:40776.
[3] SPEAKER M G,MILCH F A,SHAH M K,EISNER W,KREISWIRTH B N.Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis[J].Ophthalmology,1991,98(5):639-650.
[4] GWON A.Topical ofloxacin compared with gentamicin in the treatment of external ocular infection.Ofloxacin Study Group[J].Br J Ophthalmol,1992,76(12):714-718.
[5] BAUSZ M,FODOR E,RESCH M D,KRISTOF K.Bacterial contamination in the anterior chamber after povidone-iodine application and the effect of the lens implantation device[J].J Cataract Refract Surg,2006,32(10):1691-1695.
[6] LEONG J K,SHAH R,MCCLUSKEY P J,BENN R A,TAYLOR R F.Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery[J].J Cataract Refract Surg,2002,28(5):826-833.
[7] SRINIVASAN R,GUPTA A,KALIAPERUMAL S,BABU R K,THIMMARAYAN S K,BELGODE H N.Efficacy of intraoperative vancomycin in irrigating solutions on aqueous contamination during phacoemulsification[J].Indian J Ophthalmol,2008,56(5):399-402.
[8] DICKEY J B,THOMPSON K D,JAY W M.Anterior chamber aspirate cultures after uncomplicated cataract surgery[J].Am J Ophthalmol,1991,112(3):278-282.
[9] CHANG D F,BRAGA-MELE R,MAMALIS N,MASKET S,MILLER K M,NICHAMIN L D,et al.Prophylaxis of postoperative endophthalmitis after cataract surgery:results of the 2007 ASCRS member survey[J].J Cataract Refract Surg,2007,33(10):1801-1805.
[10] CHANG D F,BRAGA-MELE R,HENDERSON B A,MAMALIS N,VASAVADA A.Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery:Results of the 2014 ASCRS member survey[J].J Cataract Refract Surg,2015,41(6):1300-1305.
[11] ENDOPHTHALMITIS STUDY GROUP,EUROPEAN SOCIETY OF CATARACT & REFRATIVE SURGEONS.Prophylaxis of postoperative endophthalmitis following cataract surgery:results of the ESCRS multicenter study and identification of risk factors[J].J Cataract Refract Surg,2007,33(6):978-988.
[12] RODRIGUEZ-CARAVACA G,GARCIA-SAENZ M C,VILLAR-DEL-CAMPO M C,ANDRES-ALBA Y,ARIAS-PUENTE A.Incidence of endophthalmitis and impact of prophylaxis with cefuroxime on cataract surgery[J].J Cataract Refract Surg,2013,39(9):1399-1403.
[13] HERRINTON L J,SHORSTEIN N H,PASCHAL J F,LIU L,CONTRERAS R,WINTHROP K L,et al.Comparative effectiveness of antibiotic prophylaxis in cataract surgery[J].Ophthalmology,2016,123(2):287-294.
[14] CHINESE MEDICAL ASSOCIATION OPHTHALMOLOGY BR-ANCH OF CATARACT AND INTRAOCULAR LENS GROUP.Expert consensus on prevention and treatment of infective endophthalmitis after cataract extraction in China (2017)[J].Chin J Ophthalmol,2017,53(11):810-813.中华医学会眼科学分会白内障及人工晶状体学组.我国白内障摘除手术后感染性眼内炎防治专家共识(2017年)[J].中华眼科杂志,2017,53(11):810-813.
[15] HUANG Y S,DAI Y H,SUN S Y,LAN J,XIE L X.Study of different methods in reducing conjunctival bacteria before cataract surgery[J].Chin Med J,2009,35(89):2458-2461.黄钰森,代云海,孙士营,蓝婕,谢立信.白内障患者术前结膜囊细菌的清除方法[J].中华医学杂志,2009,35(89):2458-2461.
[16] ARANTES T E,CAVALCANTI R F,DINIZMDE F,SEVERO M S,LINS NETO J,CASTRO C M.Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery[J].Arq Bras Oftalmol,2006,69(1):33-36.
[17] GENTILE R C,SHUKLA S,SHAH M,RITTERBAND D C,ENGELBERT M,DAVIS A,et al.Microbiological spectrum and antibiotic sensitivity in endophthalmitis:a 25-year review[J].Ophthalmology,2014,121(8):1634-1642.
[18] MENDIVIL SOTO A,MENDIVIL M P.The effect of topical povidone-iodine,intraocular vancomycin,or both on aqueous humor cultures at the time of cataract surgery[J].Am J Ophthalmol,2001,131(3):293-300.
[19] AXER-SIEGEL R,STIEBEL-KALISH H,ROSENBLATT I,STRAS-SMANN E,YASSUR Y,WEINBERGER D.Cystoid macular edema after cataract surgery with intraocular vancomycin[J].Ophthalmology,1999,106(9):1660-1664.
[20] WITKIN A J,SHAH A R,ENGSTROM R E,KRON-GRAY M M,BAUMAL C R,JOHNSON M W,et al.Postoperative hemorrhagic occlusive retinal vasculitis:Expanding the clinical spectrum and possible association with vancomycin[J].Ophthalmology,2015,122(7):1438-1451.
[21] Recommendations for preventing the spread of vancomycin resistance:Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)[J].Am J Infect Control,1995,23(2):87-94.
[22] CONTE J E,J R.,COHEN S N,ROE B B,ELASHOFF R M.Antibiotic prophylaxis and cardiac surgery.A prospective double-blind comparison of single-dose versus multiple-dose regimens[J].Ann Intern Med,1972,76(6):943-949.
[23] Chinese Medical Association Ophthalmology Branch of Cataract And Intraocular Lens Group.Expert advice on the standardization of perioperative infection prevention measures[J].Chin J Ophthalmol,2013,49(1):76-78.中华医学会眼科学分会白内障和人工晶状体学组.关于白内障围手术期预防感染措施规范化的专家建议(2013年)[J].中华眼科杂志,2013,49(1):76-78.
[24] MONTAN P G,WEJDE G,KORANYI G,RYLANDER M.Prop-hylactic intracameral cefuroxime.Efficacy in preventing endophthalmitis after cataract surgery[J].J Cataract Refract Surg,2002,28(6):977-981.
[25] SCOTT L J,ORMROD D,GOA K L.Cefuroxime axetil:an updated review of its use in the management of bacterial infections[J].Drugs,2001,61(10):1455-1500.
[26] OLAVI P.Ocular toxicity in cataract surgery because of inaccurate preparation and erroneous use of 50mg/ml intracameral cefuroxime[J].Acta Ophthalmol,2012,90(2):e153-154.
[27] CAKIR M,IMAMOGLU S,CEKIC O,BOZKURT E,ALAGOZ N,OKSUZ L,et al.An outbreak of early-onset endophthalmitis caused by Fusarium species following cataract surgery[J].Curr Eye Res,2009,34(11):988-995.
[28] KEATING G M.Intracameral cefuroxime:prophylaxis of pos-toperative endophthalmitis after cataract surgery[J].Drugs,2013,73(2):179-186.
[29] BARRY P,CORDOVéS L,GARDNER S.ESCRS guidelines for prevention and treatment of endophthalmitis following cataract surgery:data,dilemmas and conclusions 2013[EB/OL].(2014-03-12)[2016-12-28].http://www.escrs.org/downloads/E-ndophthalmitis Guidelines.pdf.
[30] SUZUKI T,YAMAMOTO T,TORIKAI T,OHASHI Y.Combination effect of cefuroxime and levofloxacin against bacteria isolated from the healthy conjunctival sac and endophthalmitis cases using a fractional inhibitory concentration index[J].J Ocul Pharmacol Ther,2017,33(1):19-23.
[31] MONTAN P G,WEJDE G,SETTERQUIST H,RYLANDER M,ZETTERSTROM C.Prophylactic intracameral cefuroxime.Evaluation of safety and kinetics in cataract surgery[J].J Cataract Refract Surg,2002,28(6):982-987.
[32] SHAHRAKI K,FARD M N A,SHAHRI F,POURMATIN R,MOHAMMADI T,BOROUMAND P G,et al.Effects of intracameral cefuroxime on corneal endothelial cell counts and its morphology after cataract surgery[J].Interv Med Appl Sci,2017,9(2):100-104.
[33] MOISSEIEV E,LEVINGER E.Anaphylactic reaction following intracameral cefuroxime injection during cataract surgery[J].J Cataract Refract Surg,2013,39(9):1432-1434.