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AAC:金黄色葡萄球菌扩散到眼球威胁视力

  1. 抗生素
  2. 视力
  3. 金黄色葡萄球菌

来源:本站原创 2016-02-01 10:47

在一项新的研究中,一个韩国临床研究小组发现将近10%的血液金黄色葡萄球菌感染能够从血液扩散到眼球中。这种扩散能够严重损害视力,甚至导致失明。
2016年2月1日讯 /生物谷BIOON/ --金黄色葡萄球菌 (Staphylococcus aureus ) 是人类的一种重要病原菌,隶属于葡萄球菌属(Staphylococcus),有“嗜肉菌"的别称,是革兰氏阳性菌的代表,可引起许多严重感染。金黄色葡萄球菌在自然界中无处不在,空气、水、灰尘及人和动物的排泄物中都可找到。因此,食品受到污染的机会很多。美国疾病控制中心报告,由金黄色葡萄球菌引起的感染占第二位,仅次于大肠杆菌。金黄色葡萄球菌肠毒素是个世界性卫生难题。

在一项新的研究中,一个韩国临床研究小组发现将近10%的血液金黄色葡萄球菌感染能够从血液扩散到眼球中。这种扩散能够严重损害视力,甚至导致失明。相关研究结果近期发表在Antimicrobial Agents and Chemotherapy期刊上。

除了血液感染外,金黄色葡萄球菌感染眼球的风险因子包括心内膜炎,即心室和心瓣内膜内的炎症,和金黄色葡萄球菌体内多处感染。论文通讯作者、韩国蔚山大学医学院峨山医学中心传染病科助理教授Yong Pil Chong博士说,眼球金黄色葡萄球菌感染经常没有症状出现,这就突出强调了检查病人的金黄色葡萄球菌感染是否扩散到眼球的重要性。
 
Chong说,“如果病人遭受严重感染,如眼内炎,除了全身性抗生素治疗外还需要采取诸如玻璃体切除术和玻璃体腔内抗生素注射之类的局部治疗。眼内炎是一种眼球内的感染。玻璃体切除术一种能够治疗这种疾病的外科手术。我们经常观察到金黄色葡萄球菌血液感染的病人丧失视力。”
 
在这项研究中,研究人员分析了612名金黄色葡萄球菌血液感染患者中眼球感染发病率及其风险因子,其中15名病人患有眼内炎,另外还有41人患有脉络膜视网膜炎,其中后者是一种在眼球中层发生的炎症,也能够导致严重的视力丧失。眼球中层含有眼球中的绝大多数血管。Chong说,“在我们的研究中,还没有病人失明,但是一些病人的视力因为眼球感染而持续下降。”
 
Chong说,早期检测和治疗眼球感染是维持良好视力的关键,“因此,我们认为对金黄色葡萄球菌血液感染患者进行眼球检查是比较重要的。”(生物谷Bioon.com)

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doi:10.1128/AAC.02651-15

Ocular involvement of bacteremia: incidence and risk factors

Jiwon Jung1, Junyeop Lee2, Shi Nae Yu1, Yong Kyun Kim1, Ju Young Lee1, Heungsup Sung3, Mi-Na Kim3, Sung-Han Kim1, Sang-Oh Lee1, Sang-Ho Choi1, Jun Hee Woo1, Joo Yong Lee2, Yang Soo Kim1 and Yong Pil Chong1

Staphylococcus aureus bacteremia (SAB) often leads to ocular infection including endophthalmitis and chorioretinitis. However, the incidence, risk factors, and outcome of ocular infection complicated by SAB are largely unknown. We retrospectively analyzed the incidence and risk factors of ocular involvement in a prospective cohort of patients with SAB at a tertiary-care hospital. Ophthalmologists reviewed the fundoscopic findings and classified the ocular infection as endophthalmitis or chorioretinitis. During the 5 year study period, 1,109 patients had SAB and 612 (55%) who underwent ophthalmic examination within 14 days after SAB were analyzed. Of these 612 patients, 56 (9%, 95% confidence interval [CI], 7-12%) had ocular involvement; 15 (2.5%) with endophthalmitis and 41 (6.7%) with chorioretinitis. In multivariate analysis, infective endocarditis (adjusted odds ratio [aOR], 5.74; 95% CI, 2.25-14.64) and metastatic infection (aOR, 2.38; 95% CI, 1.29-4.39) were independent risk factors for ocular involvement. Of the 47 patients with ocular involvement who could communicate, only 17 (36%) had visual disturbance. Two-thirds (10/15) of the patients with endophthalmitis were treated with intravitreal antibiotics combined with parenteral antibiotics, whereas all the patients with chorioretinitis were treated with systemic antibiotics only. No one became blinded. Among 42 patients with follow-up assessment available, the ocular lesion improved in 29 (69%) but remained stationary in the others. Ocular involvement was independently associated with 30-day mortality after SAB. Ocular involvement is not uncommon in patients with SAB. Routine ophthalmic examination should be considered in patients with infective endocarditis or metastatic infection caused by SAB.

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