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복합 세균각막염과 단일 세균각막염의 임상 비교 분석

Comparative Clinical Analysis of Polymicrobial and Monomicrobial Bacterial Keratitis

이상범|조찬호|백승철
대한안과학회 (The Korean Ophthalmological Society)|2021.11|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제62권 제11호|pp. 1465-1477

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키워드

Polymicrobial infectionCorneal ulcerBacterial keratitis
주제분류안과학

초록

목적: 복합 세균각막염의 균주분포, 선행인자, 임상양상 및 치료 결과를 단일 세균각막염과 비교해 보고자 하였다. 대상과 방법: 2007년부터 2016년까지 감염각막염으로 치료받고 배양검사에서 세균이 동정된 194안을 대상으로 하여 후향적으로 분석하였다. 전체 군을 복합세균감염(polymicrobial bacterial keratitis [PBK], 29안 62균주)과 단일세균감염(monomicrobial bacterial keratitis [MBK], 165안 165균주)으로 나누어 균주분포, 역학, 선행인자, 임상양상 및 치료 결과를 비교하였다. 결과: PBK에서 Enterobacter spp. (24%), MBK에서 Staphylococcus spp. (22%)가 가장 흔했다. 두 군 사이에 안구표면질환, 안수술력, 이전 스테로이드 사용 비율, 상피결손크기 및 전방축농 비율은 차이가 없었다. 나이 ≥60세(PBK vs. MBK, 31% vs. 51%, p=0.048), 증상 내원 기간(4.7일 vs. 8.0일, p=0.009) 및 콘택트렌즈 착용(34% vs. 18%, p=0.036)은 두 군 간에 차이를 보였다. 상피재생기간 ≥10일, 최종 최대교정시력, 수술적 치료 및 불량한 임상결과는 두 군 간 차이가 없었다. 전체 군에서 불량한 임상결과의 위험인자로 초진 최대교정시력 0.1 미만(Z=6.33, two-proportion Z-test), 상피결손크기 5 mm2 이상(Z=4.56) 및 이전 안구표면질환(Z=4.36) 등이 나타났다. 결론: PBK에서 MBK에 비해 비교적 젊은 연령 분포, 콘택트렌즈 착용 및 빠른 내원과 연관된 경우가 많았다.

Abstract

Purpose: We comparatively analyzed the microbiological profiles, predisposing factors, clinical aspects, and treatment outcomes of patients with polymicrobial and monomicrobial bacterial keratitis. Methods: A total of 194 cases of culture-proven bacterial keratitis treated between January 2007 and December 2016 were reviewed. Microbiological profiles, the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between the polymicrobial group (polymicrobial bacterial keratitis [PBK]; 29 eyes, 62 isolates) and monomicrobial (monomicrobial bacterial keratitis [MBK]; 165 eyes, 165 isolates) group. Results: The most common isolates were Enterobacter (24%) in the PBK group and Staphylococcus (22%) in the MBK group. There were no significant differences between the two groups in previous ocular surface disease, previous ocular surgery, prior topical steroid use, epithelial defect size, and hypopyon. Age ≥60 years (PBK vs. MBK, 31% vs. 51%, p = 0.048), symptom duration (4.7 days vs. 8.0 days, p = 0.009), and contact lens use (34% vs. 18%, p = 0.036) were significantly different between the two groups. Regarding treatment outcomes, epithelial healing time ≥10 days, the final best-corrected visual acuity (BCVA), a need for surgical intervention, and the rate of poor clinical outcome were not significantly different between the two groups. Significant risk factors for a poor clinical outcome in all patients were an initial BCVA <0.1 (Z = 6.33, two-proportion Z-test), an epithelial defect size ≥5 mm2 (Z = 4.56), and previous ocular surface disease (Z = 4.36). Conclusions: Polymicrobial bacterial keratitis, compared to monomicrobial bacterial keratitis, was more significantly associated with younger age, contact lens use, and shorter symptom duration.

참고문헌 (52)

  1. Ahn M, "Clinical aspects and prognosis of mixed microbial(bacterial and fungal)keratitis", Cornea, 30, pp.409~413 (2011)
  2. Lim NC, "Polymicrobial versus monomicrobial keratitis : a retrospective comparative study", Eye Contact Lens, 39, pp.348~354 (2013)
  3. Fernandes M, "Comparison between polymicrobial and fungal keratitis : clinical features, risk factors, and outcome", Am J Ophthalmol, 160, pp.873~881 (2015)
  4. Tu EY, "Polymicrobial keratitis : acanthamoeba and infectious crystalline keratopathy", Am J Ophthalmol, 148, pp.13~19 (2009)
  5. Mukerji N, "Technique of area measurement of epithelial defects", Cornea, 22, pp.549~551 (2003)
  6. Green MD, "Clinical outcomes of keratitis", Clin Exp Ophthalmol, 35, pp.421~426 (2007)
  7. Biemer JJ, "Antimicrobial susceptibility testing by the Kirby-Bauer disc diffusion method", Ann Clin Lab Sci, 3, pp.135~140 (1973)
  8. Jorgensen JH, "New consensus guidelines from the Clinical and Laboratory Standards Institute for antimicrobial susceptibility testing of infrequently isolated or fastidious bacteria", Clin Infect Dis, 44, pp.280~286 (2007)
  9. den Dekker MH, "Comparability of Z-score equations of cardiac structures in hypoplastic left heart complex", J Am Soc Echocardiogr, 26, pp.1314~1321 (2013)
  10. Tuft S, "Polymicrobial infection and the eye", Br J Ophthalmol, 90, pp.257~258 (2006)
  11. Jones DB, "Polymicrobial keratitis", Trans Am Ophthalmol Soc, 79, pp.153~167 (1981)
  12. Bourcier T, "Bacterial keratitis : predisposing factors, clinical and microbiological review of 300 cases", Br J Ophthalmol, 87, pp.834~838 (2003)
  13. Ni N, "Seasonal, geographic, and antimicrobial resistance patterns in microbial keratitis: 4-year experience in eastern Pennsylvania", Cornea, 34, pp.296~302 (2015)
  14. Dickson RM, "Traumatic ulcer of the cornea with special reference to coal miners", Br J Ophthalmol, 26, pp.529~546 (1942)
  15. Liesegang TJ, "Spectrum of microbial keratitis in South Florida", Am J Ophthalmol, 90, pp.38~47 (1980)
  16. Ng AL, "Predisposing factors, microbial characteristics, and clinical outcome of microbial keratitis in a tertiary centre in Hong Kong : a 10-year experience", J Ophthalmol, 2015, pp.769436~ (2015)
  17. Kaliamurthy J, "Spectrum of bacterial keratitis at a tertiary eye care centre in India", Biomed Res Int, 2013, pp.181564~ (2013)
  18. 조은영, "15년간 그람음성세균각막염의 임상적 고찰", 대한안과학회지, 56(10), pp.1479~1488 (2015), 대한안과학회
  19. Tam ALC, "Bacterial keratitis in Toronto : a 16-year review of the microorganisms isolated and the resistance patterns observed", Cornea, 36, pp.1528~1534 (2017)
  20. Tan SZ, "Twelve-year analysis of microbial keratitis trends at a UK tertiary hospital", Eye(Lond), 31, pp.1229~1236 (2017)
  21. Peng MY, "Bacterial keratitis : isolated organisms and antibiotic resistance patterns in San Francisco", Cornea, 37, pp.84~87 (2018)
  22. Hsiao CH, "Shifting trends in bacterial keratitis in Taiwan : a 10-year review in a tertiary-care hospital", Cornea, 35, pp.313~317 (2016)
  23. Alexandrakis G, "Shifting trends in bacterial keratitis in South Florida and emerging resistance to fluoroquinolones", Ophthalmology, 107, pp.1497~1502 (2000)
  24. Shalchi Z, "Antibiotic resistance in microbial keratitis : ten-year experience of corneal scrapes in the United Kingdom", Ophthalmology, 118, pp.2161~2165 (2011)
  25. Kumar J, "Clinical aspects and etiology of mixed microbial(bacterial and fungal)keratitis", IOSR-JDMS, 15, pp.5~10 (2016)
  26. Ray M, "Triple infection keratitis", Eye Contact Lens, 40, pp.123~126 (2014)
  27. Gorski M, "Seasonal variation in the presentation of infectious keratitis", Eye Contact Lens, 42, pp.295~297 (2016)
  28. Sızmaz S, "Polymicrobial infection of the cornea due to contact lens wear", Turk J Ophthalmol, 46, pp.83~86 (2016)
  29. Venincasa VD, "Contact lens-related polymicrobial keratitis from Pantoea agglomerans and Escherichia vulneris", Am J Ophthalmol Case Rep, 1, pp.5~7 (2016)
  30. McLaughlin-Borlace L, "Bacterial biofilm on contact lenses and lens storage cases in wearers with microbial keratitis", J Appl Microbiol, 84, pp.827~838 (1998)
  31. Zegans ME, "The role of bacterial biofilms in ocular infections", DNA Cell Biol, 21, pp.415~420 (2002)
  32. Behlau I, "Microbial biofilms in ophthalmology and infectious disease", Arch Ophthalmol, 126, pp.1572~1581 (2008)
  33. Dosler S, "Biofilm modelling on the contact lenses and comparison of the in vitro activities of multipurpose lens solutions and antibiotics", PeerJ, 8, pp.e9419~ (2020)
  34. Wilson M, "Bacterial biofilms and human disease", Sci Prog, 84(Pt 3), pp.235~254 (2001)
  35. Arampatzi SI, "Biofilm formation : a complicated microbiological process", AUMJ, 38, pp.21~29 (2011)
  36. Chen M, "Novel strategies for the prevention and treatment of biofilm related infections", Int J Mol Sci, 14, pp.18488~18501 (2013)
  37. Taban M, "Acute endophthalmitis following cataract surgery : a systematic review of the literature", Arch Ophthalmol, 123, pp.613~620 (2005)
  38. West ES, "The incidence of endophthalmitis after cataract surgery among the U.S. Medicare population increased between 1994 and 2001", Ophthalmology, 112, pp.1388~1394 (2005)
  39. Elder MJ, "Biofilm-related infections in ophthalmology", Eye (Lond), 9(Pt 1), pp.102~109 (1995)
  40. Zamora KV, "Polymicrobial keratitis after a collagen cross-linking procedure with postoperative use of a contact lens : a case report", Cornea, 28, pp.474~476 (2009)
  41. Sharma N, "Polymicrobial keratitis after laser subepithelial keratomileusis", J Refract Surg, 22, pp.129~130 (2006)
  42. Ting DSJ, "Polymicrobial keratitis with Cryptococcus curvatus, Candida parapsilosis, and Stenotrophomonas maltophilia after penetrating keratoplasty : a rare case report with literature review", Eye Contact Lens, 45, pp.e5~e10 (2019)
  43. Suie T, "The effect of cortisone on experimental Pseudomonas corneal ulcers", AMA Arch Ophthalmol, 56, pp.53~56 (1956)
  44. Gritz DC, "Topical anti-inflammatory agents in an animal model of microbial keratitis", Arch Ophthalmol, 108, pp.1001~1005 (1990)
  45. Leibowitz HM, "Topically administered corticosteroids : effect on antibiotic-treated bacterial keratitis", Arch Ophthalmol, 98, pp.1287~1290 (1980)
  46. Willcox MD, "Review of resistance of ocular isolates of Pseudomonas aeruginosa and staphylococci from keratitis to ciprofloxacin, gentamicin and cephalosporins", Clin Exp Optom, 94, pp.161~168 (2011)
  47. 유인천, "배양 양성 감염각막염의 임상양상 및 항생제감수성 변화: 10년간의국내 다기관 연구", 대한안과학회지, 62(4), pp.447~462 (2021), 대한안과학회
  48. Bottery MJ, "Ecology and evolution of antimicrobial resistance in bacterial communities", ISME J, 15, pp.939~948 (2021)
  49. Nabb DL, "Polymicrobial interactions induce multidrug tolerance in Staphylococcus aureus through energy depletion", Front Microbiol, 10, pp.2803~ (2019)
  50. 김우진, "세균각막염의 예후인자 및 항생제 감수성 변화에 대한 8년간의 고찰", 대한안과학회지, 50(10), pp.1495~1504 (2009), 대한안과학회
  51. Botelho PJ, "The effect of aspirin on the visual outcome of nonarteritic anterior ischemic optic neuropathy", Am J Ophthalmol, 121, pp.450~451 (1996)
  52. Hazra A, "Using the confidence interval confidently", J Thorac Dis, 9, pp.4125~4130 (2017)

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