눈물길우회술 후 경과관찰기간에 따른 죤스관의 균주에 대한 변화
The Change of the Pathogen in Cultured Jones Tubes according to the Postoperative Periods
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목적: 눈물길우회술 후 경과 관찰 기간에 따른 죤스관의 배양 균주 변화를 알아보고, 술 후 염증치료나 기능성 눈물길 스텐트의 개발에 근본적인 자료를 제공하고자 한다. 대상과 방법: 본원에서 눈물길우회술을 시행 받은 환자 중, 염증 혹은 관 이동에 의한 폐쇄로 유루증이 재발하여 죤스관을 제거한 환자 50명을 대상으로 죤스관에 존재하는 세균을 배양하고 이에 대한 항생제 감수성 검사를 시행하였다. 눈물길우회술 후 죤스관제거까지의 기간을 각각 1년 이내, 1-5년, 5-10년, 그리고 10년 이상으로 나누어 배양 균주의 종류와 항생제 감수성 검사 결과를 비교하였다. 결과: 전체 50예 중 24예(48%)에서 황색포도상구균이 배양되어 가장 흔한 균주였으며, 그람양성간균 5예(10%)와 녹농균 5예가 각각 배양되었다. 전반적으로 황색포도상구균이 가장 많이 배양된 것과는 달리 10년 이상 경과된 후 죤스관을 제거한 군에서는 Proteus mirabilis가 제일 많이 배양되었다. 죤스관 제거의 원인과 배양 균주와의 연관성은 관찰되지 않았다. 배양된 황색포도상구균 중 84%가 페니실린에 내성을 가진 균이었으며, 53%가 메치실린 내성을 나타내었다. 결론: 눈물길우회술에서 사용되는 죤스관 시술은 유루증의 효과적인 치료술기이나, 관이 비강과 결막 쪽으로 직접 노출되어 있어 세균에 의한 감염 가능성이 존재한다. 관 인근 조직의 감염이 의심될 때, 원인 균주로는 황색포도상구균이 가장 많았으며 페니실린과 옥사실린에 내성을 가지는 경향을 보였다. 특히, 10년 이상 죤스관을 유치한 경우에는 Proteus mirabilis에 의한 감염이 우려된다.
Abstract
Purpose: To evaluate the change in pathogens in cultured Jones tubes used in lacrimal bypass surgery according to postoperative period and to provide basic data related to preventive antibiotics or functional lacrimal stent development. Methods: Fifty patients who underwent Jones tubes removal were enrolled in this study. Removed Jones tubes were cultured to identify bacteria and were tested for antibiotic sensitivity. The results were further analyzed according to the period between lacrimal bypass surgery and tube removal. Results: Among 50 cases, 24 (48%) showed cultured bacteria of Staphylococcus aureus, 5 (10%) were Pseudomonas, and another 5 (10%) were Gram-positive bacilli. Although Staphylococcus aureus was the most frequently cultured organism, Proteus mirabilis was the most common cultured organism in patients who underwent tube removal more than 10 years after lacrimal bypass surgery. There was no significant correlation between cultured organism and the period between lacrimal bypass surgery and tube removal. Eighty four percent of cultured Staphylococcus aureus showed resistance to penicillin, and 53% of cultured Staphylococcus aureus showed resistance to methicillin. Conclusions: Staphylococcus aureus was the most frequently cultured organism according to Jones tube-related lacrimal bypass surgery. A large proportion of cultured Staphylococcus aureus showed resistance to penicillin and methicillin. Proteus mirabilis should be considered the most common pathogen in patients more than 10 years after lacrimal bypass surgery.
참고문헌 (25)
- Angrist RC, "Silicone intubation for partial and total nasolacrimal duct obstruction in adults", Ophthal Plast Reconstr Surg, 1, pp.51~54 (1985)
- Dortzbach RK, "Silicone intubation for obstruction of the nasolacrimal duct in children", Am J Ophthalmol, 94, pp.585~590 (1982)
- Tarbet KJ, "External dacryocystorhinostomy. Surgical success, patient satisfaction, and economic cost", Ophthalmology, 102, pp.1065~1070 (1995)
- Jones LT, "The cure of epiphora due to canalicular disorders, trauma and surgical failures on the lacrimal passages", Trans Am Acad Ophthalmol Otolaryngol, 66, pp.506~524 (1962)
- 유정란, "누소관 폐쇄 환자에서 존스 튜브 시술 후의 만족도 조사", 대한안과학회지, 43(11), pp.1~2088 (2002), 대한안과학회
- Ide H, "Mollahaliloglu S. How firms set prices for medical materials:a multi-country study", Health Policy, 92, pp.73~78 (2009)
- 박성후, "눈물길우회술에 사용된 후 제거된 죤스관 배양검사 결과", 대한안과학회지, 47(5), pp.696~702 (2006), 대한안과학회
- Lee JS, "Treatment of obstructed lacrimal apparatus by Bowman’s probe guided lacrimal bypass surgery", J Korean Ophthalmol Soc, 40, pp.1746~1754 (1999)
- Lamping K, "Jones’ tubes. How good are they?", Arch Ophthalmol, 101, pp.260~261 (1983)
- Welham RA, "The Lester-Jones tube: a 15-year follow-up", Graefes Arch Clin Exp Ophthalmol, 223, pp.106~108 (1985)
- Sekhar GC, "Problems associated with conjunctivodacryocystorhinostomy", Am J Ophthalmol, 112, pp.502~506 (1991)
- Kim YS, "Clinical study conjunctivodacryocystorhinostomy with Jones tube", J Korean Ophthalmol Soc, 32, pp.129~133 (1991)
- Neuhaus RW, "Postcataract surgery endophthalmitis in a patient with a functioning Jones tube", Ophthal Plast Reconstr Surg, 8, pp.208~209 (1992)
- Bartley GB, "Acquired lacrimal drainage obstruction: an etiologic classification system, case reports, and a review of the literature. Part 3", Ophthal Plast Reconstr Surg, 9, pp.11~26 (1993)
- Steinsapir KD, "A 16-year study of conjunctival dacryocystorhinostomy", Am J Ophthalmol, 109, pp.387~393 (1990)
- Lim C, "Lacrimal canalicular bypass surgery with the Lester Jones tube", Am J Ophthalmol, 137, pp.101~108 (2004)
- Hartikainen J, "Bacteriology of lacrimal duct obstruction in adults", Br J Ophthalmol, 81, pp.37~40 (1997)
- Nakai H, "Prevalence and risk factors of infections caused by extended-spectrum β-lactamase (ESBL)- producing Enterobacteriaceae", J Infect Chemother, 22, pp.319~326 (2016)
- Shibasaki M, "Community spread of extended-spectrum β-lactamase-producing bacteria detected in social insurance hospitals throughout Japan", J Infect Chemother, 22, pp.395~399 (2016)
- Burall LS, "Proteus mirabilis genes that contribute to pathogenesis of urinary tract infection: identification of 25 signature-tagged mutants attenuated at least 100-fold", Infect Immun, 72, pp.2922~2938 (2004)
- Coker C, "Pathogenesis of Proteus mirabilis urinary tract infection", Microbes Infect, 2, pp.1497~1505 (2000)
- Shin H, "Changes in the eye microbiota associated with contact lens wearing", MBio, 7, pp.e00198~ (2016)
- Park JH, "Polydioxanone biodegradable stent placement in a canine urethral model: analysis of inflammatory reaction and biodegradation", J Vasc Interv Radiol, 25, pp.1257~1264 (2014)
- Li G, "Biodegradable weft-knitted intestinal stents: fabrication and physical changes investigation in vitro degradation", J Biomed Mater Res A, 102, pp.982~990 (2014)
- Zamiri P, "The biocompatibility of rapidly degrading polymeric stents in porcine carotid arteries", Biomaterials, 31, pp.7847~7855 (2010)