백내장수술 후 발생한 스테노트로포모나스말토필리아 안내염: 임상양상, 항생제 감수성과 예후
Endophthalmitis Caused by Stenotrophomonas maltophilia after Cataract Surgery: Clinical Features, Antibiotic Sensitivities, and Outcomes
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목적: 백내장수술 후 발생한 Stenotrophomonas maltophilia 안내염의 임상 경과와 항생제 감수성, 그리고 치료 결과에 대해서 보고하고자 한다. 대상과 방법: 2008년 1월과 2015년 12월 사이에 본원으로 안내염으로 의뢰되어 치료받은 환자 중 세균배양검사에서 Stenotrophomonas maltophilia 안내염이 확진된 환자 6명의 의무기록을 후향적으로 분석하였다. 결과: Stenotrophomonas maltophilia는 연구 기간 동안 확진된 그람 음성균 관련 안내염 중(총 23안)에서 Pseudomonas aeruginosa (14안) 다음으로 두 번째로 흔한 원인균(6안)이었다. 대상안들의 초진 시력은 light perception부터 0.02까지였다(평균 logMAR 1.72 [snellen equivalent; 20/1,049]). 초기 치료로서 모든 환자에서 vancomycin과 ceftazidime을 병합한 intravitreal antibiotics injections가 시행되었는데 5명에서는 일차적으로 유리체 절제술이 병행되었고, 1명에서는 일차적 항생제 주입 후 유리체 절제술이 추후에 추가적으로 시행되었다. 항생제 감수성 검사에서는 대상안 6안 모두 Ceftazidime과 Levofloxacin에 감수성을 보였고 Trimethoprim/Sulfamethoxazole 에는 2안에서 감수성을 보였다. 치료 후 6명의 대상안 중 5안에서 0.1 이상의 최종시력을 보였으며, 치료 후 초진시력에 비해 나쁜 시력을 보인 환자는 없었다. 결론: Stenotrophomonas maltophilia 그람 음성균 관련 안내염의 두 번째로 흔한 원인 균주였으며, 대상안 모두 ceftazidime과 Levofloxacin에 감수성을 보였다. 즉각적인 치료는 기존에 보고되었던 안내염의 치료 결과와 유사하였다.
Abstract
Purpose: To describe the clinical manifestations, treatment results, and antibiotic susceptibility in 6 cases of Stenotrophomonas maltophilia endophthalmitis. Methods: We retrospectively reviewed 6 eyes of 6 patients who were diagnosed with Stenotrophomonas maltophilia endophthalmitis. Specifically, we considered each patient's age, sex, past history, visual acuity, hypopyon, treatment, and prognosis. Results: For our study, we considered patients treated during the period of January 2008 to December 2015. Stenotrophomonas maltophilia (6 eyes) was the second most common gram-negative bacteria cause of total bacterial endophthalmitis while Pseudomonas aeruginosa (14 eyes) was the most common gram-negative bacteria cause during the same period. Visual disturbance was the dominant symptom being found in all 6 patients. Other symptoms include ocular pain and hypopyon. The initial visual acuity was light perception (1 patient), hand motion (3 patients), finger count (1 patient), and 0.02 (1 patient). Excluding the 1 patient with light perception, the mean initial visual acuity was logMAR 1.72 (Snellen equivalent; 20/1,049). Overall, 5 patients underwent vitrectomy and intravitreal antibiotics injection, while, the remaining other patient was treated with intravitreal antibiotics injection, followed by vitrectomy. All 6 patients showed sensitivity to Ceftazidime and Levofloxacin and 2 patients showed sensitivity to Trimethoprim/Sulfamethoxazole. Conclusions: Stenotrophomonas maltophilia endophthalmitis was the second most common gram negative organism to cause endophthalmitis after cataract surgery. All 6 of the tested isolates were found to be sensitive to ceftazidime and levofloxacin. Urgent treatment outcomes were similar to previous reports.
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