코눈물관폐쇄 치료에서 제거된 코눈물관스텐트의 세균 배양검사 결과
Results of the Cultured Nasolacrimal Polyurethane Stents (Song’s stent®) in Nasolacrimal Duct Obstruction Treatment
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목적: 코눈물관폐쇄를 치료하기 위해 fluoroscope guide 없이 일차적으로 폴리우레탄 재질의 코눈물관스텐트(Song's stents)를 삽입한 후 눈물주머니염 증상이 재발하였거나 코눈물관스텐트가 폐쇄된 환자에서 코눈물관스텐트를 제거하고 이를 배양하여, 스텐트에존재하는 세균의 종류와 항생제 감수성 검사의 결과를 알아보고자 하였다. 대상과 방법: 만성 눈물주머니염에 의해 눈물길 폐쇄로 진단받고, 코눈물관스텐트를 삽입한 후 염증의 재발 혹은 관의 폐쇄에 의한문제로 코눈물관스텐트를 제거한 환자 11예 11안을 대상으로 코눈물관스텐트에 존재하는 세균을 배양하고 이 균에 대한 항생제 감수성 검사를 시행하였다. 결과: 스텐트의 제거 시기는 수술 후 3년 7개월에서 17년 1개월로 평균 10년이었다. 세균배양검사상 녹농균이 7안, 황색포도상구균이2안, Stenotrophomonas maltophilia균이 2안에서 검출되었다. 항생제 내성검사에서 녹농균이 배양된 7안 중 5안에서 트리메소프림/ 설파메톡사졸(Bactrim®, Roche, Basel, Switzerland)에 내성을 가졌고 황색포도상구균이 배양된 2안은 모두 페니실린에 내성을 가졌다. 10안에서는 코눈물관스텐트를 제거한 후 동시에 실리콘관 삽입술을 시행하였고 1안은 수술적인 처치를 시행하지 않았다. 결론: 코눈물관스텐트의 폐쇄나 재발되는 염증의 원인균으로 녹농균이 가장 많았으며, 항생제에 내성이 생기기 쉬우므로 적절한 항생제의 사용이 필요하며 수술적 처치로는 코눈물관스텐트의 제거와 더불어 실리콘관 삽입술이 유루증 치료에 도움이 된다.
Abstract
Purpose: In the present study, we cultured specimens and evaluated the types of bacteria existing at the stent and their antibiotic sensitivities from removed nasolacrimal polyurethane stents (Song's stents) due to recurrent inflammation or Song's stent obstruction after placement of Song's stents without fluoroscopic guidance for the treatment of obstructed nasolacrimal ducts. Methods: In 11 eyes of 11 patients who received Song's stent intubation to resolve nasolacrimal duct obstruction, the Song's stents were removed due to either recurred symptoms, signs of chronic dacryocystitis, or tube obstruction. Song's stents were cultured to identify bacteria and tested for their antibiotic sensitivity. Results: The Song's stent removal was from 3 years 7 months to 17 years 1 month after intubation, thus the average duration was 10 years. The species of cultured bacteria were Pseudomonas in 7 eyes, Staphylococcus aureus in 2 eyes, and Stenotrophomonas maltophilia in 2 eyes. In antibiotics sensitivity tests, 5 of 7 eyes with Pseudomonas were resistant to trimethoprime/sulfamethoxazole (Bactrim®, Roche, Basel, Switzerland) and 2 eyes with Staphylococcus aureus were resistant to penicillin. Ten eyes underwent silicone tube intubation simultaneously during Song's stent removal and 1 eye underwent Song's stent removal only. Conclusions: The most common bacteriological etiology of Song's stent obstruction or recurrent inflammation is Pseudomonas species. The use of efficient antibiotics is necessary to avoid antibiotic intolerance and simultaneous silicone tube intubation during Song's stent removal and is essential for the management of epiphora.
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