세균각막염 원인균주의 항생제 감수성과 초기 항생제 선택의 적절성
Antibiotics Susceptibility in Bacterial Keratitis and Proper Initial Treatment
1
조회
0
다운로드
9
인용
0
참고문헌
키워드
초록
목적: 지난 12년간의 세균각막염의 주요 원인균과 항생제 감수성 변화에 대하여 알아 보고 초기 항생제 선택의 적절성을 고찰해 보고자하였다. 대상과 방법: 2000년 1월부터 2011년 12월까지 본원에서 감염성 각막염으로 진단받고 세균이 검출된 161명 161안을 대상으로, 의무기록을 6년씩 전반기와 후반기로 나누어 후향적으로 조사하였다. 결과: 가장 흔한 원인균은 전후반기 모두 Pseudomonas species였고, 초기 치료에 사용된 항생제는 cefazolin과 tobramycin의 병합요법이 가장 많았다(77.6%). 그람음성균은 tobramycin, ciprofloxacin에 70% 이상의 감수성을 보였고 그람양성균은 cephalothin, vancomycin 에 100%의 감수성을 보였으며 전후반기 사이의 의미 있는 차이는 없었다. 원인균주가 초기 치료 항생제에 내성을 가진 경우는 8예가있었으나 이중 치료 실패는 1예에서 발생하였다. 결론: 현재 사용되는 초기 항생제들로 대부분의 세균각막염에 대해 적절한 치료 효과를 얻을 수 있으나 이들에 대한 내성 균주가 나타나고 있으므로 항생제 감수성 결과의 세심한 관찰이 필요하다.
Abstract
Purpose: The present study aims to determine the common pathogens involved in the etiology of bacterial keratitis and to analyze not only the antibiotic susceptibility of bacterial isolates from patients with bacterial keratitis but also the propriety of initial treatment. Methods: A retrospective study of 161 eyes in 161 patients with bacterial keratitis, who were diagnosed by cultures from 2000 to 2011, was performed. Causative bacteria and antibiotic susceptibility were evaluated in consecutive 6-year periods. Results: The most common bacteria was the pseudomonas species in the 2 time periods tested and cefazolin with tobramycin was the most commonly used antibiotic (125 cases, 77.6%) for initial treatment of bacterial keratitis. In vitro testing showed gram-negative susceptibility to tobramycin and ciprofloxacin was over 70%, gram-positive susceptibility to cephalothin and vancomycin was 100% and there was no significant difference between the 2 time periods tested. Eight cases had resistance to the initial treatment, but only 1 case showed treatment failure. Conclusions: Antibiotics used for initial treatment of bacterial keratitis were able to obtain a proper effect but several cases showed bacterial resistance to antibiotics. Thus, continued testing is essential to monitor for antibiotic resistance.
참고문헌 (31)
- Verhelst D, "Clinical, epidemiological and cost aspects of contact lens related infectious keratitis in Belgium: results of a seven-year retrospective study", Bull Soc Belge Ophthalmol, 297, pp.7~15 (2005)
- Ibrahim YW, "Factors affecting the epidemiology of Acanthamoeba keratitis", Ophthalmic Epidemiol, 14, pp.53~60 (2007)
- Forster RK, "Conrad Berens Lecture. The management of infectious keratitis as we approach the 21st century", CLAO J, 24, pp.175~180 (1998)
- Scott IU, "Endophthalmitis associated with microbial keratitis", Ophthalmology, 103, pp.1864~1870 (1996)
- Krachmer JH, "Cornea", pp.1021~1023 (2005), Elsevier Mosby
- Kunimoto DY, "In vitro susceptibility of bacterial keratitis pathogens to ciprofloxacin", Ophthalmology, 106, pp.80~85 (1999)
- Schmitz FJ, "Prevalence of aminoglycoside resistance in 20 European university hospitals participating in the European SENTRY Antimicrobial Surveillance Programme", Eur J Clin Microbiol Infect Dis, 18, pp.414~421 (1999)
- Baum JL., "Initial therapy of suspected microbial corneal ulcers. I. Broad antibiotic therapy based on prevalence of organisms", Surv Ophthalmol, 24, pp.97~105 (1979)
- Cokingtin CD, "Insights from experimental data on ciprofloxacin in the treatment of bacterial keratitis and ocular infections", Am J Ophthalmol, 112, pp.25S~28S (1991)
- Jones DB, "Initial therapy of suspected microbial corneal ulcers. II. Specific antibiotic therapy based on corneal smears", Surv Ophthalmol, 24, pp.97~116 (1979)
- Kowalski RP, "Comparison of ciprofloxacin and ofloxacin using human corneal susceptibility levels", Cornea, 17, pp.282~287 (1998)
- Leibowitz HM, "Corneal disorders : clinical diagnosis and management", pp.353~386 (1984), Saunders
- Leibowitz HM., "Clinical evaluation of ciprofloxacin 0.3% ophthalmic solution for treatment of bacterial keratitis", Am J Ophthalmol, 112, pp.34S~47S (1991)
- Afshari NA, "Trends in resistance to ciprofloxacin, cefazolin, and gentamicin in the treatment of bacterial keratitis", J Ocul Pharmacol Ther, 24, pp.217~223 (2008)
- Yeh DL, "Analysis of bacterial cultures in infectious keratitis, 1997 to 2004", Am J Ophthalmol, 142, pp.1066~1068 (2006)
- Fong CF, "Antibiotic susceptibility of bacterial isolates from bacterial keratitis cases in a university hospital in Taiwan", Am J Ophthalmol, 144, pp.682~689 (2007)
- Hahn YH, "Antibiotic susceptibilities of ocular isolates from patients with bacterial keratitis: a multi-center study", J Korean Ophthalmol Soc, 40, pp.2401~2410 (1999)
- 김우진, "세균각막염의 예후인자 및 항생제 감수성 변화에 대한 8년간의 고찰", 대한안과학회지, 50(10), pp.1495~1504 (2009), 대한안과학회
- Bower KS, "Fluoroquinolones in the treatment of bacterial keratitis", Am J Ophthalmol, 121, pp.712~715 (1996)
- Jhanji V, "Fourth-generation fluoroquinolone- resistant bacterial keratitis", J Cataract Refract Surg, 33, pp.1488~1489 (2007)
- Moshirfar M, "Fourth-generation fluoroquinolone- resistant bacterial keratitis after refractive surgery", J Cataract Refract Surg, 32, pp.515~518 (2006)
- Alexandrakis G, "Shifting trends in bacterial keratitis in south Florida and emerging resistance to fluoroquinolones", Ophthalmology, 107, pp.1497~1502 (2000)
- Smitha S, "Susceptibility trends of pseudomonas species from corneal ulcers", Indian J Med Microbiol, 23, pp.168~171 (2005)
- Denton M, "Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia", Clin Microbiol Rev, 11, pp.57~80 (1998)
- Penland RL, "Stenotrophomonas maltophilia ocular infections", Arch Ophthalmol, 114, pp.433~436 (1996)
- Bottone EJ, "Acanthamoeba keratitis: synergy between amebic and bacterial cocontaminants in contact lens care systems as a prelude to infection", J Clin Microbiol, 30, pp.2447~2450 (1992)
- Mett H, "Outer membrane permeability and beta-lactamase content in Pseudomonas maltophilia clinical isolates and laboratory mutants", Rev Infect Dis, 10, pp.765~769 (1988)
- Vartivarian S, "A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy", Antimicrob Agents Chemother, 38, pp.624~627 (1994)
- Snyder ME, "Ciprofloxacin-resistant bacterial keratitis", Am J Ophthalmol, 114, pp.336~338 (1992)
- Kim EK, "Comparative bioavailability and efficasy of tobra(R) or tobrex(R)", J Korean Ophthalmol Soc, 30, pp.175~180 (1989)
- Kowal VO, "Use of routine antibiotic sensitivity testing for the management of corneal ulcers", Arch Ophthalmol, 115, pp.462~465 (1997)