術後感染予防対策としての術前結膜囊内常在菌培養検査

Preoperative culture of bacterial flora in the conjunctival sac to prevent postoperative infections

要約　目的：術前の結膜囊培養と薬剤感受性検査から術後の抗菌薬を選択する報告。対象と方法：過去8年間に内眼手術を行った4,066眼について，術前に結膜囊培養検査を行い，その結果から術後の抗菌薬を選択した。結果：2,830眼（69.6％）に3,517株の菌が検出された。内訳は，Staph. epidermidis 59.4％，Staph. aureus 5.7％，Enterococcus faecalis 3.3％，methicillin-resistant Staph. aureus（MRSA）0.9％であった。Staph. epidermidisとStaph. aureusにはセファゾリンナトリウムがそれぞれ98.6％と100％の感受性を示した。Enterococcus faecalisにはレボフロキサシンが58.8％，MRSAにはクロラムフェニコールが88.9％の感受性があった。全症例で術後の眼内炎は皆無であった。結論：術後の抗菌薬を選択する指標として，術前の結膜囊の常在菌培養は有用である。

Abstract.　Purpose：To report the significance of culture of bacterial flora in the conjunctival sac as preventive measure for postoperative infections. Objects and Method：This study was made on a series of 4,066 eyes that received inner eye surgery during an 8-year period. Each eye was examined by culture of bacterial flora in the conjunctival sac before surgery. The findings were used in choosing antibiotics after surgery. Results：A total of 3,517 strains of bacterial organisms were cultured from 2,830 eyes（69.6％）. They included：Staph. epidermidis 69.6％, Staph. aureus 5.7％, Enterococcus faecalis 3.3％, and methicillin-resistant Staph. aureus（MRSA）0.9％. Cefazolin was effective to 98.6％ of Staph. epidermidis and 100％ of Staph. aureus. Levofloxaxin was effective to 58.8％ of Enterococcus faecalis. Chloramphenicol was effective to 88.9％ of MRSA. Postoperative infection was absent throughout. Conclusion：Culture of bacterial flora in the conjunctival sac is useful in preventing postoperative infections.