グラム陰性菌を検出した細菌性角膜感染症の検討

Evaluation of microbial keratitis due to Gram -negative bacteria

　1980年1月より1987年6月までの7年半に金沢医科大学眼科外来を受診し，入院加療を要した角膜感染症59例のうち，グラム陰性菌の検出された15例を検討対象とした．15例の平均年齢は65.9歳で，発症原因は7例で明らかで，そのうち異物が4例，コンタクトレンズのトラブルが3例あった．8例に涙嚢炎，人工的無水晶体眼，瘢痕トラコーマ等の眼科的な基礎疾患を認めた．全身的な基礎疾患は9例に認め糖尿病は4例を占めた．分離菌は9種16株検出し，株数ではMorax-ella ep．の4株が最も多く，ブドウ糖非醗酵陰性桿菌が全体の25％を占めた．アミノグリコシド系薬剤とpiperacillin, minocyclineは分離菌に対し薬剤感受性は良好であり，抗生剤の投与方法は結膜下注射，点眼，全身投与を併用した．4例では視力の改善は得られなかった．今回の検討例は平均年齢が高く，眼局所および全身的なpredisposing　factorをもつ例が多く，弱毒菌による角膜感染症に関しては，高齢自体が重要なcompromised　hostであると考えられた．

We evaluated 15 cases of keratitis in which Gram -negative bacteria could be isolated. The cases belong to a larger series of 59 eyes of corneal infec-tion seen by us during 7 and half years through 1987. Both sexes were equally affected with 8 males and 7 females. The ages averaged 65.9 years. Diabetes mellitus, dacryocystitis and prolonged contact lens wear frequently served as general or local predisposing factors. Keratitis due to Gram-negative bacteria was more prevalent in elderly subjects. Moraxella sp. and non-fermenting Gram-negative rods, including Ps. aeruginosa and Ps. cepacia were isolated in 50 % of the cases. These organisms were in general sensitive to aminog-lycosides, piperacillin and minocycline. Non-fer-menting Gram-negative rods and S. rnarcescence were resistant to a wide range of antibiotics. Early and energetic treatment led to favorable visual prognosis. Poor visual prognosis resulted in 4 cases despite intensive antimicrobial therapy.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(10) : 1139-1142, 1988