배양 양성 여부에 따른 세균각막염의 임상분석

Clinical Analysis of Bacterial Keratitis According to Culture Positivity

목적: 세균각막염을 배양 양성 여부에 따라 두 군(culture positive [CP], culture negative [CN])으로 나누어 임상분석을 시행하였다. 대상과 방법: 영남대학교병원 안과에서 6년간(2011-2016) 입원하여 세균각막염으로 치료한 98안(CP 39안, CN 59안)을 대상으로 하였다. 역학, 선행인자, 임상양상, 치료 결과를 두 군 간에 비교 분석하였다. 불량한 임상결과의 위험인자는 전체 군을 기준으로 다변량 분석을 통하여 분석하였다. 결과: 동정된 균주는 Pseudomonas spp. (31%)와 Staphylococcus spp. (24%)가 흔하였다. 두 군 간에 이전 안구표면질환, 콘택트렌즈 착용 및 전방축농 유무는 유의한 차이가 없었다. CP군에서 상피결손 크기 5 ㎟이상(51%:31%, p=0.04)과 초진 시력 0.1 미만(51%:31%, p=0.04)이 CN군에 비해 유의하게 많았다. 상피재생일 14일 이상(18%:5%, p=0.08)과 불량한 임상결과(28%:20%, p=0.37)는 CN군에 비해 CP군에서 더 많았으나 통계적 유의한 차이는 없었다. 불량한 임상결과의 위험인자는 이전 안구표면질환(OR=11.29, 95% CI=2.01-63.41, p=0.006)과 안수술력(OR=6.98, 95% CI=1.51-32.20, p=0.01)으로 나타났다. 결론: CP군이 CN군에 비해 초진 임상양상이 비교적 나빴으며, 치료 결과도 CP군에서 조금 더 나빴지만 유의한 차이까지는 보이지 않았다. 이전 안구표면질환과 안수술력이 치료 예후와 관련 있었다.

Purpose: The purpose of this study was to evaluate the clinical aspects of inpatients with bacterial keratitis according to culture positivity. Methods: This was a retrospective review of 98 cases of inpatients with bacterial keratitis who were treated between January 2011 and December 2016 in Yeungnam University Hospital. Epidemiology, predisposing factors, clinical characteristics, and treatment outcomes were compared between culture positive (CP, 39 eyes) and culture negative (CN, 59 eyes) groups. Risk factors for poor clinical outcome were evaluated in the total cohort and analyzed using multivariate logistic regression. Results: Pseudomonas spp. (31%) and Staphylococcus spp. (24%) were common in the CP group. There were no significant differences in previous ocular surface disease, contact lens wear, or hypopyon between the two groups. Epithelial defect size ≥5㎟ (51%:31%, p = 0.04) and initial visual acuity <0.1 (Snellen) (51%:31%, p = 0.04) were significantly higher in the CP group than in the CN group. Epithelial healing time ≥14 days (18%:5%, p = 0.08) and poor clinical outcome (28%:20%, p = 0.37) were more common in the CP group than in the CN group. Risk factors for poor clinical outcome were previous ocular surface disease (odds ratio [OR] = 11.29, 95% confidence interval [CI] = 2.01-63.41, p = 0.006) and previous ocular surgery (OR = 6.98, 95% CI = 1.51-32.20, p = 0.01). Conclusions: The CP group showed relatively worse initial clinical characteristics than the CN group. Treatment outcomes were slightly worse in the CP group than in the CN group; however, this difference was not statistically significant. Previous ocular surface disease and previous ocular surgery were associated with poor clinical outcome.