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Alenezi H, Parnell G, Schibeci S, Ozkan J, Willcox M, White AJR, Carnt N. Ocular surface immune transcriptome and tear cytokines in corneal infection patients. Front Cell Infect Microbiol 2024; 14:1346821. [PMID: 38694515 PMCID: PMC11061372 DOI: 10.3389/fcimb.2024.1346821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/19/2024] [Indexed: 05/04/2024] Open
Abstract
Background Microbial keratitis is one of the leading causes of blindness globally. An overactive immune response during an infection can exacerbate damage, causing corneal opacities and vision loss. This study aimed to identify the differentially expressed genes between corneal infection patients and healthy volunteers within the cornea and conjunctiva and elucidate the contributing pathways to these conditions' pathogenesis. Moreover, it compared the corneal and conjunctival transcriptomes in corneal-infected patients to cytokine levels in tears. Methods Corneal and conjunctival swabs were collected from seven corneal infection patients and three healthy controls under topical anesthesia. RNA from seven corneal infection patients and three healthy volunteers were analyzed by RNA sequencing (RNA-Seq). Tear proteins were extracted from Schirmer strips via acetone precipitation from 38 cases of corneal infection and 14 healthy controls. The cytokines and chemokines IL-1β, IL-6, CXCL8 (IL-8), CX3CL1, IL-10, IL-12 (p70), IL-17A, and IL-23 were measured using an antibody bead assay. Results A total of 512 genes were found to be differentially expressed in infected corneas compared to healthy corneas, with 508 being upregulated and four downregulated (fold-change (FC) <-2 or > 2 and adjusted p <0.01). For the conjunctiva, 477 were upregulated, and 3 were downregulated (FC <-3 or ≥ 3 and adjusted p <0.01). There was a significant overlap in cornea and conjunctiva gene expression in patients with corneal infections. The genes were predominantly associated with immune response, regulation of angiogenesis, and apoptotic signaling pathways. The most highly upregulated gene was CXCL8 (which codes for IL-8 protein). In patients with corneal infections, the concentration of IL-8 protein in tears was relatively higher in patients compared to healthy controls but did not show statistical significance. Conclusions During corneal infection, many genes were upregulated, with most of them being associated with immune response, regulation of angiogenesis, and apoptotic signaling. The findings may facilitate the development of treatments for corneal infections that can dampen specific aspects of the immune response to reduce scarring and preserve sight.
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Affiliation(s)
- Heba Alenezi
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Grant Parnell
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephen Schibeci
- Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Jerome Ozkan
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Mark Willcox
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Andrew J. R. White
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Nicole Carnt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
- Institute of Ophthalmology, University College London, London, United Kingdom
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Khalil H, Bolz M, Waser K, Pomberger L, Laubichler P, Jirak P, Hirnschall N. Diagnostic Potential of Anterior Segment Optical Coherence Tomography Scans for Pseudomonas Keratitis. Transl Vis Sci Technol 2023; 12:34. [PMID: 38019500 PMCID: PMC10691401 DOI: 10.1167/tvst.12.11.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose The purpose of this study was to investigate the diagnostic value of anterior segment optical coherence tomography (AS-OCT) scans for Pseudomonas keratitis. Methods Patients with treatment-naïve keratitis underwent AS-OCT imaging. The following parameters were evaluated: corneal thickness (CT), infiltrate thickness (IT), infiltrate diameter (ID), tissue loss/gain, entropy, and distance of the lesion from the corneal pupillary center. Three different OCT devices were used for the analysis. The relationship between the detected pathogen and the OCT patterns was analyzed. Results Nineteen eyes of 19 patients were included in the analysis: seven cases in the Pseudomonas group and 12 cases in the Gram-positive group. The mean (SD) values for the Pseudomonas and Gram-positive groups, respectively, were as follows: CT, 834 µm (165 µm) and 760 µm (120 µm); IT, 290 µm (152 µm) and 287 µm (84 µm); ID, 2067 µm (1470 µm) and 1307 µm (745 µm); distance to center, 3.0 mm (1.2 mm) and 3.0 mm (1.6 mm); epithelial defect, 1193 µm (586 µm) and 484 µm (615 µm); tissue gain, +31% (19%) and +10% (12%); and entropy level, 4.0 (0.8) and 3.9 (1.1). Conclusions This study introduces novel insights by identifying specific OCT parameters that distinguish Pseudomonas keratitis, including a 30% tissue gain. These findings align with earlier research that underscores the potential of OCT in differentiating various pathogens causing keratitis. Translational Relevance The findings of this study could be used to develop new diagnostic strategies for Pseudomonas keratitis. The OCT findings could be used to develop new biomarkers for the infection.
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Affiliation(s)
- Haidar Khalil
- Department of Ophthalmology and Optometry, Kepler University Clinic GmbH, Johannes Kepler University, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Matthias Bolz
- Department of Ophthalmology and Optometry, Kepler University Clinic GmbH, Johannes Kepler University, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Klemens Waser
- Department of Ophthalmology and Optometry, Kepler University Clinic GmbH, Johannes Kepler University, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Leon Pomberger
- Department of Ophthalmology and Optometry, Kepler University Clinic GmbH, Johannes Kepler University, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Peter Laubichler
- Department of Ophthalmology and Optometry, Kepler University Clinic GmbH, Johannes Kepler University, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Paul Jirak
- Department of Ophthalmology and Optometry, Kepler University Clinic GmbH, Johannes Kepler University, Linz, Austria
| | - Nino Hirnschall
- Department of Ophthalmology and Optometry, Kepler University Clinic GmbH, Johannes Kepler University, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
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Woodward MA, Niziol LM, Ballouz D, Lu MC, Kang L, Thibodeau A, Singh K. Prediction of Visual Acuity in Patients With Microbial Keratitis. Cornea 2023; 42:217-223. [PMID: 36256452 PMCID: PMC9805475 DOI: 10.1097/ico.0000000000003129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to predict visual acuity (VA) 90 days after presentation for patients with microbial keratitis (MK) from data at the initial clinical ophthalmic encounter. METHODS Patients with MK were identified in the electronic health record between August 2012 and February 2021. Random forest (RF) models were used to predict 90-day VA < 20/40 [visual impairment (VI)]. Predictors evaluated included age, sex, initial VA, and information documented in notes at presentation. Model diagnostics are reported with 95% confidence intervals (CIs) for area under the curve (AUC), misclassification rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS One thousand seven hundred ninety-one patients were identified. The presenting logMAR VA was on average 0.86 (Snellen equivalent and standard deviation = 20/144 ± 12.6 lines) in the affected or worse eye, and 43.6% with VI. VI at 90-day follow-up was present in the affected eye or worse eye for 26.9% of patients. The RF model for predicting 90-day VI had an AUC of 95% (CI: 93%-97%) and a misclassification rate of 9% (7%-12%). The percent sensitivity, specificity, PPV, and NPV were 86% (80%-91%), 92% (89%-95%), 81% (74%-86%), and 95% (92%-97%), respectively. Older age, worse presenting VA, and more mentions of "penetrating keratoplasty" and "bandage contact lens" were associated with increased probability of 90-day VI, whereas more mentions of "quiet" were associated with decreased probability of 90-day VI. CONCLUSIONS RF modeling yielded good sensitivity and specificity to predict VI at 90 days which could guide clinicians about the risk of poor vision outcomes for patients with MK.
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Affiliation(s)
- Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Dena Ballouz
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Alexa Thibodeau
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Karandeep Singh
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Mei JA, Johnson W, Kinn B, Laskey E, Nolin L, Bhamare P, Stalker C, Dunman PM, Wozniak RAF. Antimicrobial Activity of a Triple Antibiotic Combination Toward Ocular Pseudomonas aeruginosa Clinical Isolates. Transl Vis Sci Technol 2022; 11:26. [PMID: 35612831 PMCID: PMC9145016 DOI: 10.1167/tvst.11.5.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Pseudomonas aeruginosa is a leading cause of corneal infections. Recently, we discovered an antimicrobial drug combination, polymyxin B/trimethoprim (PT) + rifampin, that displayed impressive efficacy toward P. aeruginosa in both in vitro and in vivo studies. As such, this combination was further evaluated as a potential keratitis therapeutic through testing the combination's efficacy against a diverse set of P. aeruginosa clinical isolates. Methods Minimum inhibitory concentrations (MICs) of moxifloxacin, levofloxacin, erythromycin, tobramycin, PT, polymyxin B (alone), trimethoprim (alone), and rifampin were determined for 154 ocular clinical P. aeruginosa isolates, 90% of which were derived from corneal scrapings. Additionally, the efficacy of PT + rifampin was evaluated utilizing fractional inhibitory concentration (FIC) testing. Results While 100% of isolates were resistant to erythromycin (average MIC 224 ± 110 µg·mL−1) and trimethoprim (alone) (206 ± 67.3 µg·mL−1), antibiotic resistance was generally found to be low: moxifloxacin (2% of isolates resistant; average MIC 1.08 ± 1.61 µg·mL−1), levofloxacin (3.9%; 1.02 ± 2.96 µg·mL−1), tobramycin (1%; 0.319 ± 1.31 µg·mL−1), polymyxin B (0%; 0.539 ± 0.206 µg·mL−1), PT (0%; 0.416 ± 0.135 µg·mL−1), and rifampin (0%; 23.4 ± 6.86 µg·mL−1). Additionally, FIC testing revealed that PT + rifampin eradicated 100% of isolates demonstrating additive or synergistic activity in 95% of isolates (average FIC index 0.701 ± 0.132). Conclusions The drug combination of PT + rifampin was effective against a large panel of clinically relevant P. aeruginosa strains and, as such, may represent a promising therapeutic for P. aeruginosa keratitis. Translational Relevance This work furthers the preclinical development of a novel antibiotic combination for the treatment of corneal infections (bacterial keratitis).
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Affiliation(s)
- Jia A Mei
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - William Johnson
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Bailey Kinn
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Emily Laskey
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Lydia Nolin
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Pratham Bhamare
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Charlotte Stalker
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Paul M Dunman
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Rachel A F Wozniak
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Shigeyasu C, Yamada M, Fukuda M, Koh S, Suzuki T, Toshida H, Oie Y, Nejima R, Eguchi H, Kawasaki R, Nishida K. Severe Ocular Complications Associated With Wearing of Contact Lens in Japan. Eye Contact Lens 2022; 48:63-68. [PMID: 34860721 DOI: 10.1097/icl.0000000000000870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the severe ocular complications associated with contact lens wearing in Japan. METHOD A questionnaire was sent to 964 ophthalmologist training facilities inquiring for cases of contact lens-associated complications from April 2016 to March 2018. The inclusion criteria were as follows: (1) corrected distance visual acuity ≤0.1 decimal after treatment for 3 months, (2) corneal perforation observed during follow-up, and (3) requiring surgery. A secondary analysis was conducted, inquiring for further information on the type of contact lens, clinical manifestations, and course of treatment. RESULTS Forty-two patients with infectious keratitis met the inclusion criteria. Eight patients were users of rigid gas-permeable contact lens, and 34 were users of soft contact lens. Microbiological tests were positive in 73.0%. The organisms isolated in microbiological culture were bacteria in 11 patients (Pseudomonas aeruginosa in 9 patients), fungi in 2 patients, and Acanthamoeba in 14 patients. Ten patients were treated with local antibiotics, 11 with a combination of systemic antibiotics, and 21 with a combination of surgical approaches, including 13 with corneal transplantation. CONCLUSIONS The major cause of serious contact lens-associated ocular complications was microbial keratitis, and P. aeruginosa and Acanthamoeba were the major pathogens in Japan.
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Affiliation(s)
- Chika Shigeyasu
- Department of Ophthalmology (C.S., M.Y.), Kyorin University School of Medicine, Tokyo, Japan ; Department of Ophthalmology (M.F.), Kindai University Faculty of Medicine, Nara Hospital, Nara, Japan ; Department of Ophthalmology (S.K., Y.O., R.K., K.N.), Osaka University Graduate School of Medicine, Osaka, Japan ; Department of Ophthalmology (T.S.), Toho University School of Medicine, Omori Medical Center, Tokyo, Japan ; Department of Ophthalmology (H.T.), Juntendo University School of Medicine, Shizuoka Hospital, Shizuoka, Japan ; Miyata Eye Hospital (R.N.), Miyazaki, Japan; and Department of Ophthalmology (H.E.), Kindai University Faculty of Medicine, Osakasayama, Japan
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The Impact of Antibiotic Usage Guidelines, Developed and Disseminated through Internet, on the Knowledge, Attitude and Prescribing Habits of Orthokeratology Contact Lens Practitioners in China. Antibiotics (Basel) 2022; 11:antibiotics11020179. [PMID: 35203782 PMCID: PMC8868172 DOI: 10.3390/antibiotics11020179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 01/16/2023] Open
Abstract
It has been previously reported that the improper prescribing of antibiotic eye drops is common among orthokeratology (ortho-k) practitioners. Guidelines have since been developed and disseminated to improve their understanding and implementation of antibiotic prescriptions. This study aimed to investigate the influence of these guidelines on the knowledge, attitude, and prescribing habits of ortho-k practitioners by means of a questionnaire, which was administered nationwide via an official online account to eye care practitioners (ECPs) involved in ortho-k lens fitting, 548 of whom completed the survey. Differences in characteristics before and after the dissemination of the guidelines and between the groups were explored using χ2 tests. The relationship between prescribing habits and demographics was analyzed using stepwise logistic regression models. The implementation of the guidelines significantly improved the overall prescribing habits of ECPs (p < 0.001), especially for prophylactic antibiotic use before and after ortho-k lens wear (p < 0.001). Most ECPs who prescribed antibiotics properly displayed significantly better knowledge of correct antibiotic use, which in turn affected the compliance in their ortho-k patients (p < 0.001). The ECPs’ occupations (professionals other than ophthalmologists and optometrists, including nurses and opticians), clinical setting (distributor fitting centers), and age (younger than 25 years) were risk factors for the misuse of antibiotics. Although the implementation of the antibiotic guidelines significantly improved overall prescribing habits, some practitioners’ prescribing behavior still needs improvement. A limitation of this study was that all questions were mandatory, requiring ECPs to recall information, and therefore was subjected to selection and recall bias.
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Subedi D, Vijay AK, Willcox M. Overview of mechanisms of antibiotic resistance in Pseudomonas aeruginosa: an ocular perspective. Clin Exp Optom 2021; 101:162-171. [DOI: 10.1111/cxo.12621] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dinesh Subedi
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Ajay Kumar Vijay
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Mark Willcox
- School of Optometry and Vision Science, Faculty of Science, The University of New South Wales, Sydney, New South Wales, Australia,
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Ting DSJ, Ho CS, Deshmukh R, Said DG, Dua HS. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond) 2021; 35:1084-1101. [PMID: 33414529 PMCID: PMC8102486 DOI: 10.1038/s41433-020-01339-3] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 01/30/2023] Open
Abstract
Corneal opacity is the 5th leading cause of blindness and visual impairment globally, affecting ~6 million of the world population. In addition, it is responsible for 1.5-2.0 million new cases of monocular blindness per year, highlighting an ongoing uncurbed burden on human health. Among all aetiologies such as infection, trauma, inflammation, degeneration and nutritional deficiency, infectious keratitis (IK) represents the leading cause of corneal blindness in both developed and developing countries, with an estimated incidence ranging from 2.5 to 799 per 100,000 population-year. IK can be caused by a wide range of microorganisms, including bacteria, fungi, virus, parasites and polymicrobial infection. Subject to the geographical and temporal variations, bacteria and fungi have been shown to be the most common causative microorganisms for corneal infection. Although viral and Acanthamoeba keratitis are less common, they represent important causes for corneal blindness in the developed countries. Contact lens wear, trauma, ocular surface diseases, lid diseases, and post-ocular surgery have been shown to be the major risk factors for IK. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though its effectiveness is being challenged by the emergence of antimicrobial resistance, including multidrug resistance, in some parts of the world. In this review, we aim to provide an updated review on IK, encompassing the epidemiology, causative microorganisms, major risk factors and the impact of antimicrobial resistance.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | | | - Rashmi Deshmukh
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
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A New Treatment Experience in Pseudomonas Keratitis: Topical Meropenem and Cefepime. Eye Contact Lens 2021; 47:174-179. [PMID: 33196501 DOI: 10.1097/icl.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the efficacy of topical meropenem and cefepime treatments with respect to moxifloxacin as new treatment options in an experimental Pseudomonas keratitis model. METHODS Twenty-four rabbits in which keratitis are induced using Pseudomonas aeruginosa were divided into four groups according to treatment options. A solution of 50 mg/mL meropenem was prepared and topically applied to the first group, 50 mg/mL cefepime solution to the second group, topical 0.5% moxifloxacin drop to the third group, and topical isotonic (0.9% saline) solution to the fourth (control) group. The eyes were examined before and after treatment to score the clinical severity. After the subjects were sacrificed, their corneas were excised. To determine the efficacy of treatments, clinical score, bacterial load, and histopathological and immunohistochemical findings were evaluated. RESULTS When the three treatment groups were compared, there was a significant difference in the colony-forming unit (CFU) value, polymorph-nuclear leukocyte (PMNL) infiltration, and matrix metalloproteinase (MMP)-9 immunoreactivity (P=0.022, P=0.038, and P=0.037, respectively). The CFU values, PMNL infiltration scores and MMP-9 immunoreactivity were significantly lower in the meropenem and moxifloxacin groups compared with the cefepime group (P<0.05 for all). There was no significant difference between the meropenem and moxifloxacin groups in respect of the CFU values, PMNL infiltration, and MMP-9 immunoreactivity (P=0.842, P=0.784, and P=0.699, respectively). CONCLUSION The results of our study indicate that topical meropenem is at least as effective as topical moxifloxacin in the treatment of Pseudomonas keratitis. The meropenem and moxifloxacin are safer and suitable in the limited corneal invasion than cefepime. Thus, topical meropenem may be an alternative drug in the treatment of this condition. Clinical studies are needed to be conducted to assess this possibility more accurately.
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Shrestha GS, Vijay AK, Stapleton F, Henriquez FL, Carnt N. Understanding clinical and immunological features associated with Pseudomonas and Staphylococcus keratitis. Cont Lens Anterior Eye 2020; 44:3-13. [PMID: 33303356 DOI: 10.1016/j.clae.2020.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022]
Abstract
Pseudomonas aeruginosa and Staphylococcus aureus are the two dominant Gram-negative and -positive species, respectively, isolated from patients with contact lens-related bacterial keratitis. The clinical features of bacterial keratitis vary, such that timely differential diagnosis can be challenging, which may cause a delay in diagnosis resulting in poorer outcome. This review aims to explore the current understanding of clinical and immunological features associated with contact lens-related P. aeruginosa and S. aureus keratitis based on currently available evidence. Firstly, the review characterises contact lens-related P. aeruginosa and S. aureus keratitis, based on clinical features and prognostic factors. Secondly, the review describes the primary immune response associated with a bacterial infection in in-vivo non-scratch contact lens-wearing animal models, colonised by bacteria on contact lens and topical administration of bacteria on the cornea. Finally, the review discusses the role of macrophage inflammatory protein-2 (MIP-2) and intercellular adhesion molecule (ICAM-1) in neutrophil recruitment based on both in-vivo scratch models of bacterial keratitis and bacterial challenged in cell culture models.
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Affiliation(s)
| | | | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
| | - Fiona L Henriquez
- School of Health and Life Sciences, The University of the West of Scotland, United Kingdom
| | - Nicole Carnt
- School of Optometry and Vision Science, UNSW Sydney, Australia; Westmead Institute for Medical Research, University of Sydney, Australia; Institute of Ophthalmology, University College London, United Kingdom
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11
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Seven-Year Analysis of Microbial Keratitis Tendency at an Ophthalmology Department in Poland: A Single-Center Study. J Ophthalmol 2020; 2020:8851570. [PMID: 33489345 PMCID: PMC7803137 DOI: 10.1155/2020/8851570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 12/05/2022] Open
Abstract
This study aimed to analyze the frequency, drug susceptibility, and drug resistance of pathogens causing microbial keratitis (a corneal inflammation) in the Clinical Department of Ophthalmology, Medical University of Silesia, Katowice. Despite intensive treatment, severe inflammation causes irreversible blindness in ∼7% of cases and eye loss (evisceration or enucleation of the eyeball) in ∼1% of cases at our hospital. The choice of a targeted drug depends on the culture result and drug resistance of the microorganism. This was a retrospective observation study. Conjunctival swabs and corneal scrapes were collected between January 1, 2013, and December 31, 2019, in the tertiary reference center for keratitis. The collected data included the type of material received, culture result, and antimicrobial susceptibilities. Of the 2482 samples analyzed, 679 were positive and 1803 were negative. Of the total pathogens isolated, 69.9% were Gram-positive bacteria, 20.8% were Gram-negative bacteria, and 7.1% were fungi. A significant increase in the number of Gram-positive methicillin-resistant Staphylococcus aureus and a partial increase in the number of Gram-negative beta-lactams-resistant bacteria were observed. All fungal species were sensitive to amphotericin B, 82.81% were sensitive to voriconazole, and 56.25% were sensitive to fluconazole. Dual drug therapy (levofloxacin and tobramycin) was the first-line treatment. Drug susceptibility testing of the cultured microorganisms is necessary to initiate targeted treatment. Increased drug resistance was observed in this study. In the present study, most bacteria were sensitive to fluoroquinolones. Ciprofloxacin therapy remains the recommended empirical treatment in microbial keratitis. According to our study, voriconazole remains a first-line antifungal drug, when a fungal infection is suspected.
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12
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Stellwagen A, MacGregor C, Kung R, Konstantopoulos A, Hossain P. Personal hygiene risk factors for contact lens-related microbial keratitis. BMJ Open Ophthalmol 2020; 5:e000476. [PMID: 32953996 PMCID: PMC7481083 DOI: 10.1136/bmjophth-2020-000476] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/04/2020] [Accepted: 08/15/2020] [Indexed: 11/28/2022] Open
Abstract
Objective Microbial keratitis is a sight-threatening complication of contact lens wear, which affects thousands of patients and causes a significant burden on healthcare services. This study aims to identify compliance with contact lens care recommendations and identify personal hygiene risk factors in patients who develop contact lens-related microbial keratitis. Methods and analysis A case–control study was conducted at the University Hospital Southampton Eye Casualty from October to December 2015. Two participant groups were recruited: cases were contact lens wearers presenting with microbial keratitis and controls were contact lens wearers without infection. Participants underwent face-to-face interviews to identify lens wear practices, including lens type, hours of wear, personal hygiene and sleeping and showering in lenses. Univariate and multivariate regression models were used to compare groups. Results 37 cases and 41 controls were identified. Showering in contact lenses was identified as the greatest risk factor (OR, 3.1; 95% CI, 1.2 to 8.5; p=0.03), with showering daily in lenses compared with never, increasing the risk of microbial keratitis by over seven times (OR, 7.1; 95% CI, 2.1 to 24.6; p=0.002). Other risks included sleeping in lenses (OR, 3.1; 95% CI, 1.1 to 8.6; p=0.026), and being aged 25–39 (OR, 6.38; 95% CI, 1.56 to 26.10; p=0.010) and 40–54 (OR, 4.00; 95% CI 0.96 to 16.61; p=0.056). Conclusion The greatest personal hygiene risk factor for contact lens-related microbial keratitis was showering while wearing lenses, with an OR of 3.1, which increased to 7.1 if patients showered daily in lenses. The OR for sleeping in lenses was 3.1, and the most at-risk age group was 25–54.
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Affiliation(s)
- Anna Stellwagen
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Eye Unit, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Cheryl MacGregor
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Roger Kung
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Eye Unit, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | | | - Parwez Hossain
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Eye Unit, Clinical and Experimental Sciences, University of Southampton, Southampton, UK
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13
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Chen Z, Jiang J, Xu J, Yang X, Yang Y, Wang K, Song H, Yang B, Cho P. Antibiotic eye drops prescription patterns by orthokeratology practitioners in China and the development of antibiotic usage guidelines. Cont Lens Anterior Eye 2020; 44:101354. [PMID: 32798156 DOI: 10.1016/j.clae.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate antibiotic eye drops prescribing patterns of contact lens practitioners in Mainland China for orthokeratology (ortho-k) patients and to develop guidelines for their use. METHODS A questionnaire on their antibiotic prescribing habits was administered to eye care practitioners (ECP) involved in ortho-k lens fitting nationwide via an official online account. Multiple logistic regression models were used to assess the relationships between prescribing habits and demographics. RESULTS A total of 555 ECP completed the survey, of whom 50.5 % were optometrists (non-medical degree). About 30 % of the respondents routinely prescribed antibiotic eye drops for prophylactic use before and/or after commencement of ortho-k treatment. Forty one percent of the respondents dispensed antibiotics to patients for emergency use without giving written instructions, 48.5 % used antibiotic eye drops to wet fluorescein strips during ortho-k lens fitting, and 44.9 % considered treating corneal infiltrate(s) with antibiotics to be appropriate. A set of guidelines, including when to use antibiotic eye drops during ortho-k lens treatment and their proper use, stratified by different corneal conditions, was developed. CONCLUSIONS Inappropriate use of antibiotic eye drops appeared to be common among ortho-k practitioners in Mainland China. Taking into account deficiencies and errors identified from the survey, a set of guidelines based on best practice was developed and can serve to provide advice for proper use of antibiotics in ortho-k practice.
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Affiliation(s)
- Zhi Chen
- Department of Ophthalmology and Vision Science, Fudan University Eye and ENT Hospital, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, China.
| | - Jun Jiang
- The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingjing Xu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, China
| | - Yin Yang
- Department of Ophthalmology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Medical College, University of Electronic Science and Technology, Chengdu, China
| | - Kai Wang
- Department of Ophthalmology, Peking University People's Hospital, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Hongxin Song
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, National Engineering Research Center for Ophthalmology, Beijing, China
| | - Bi Yang
- Department of Optometry and Visual Science, West China School of Medicine, Sichuan University, Chengdu, China
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
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14
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Sagerfors S, Ejdervik‐Lindblad B, Söderquist B. Infectious keratitis: isolated microbes and their antibiotic susceptibility pattern during 2004-2014 in Region Örebro County, Sweden. Acta Ophthalmol 2020; 98:255-260. [PMID: 31580009 PMCID: PMC7216983 DOI: 10.1111/aos.14256] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 09/06/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To describe predisposing risk factors, causative microorganisms and their antibiotic susceptibility patterns in infectious keratitis during an 11-year period in Region Örebro County, Sweden. METHODS This is a descriptive study conducted as a retrospective audit of clinical records. Patients who received treatment for infectious keratitis at any of the three ophthalmological departments within Region Örebro County, Sweden, between 2004 and 2014 were included if they fulfilled the predefined criteria for infectious keratitis. Data regarding culture results, antibiotic susceptibility pattern and risk factors for infectious keratitis were obtained from medical records and microbiological reports. RESULTS In total, 398 episodes of infectious keratitis in 392 patients were included, and 285 were culture positive. The most common predisposing risk factor was contact lens wear (45%). Coagulase-negative staphylococci (39.6%) was the most commonly isolated type of organism. Staphylococcus aureus (15.1%) followed by Moraxella spp. (7.4%) and Pseudomonas aeruginosa (6.7%) were among the most common isolated bacteria not considered to be commensal. Reduced susceptibility to fluoroquinolones was observed in five of 43 S. aureus isolates and in four of nine Streptococcus pneumoniae isolates. CONCLUSION The most common predisposing risk factor for keratitis was contact lens wear. Among the most common microbes, not considered to be exclusively commensals, isolated from the cornea in microbial keratitis were S. aureus, Moraxella spp. and P. aeruginosa. The antibiotic susceptibility patterns showed low proportion of resistance. Empiric treatment of suspected infectious keratitis with topical fluoroquinolones and chloramphenicol might be considered in a setting like ours pending culture results.
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Affiliation(s)
- Susanna Sagerfors
- Department of OphthalmologyFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden,School of Medical SciencesFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Birgitta Ejdervik‐Lindblad
- Department of OphthalmologyFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden,School of Medical SciencesFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
| | - Bo Söderquist
- School of Medical SciencesFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden,Department of Laboratory Medicine Clinic of MicrobiologyFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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15
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Oliveira Dos Santos C, Kolwijck E, van Rooij J, Stoutenbeek R, Visser N, Cheng YY, Santana NTY, Verweij PE, Eggink CA. Epidemiology and Clinical Management of Fusarium keratitis in the Netherlands, 2005-2016. Front Cell Infect Microbiol 2020; 10:133. [PMID: 32318355 PMCID: PMC7146074 DOI: 10.3389/fcimb.2020.00133] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/12/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: Recognizing fungal keratitis based on the clinical presentation is challenging. Topical therapy may be initiated with antibacterial agents and corticosteroids, thus delaying the fungal diagnosis. As a consequence, the fungal infection may progress ultimately leading to more severe infection and blindness. We noticed an increase of fungal keratitis cases in the Netherlands, especially caused by Fusarium species, which prompted us to conduct a retrospective cohort study, aiming to describe the epidemiology, clinical management, and outcome. Materials and Methods: As fungi are commonly sent to the Dutch mycology reference laboratory for identification and in vitro susceptibility testing, the fungal culture collection was searched for Fusarium isolates from corneal scrapings, corneal swabs, and from contact lens (CL) fluid, between 2005 and 2016. All Fusarium isolates had been identified up to species level through sequencing of the ITS1-5.8S-ITS2 region of the rDNA and TEF1 gene. Antifungal susceptibility testing was performed according to the EUCAST microbroth dilution reference method. Antifungal agents tested included amphotericin B, voriconazole, and natamycin. In addition, susceptibility to the antisepticum chlorhexidine was tested. Ophthalmologists were approached to provide demographic and clinical data of patients identified through a positive culture. Results: Between 2005 and 2016, 89 cases of Fusarium keratitis from 16 different hospitals were identified. The number of cases of Fusarium keratitis showed a significant increase over time (R2 = 0.9199), with one case in the first 5 years (2005–2009) and multiple cases from 2010 and onwards. The male to female ratio was 1:3 (p = 0.014). Voriconazole was the most frequently used antifungal agent, but treatment strategies differed greatly between cases including five patients that were treated with chlorhexidine 0.02% monotherapy. Keratitis management was not successful in 27 (30%) patients, with 20 (22%) patients requiring corneal transplantation and seven (8%) requiring enucleation or evisceration. The mean visual acuity (VA) was moderately impaired with a logMAR of 0.8 (95% CI 0.6–1, Snellen equivalent 0.16) at the time of Fusarium culture. Final average VA was within the range of normal vision [logMAR 0.2 (95% CI 0.1–0.3), Snellen equivalent 0.63]. CL wear was reported in 92.9% of patients with Fusarium keratitis. The time between start of symptoms and diagnosis of fungal keratitis was significantly longer in patients with poor outcome as opposed to those with (partially) restored vision; 22 vs. 15 days, respectively (mean, p = 0.024). Enucleation/evisceration occurred in patients with delayed fungal diagnosis of more than 14 days after initial presentation of symptoms. The most frequently isolated species was F. oxysporum (24.7%) followed by F. solani sensu stricto (18%) and F. petroliphilum (9%). The lowest MICs were obtained with amphotericin B followed by natamycin, voriconazole, and chlorhexidine. Conclusion: Although Fusarium keratitis remains a rare complication of CL wear, we found a significant increase of cases in the Netherlands. The course of infection may be severe and fungal diagnosis was often delayed. Antifungal treatment strategies varied widely and the treatment failure rate was high, requiring transplantation or even enucleation. Our study underscores the need for systematic surveillance of fungal keratitis and a consensus management protocol.
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Affiliation(s)
- Claudy Oliveira Dos Santos
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands.,Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Eva Kolwijck
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands
| | | | - Remco Stoutenbeek
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Nienke Visser
- Maastricht University Medical Center+, University Eye Clinic, Maastricht, Netherlands
| | - Yanny Y Cheng
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Nathalie T Y Santana
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands
| | - Cathrien A Eggink
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, Netherlands
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16
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Karaca I, Barut Selver O, Palamar M, Egrilmez S, Aydemir S, Yagci A. Contact Lens–Associated Microbial Keratitis in a Tertiary Eye Care Center in Turkey. Eye Contact Lens 2020; 46:110-115. [DOI: 10.1097/icl.0000000000000617] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Abstract
Pseudomonas aeruginosa, a versatile Gram-negative pathogen that can cause a wide range of infections, is the most common causative agent in cases of bacterial keratitis associated with contact-lens use. Corneal infections with P. aeruginosa often have poor clinical outcomes and can result in long and costly treatments. During the infection process, the pathogen exploits its large genome, encoding complex regulatory networks and a wide range of virulence factors, including motility and the secretion of various proteases and toxins. Although antibiotic resistance levels in the UK are low, higher levels have been seen in some other countries. In the face of increasing antibiotic resistance, alternative therapeutic approaches such as antivirulence strategies and phage therapy are being developed. There is increasing evidence to suggest that keratitis infections are associated with a phylogenetic subgroup of P. aeruginosa isolates carrying the gene encoding the potent cytotoxin exotoxin U, one of two mutually exclusive exotoxins secreted via the type III secretion system. The mechanisms behind this association are unclear, but understanding the genetic differences that predispose P. aeruginosa to cause corneal infections may allow for the development of targeted and more effective future treatments to reduce the morbidity of P. aeruginosa keratitis. In order to minimize the risk of severe P. aeruginosa eye infections, a wide range of contact-lens disinfection solutions are available. Constant exposure to biocides at a range of concentrations, from sub-inhibitory to inhibitory, could contribute to the development of resistance to both antibiotics and disinfectants.
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Affiliation(s)
- Yasmin Hilliam
- Department of Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Stephen Kaye
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, L7 8TX, UK
| | - Craig Winstanley
- Department of Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
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18
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Abstract
Background:In microbial keratitis, infection of the cornea can threaten vision through permanent corneal scarring and even perforation resulting in the loss of the eye. A literature review was conducted by Karsten, Watson and Foster (2012) to determine the spectrum of microbial keratitis. Since this publication, there have been over 2600 articles published investigating the causative pathogens of microbial keratitis.Objective:To determine the current spectrum of possible pathogens implicated in microbial keratitis relative to the 2012 study.Methods:An exhaustive literature review was conducted of all the peer-reviewed articles reporting on microbial pathogens implicated in keratitis. Databases including MEDLINE, EMBASE, Scopus and Web of Science were searched utilising their entire year limits (1950-2019).Results:Six-hundred and eighty-eight species representing 271 genera from 145 families were implicated in microbial keratitis. Fungal pathogens, though less frequent than bacteria, demonstrated the greatest diversity with 393 species from 169 genera that were found to cause microbial keratitis. There were 254 species of bacteria from 82 genera, 27 species of amoeba from 11 genera, and 14 species of virus from 9 genera, which were also identified as pathogens of microbial keratitis.Conclusion:The spectrum of pathogens implicated in microbial keratitis is extremely diverse. Bacteria were most commonly encountered and in comparison, to the review published in 2012, further 456 pathogens have been identified as causative pathogens of microbial keratitis. Therefore, the current review provides an important update on the potential spectrum of microbes, to assist clinicians in the diagnosis and treatment of microbial keratitis.
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19
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Saleem W, Benton AH, Marquart ME, Wang S, Saleem W, Vigil R, Huang B, Sharma AC. Innovative Cold Atmospheric Plasma (iCAP) Decreases Mucopurulent Corneal Ulcer Formation and Edema and Reduces Bacterial Load in Pseudomonas Keratitis. CLINICAL PLASMA MEDICINE 2019; 16. [PMID: 34926141 DOI: 10.1016/j.cpme.2019.100093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose To evaluate the effect of application of 3% air in helium cold atmospheric plasma jet, using an inexpensive device termed iCAP, in corneal scratch wound closure in vitro and the treatment of Pseudomonas aeruginosa (P. aeruginosa) keratitis in vivo. Methods Thermal imaging to measure temperature of surfaces to which iCAP was applied and UV energy density delivered by iCAP were measured. Scratch wounds inflicted on in vitro cultures of a human corneal epithelial cell line were treated with iCAP and wound widths at various times post-application were measured. Rabbit eyes infected with P. aeruginosa were treated with iCAP and slit lamp biomicroscope examination conducted to determine corneal health outcomes 25h post infection. Corneal homogenates were plated on agar and viable bacterial colonies enumerated to determine the effect of iCAP on bacterial load in vivo in P. aeruginosa keratitis. Results iCAP was shown to operate in the non-thermal regime and also shown to deliver much lower UV energy density than that necessary to cause harmful effects on ocular tissue. iCAP treatment significantly improved the rate of scratch wound gap closure in vitro in a human corneal epithelial cell line compared to controls. In vivo, iCAP treatment of P. aeruginosa keratitis infection in the rabbit eyes (N = 20) significantly reduced the incidence of corneal ulcer (P = 0.003) and corneal edema (P = 0.011) and significantly improved total cornea health (P = 0.034) compared to untreated (N = 10). Finally, in vivo iCAP treatment of P. aeruginosa keratitis infection in the rabbit eyes (N = 19) significantly reduced bacterial loads (P = 0.012) compared to untreated (N = 9). Conclusion Our results strongly suggest that iCAP treatment was effective in improving corneal epithelial defect closure in vitro, reducing ulcer formation and decreasing inflammation in P. aeruginosa infected corneas in vivo and decreasing bacterial loads in P. aeruginosa infected corneas in vivo which led to improved overall cornea health outcomes in vivo. Further studies to investigate iCAP's safety and efficacy against other infectious microbes responsible for causing ulcerative keratitis, with and without co-treatment with antimicrobial therapies are warranted.
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Affiliation(s)
- Wahaj Saleem
- Experimental Therapeutics and Diagnostics Group, Lynntech, Inc., 2501 Earl Rudder Fwy S., College Station, TX 77845, USA
| | - Angela H Benton
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Mary E Marquart
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Shuli Wang
- Experimental Therapeutics and Diagnostics Group, Lynntech, Inc., 2501 Earl Rudder Fwy S., College Station, TX 77845, USA
| | - Waqas Saleem
- Experimental Therapeutics and Diagnostics Group, Lynntech, Inc., 2501 Earl Rudder Fwy S., College Station, TX 77845, USA
| | - Randy Vigil
- Experimental Therapeutics and Diagnostics Group, Lynntech, Inc., 2501 Earl Rudder Fwy S., College Station, TX 77845, USA
| | - Bo Huang
- Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Anjal C Sharma
- Experimental Therapeutics and Diagnostics Group, Lynntech, Inc., 2501 Earl Rudder Fwy S., College Station, TX 77845, USA
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20
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Willcox MDP, Chen R, Kalaiselvan P, Yasir M, Rasul R, Kumar N, Dutta D. The Development of an Antimicrobial Contact Lens - From the Laboratory to the Clinic. Curr Protein Pept Sci 2019; 21:357-368. [PMID: 31429686 DOI: 10.2174/1389203720666190820152508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/14/2019] [Accepted: 07/22/2019] [Indexed: 11/22/2022]
Abstract
Contact lens wear is generally safe and provides excellent vision. However, contact lens wear is often associated with the risk of developing ocular surface infection and inflammation, and in severe cases, the infection can result in loss of vision. Antimicrobial peptide-coated contact lenses have been made to help reduce the incidence of infection and inflammation. This paper reviews the research progress from conception, through the laboratory and preclinical tests to the latest information on clinical testing of an antimicrobial contact lens. We provide insights into the pathways followed and pitfalls that have been encountered. The journey has not always been linear or smooth, but has resulted in some of the first published clinical testing of antimicrobial peptide-coated contact lenses in humans. We hope this may help lead to the development and commercialisation of antimicrobial contact lenses in the future.
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Affiliation(s)
- Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - R Chen
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - P Kalaiselvan
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - M Yasir
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - R Rasul
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - N Kumar
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - D Dutta
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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21
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A review of cosmetic contact lens infections. Eye (Lond) 2018; 33:78-86. [PMID: 30385879 DOI: 10.1038/s41433-018-0257-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 11/08/2022] Open
Abstract
This paper provides a comprehensive review of the existing literature surrounding cosmetic contact lens infections. In this paper, lens-related, dispensing-related and patient-related factors are examined in detail.
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22
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Vagge A, Ferro Desideri L, Nucci P, Serafino M, Giannaccare G, Traverso CE. Prevention of Progression in Myopia: A Systematic Review. Diseases 2018; 6:E92. [PMID: 30274355 PMCID: PMC6313317 DOI: 10.3390/diseases6040092] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 11/25/2022] Open
Abstract
The prevalence of myopia has increased worldwide in recent decades and now is endemic over the entire industrial world. This increase is mainly caused by changes in lifestyle and behavior. In particular, the amount of outdoor activities and near work would display an important role in the pathogenesis of the disease. Several strategies have been reported as effective. Spectacles and contact lenses have shown only slight results in the prevention of myopia and similarly ortokerathology should not be considered as a first-line strategy, given the high risk of infectious keratitis and the relatively low compliance for the patients. Thus, to date, atropine ophthalmic drops seem to be the most effective treatment for slowing the progression of myopia, although the exact mechanism of the effect of treatment is still uncertain. In particular, low-dose atropine (0.01%) was proven to be an effective and safe treatment in the long term due to the lowest rebound effect with negligible side effects.
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Affiliation(s)
- Aldo Vagge
- Eye Clinic of Genoa, Policlinico San Martino, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, 16132 Genova, Italy.
| | - Lorenzo Ferro Desideri
- School of Medicine and Pharmacy, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16132 Genoa, Italy.
| | - Paolo Nucci
- University Eye Clinic San Giuseppe Hospital, University of Milan, 20162 Milano, Italy.
| | - Massimiliano Serafino
- University Eye Clinic San Giuseppe Hospital, University of Milan, 20162 Milano, Italy.
| | - Giuseppe Giannaccare
- Ophthalmology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, S. Orsola-Malpighi Teaching Hospital, 40138 Bologna, Italy.
| | - Carlo E Traverso
- Eye Clinic of Genoa, Policlinico San Martino, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, 16132 Genova, Italy.
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy.
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23
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Cury ESJ, Chang MR, Pontes ERJC. Non-viral microbial keratitis in adults: clinical and laboratory aspects. Braz J Microbiol 2018; 49 Suppl 1:205-212. [PMID: 30146181 PMCID: PMC6328808 DOI: 10.1016/j.bjm.2018.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 04/24/2018] [Accepted: 05/10/2018] [Indexed: 11/21/2022] Open
Abstract
This study compares patients with and without non-viral microbial keratitis in relation to sociodemographic variables, clinical aspects, and involved causative agent. Clinical aspects, etiology and therapeutic procedures were assessed in patients with and without keratitis that were diagnosed in an Eye Care Center in Campo Grande, MS, Brazil. Patients were divided into two groups: (a) cases: 64 patients with non-viral microbial keratitis diagnosed at biomicroscopy; and (b) controls: 47 patients with other eye disorders that were not keratitis. Labor activity related to agriculture, cattle raising, and contact lens use were all linked to keratitis occurrence (p < 0.005). In patients with keratitis, the most common symptoms were pain and photophobia, and the most frequently used medicines were fourth-generation fluoroquinolones (34.4%), amphotericin B (31.3%), and natamycin (28.1%). Microbial keratitis evolved to corneal perforation in 15.6% of cases; transplant was indicated in 10.9% of cases. Regarding the etiology of this condition, 23 (42.2%) keratitis cases were caused by bacteria (Pseudomonas aeruginosa, 12.5%), 17 (39.1%) by fungi (Fusarium spp., 14.1% and Aspergillus spp., 4.7%), and 4 (6.3%) by Acanthamoeba. Patients with keratitis present with a poorer prognosis. Rapid identification of the etiologic agent is indispensable and depends on appropriate ophthalmological collection and microbiological techniques.
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Clinical Features, Antibiotic Susceptibility Profile, and Outcomes of Infectious Keratitis Caused by Stenotrophomonas maltophilia. Cornea 2018; 37:326-330. [PMID: 29408828 DOI: 10.1097/ico.0000000000001486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Stenotrophomonas maltophilia, an uncommon cause of infectious keratitis, is difficult to treat because of its resistance to multiple antibiotics. The purpose of this study is to describe the clinical features, antibiotic susceptibility profile, and outcomes of S. maltophilia keratitis. METHODS A retrospective review of records from 1987 to 2016 identified 26 eyes of 26 patients who were treated at the Bascom Palmer Eye Institute for an S. maltophilia corneal ulcer. Clinical data were analyzed as to predisposing factors, clinical presentation, antibiotic susceptibility, treatment selection, and clinical outcomes. RESULTS Median age at presentation was 65 years (range, 16-98). Twelve patients were using topical corticosteroids, 8 patients had a history of penetrating keratoplasty, and 9 were contact lens wearers. All patients received topical antibiotics, 2 required therapeutic penetrating keratoplasty, and 1 was enucleated. At presentation, 57.7% (15/26) of the patients had visual acuity of 20/400 or worse. At the final visit, only 30.4% (7/23) of the patients had visual acuity worse than 20/400, whereas 65.2% (15/23) of the patients had 20/100 or better. Almost all isolates (25/26, 96.2%) were susceptible to fluoroquinolones and 77.3% (17/22) of them to polymyxin B/trimethoprim. Only 33.3% (5/15) of the tested isolates were susceptible to aminoglycosides and 58.3% (7/12) to cephalosporins. CONCLUSIONS Infectious keratitis due to S. maltophilia presents a treatment challenge because of its resistance to aminoglycosides and cephalosporins, which are typically used for empiric broad-spectrum gram-negative coverage as fortified solutions. Fluoroquinolones and polymyxin B/trimethoprim should be considered instead in cases of S. maltophilia infection.
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Termote K, Joe AW, Butler AL, McCarthy M, Blondeau JM, Iovieno A, Holland SP, Yeung SN. Epidemiology of bacterial corneal ulcers at tertiary centres in Vancouver, B.C. Can J Ophthalmol 2018; 53:330-336. [PMID: 30119785 DOI: 10.1016/j.jcjo.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/30/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To report the epidemiology of culture-positive bacterial corneal ulcers in Vancouver, B.C., Canada. DESIGN Retrospective, observational case series. METHODS Predetermined search terms were entered into the hospitals' electronic microbiology databases to create a cohort of patients who had undergone corneal scrapings for ulcers from April 2006 to March 2011. All specimens were plated on culture media. Cultured species were identified, and antimicrobial sensitivities were obtained. Clinical charts were then reviewed to identify associated risk factors. RESULTS In total 281 corneal scrapings were included, with a positive culture recovery rate of 75%. Bacterial keratitis accounted for 84.8% of culture-positive ulcers, followed by fungi (10%) and finally Acanthamoeba (5.2%); 73% of ulcers were monomicrobial in origin and 28% polymicrobial. We found an increase in Gram-negative micro-organisms over time. General sensitivity to antibiotics did not change over time. A major risk factor for Gram-positive involvement was ocular surface disease, whereas contact lens wear was a major risk factor for Gram-negative involvement. CONCLUSIONS Bacterial keratitis was found to be the major cause of infectious keratitis in Vancouver, B.C. The majority of bacterial ulcers were caused by Gram-positive bacteria. However, we found an increase in Gram-negative involvement over time. Contact lens wear was identified as the major risk factor for development of Gram-negative ulcers. Pre-existing ocular disease was associated with Gram-positive infection. Susceptibility of Gram-negative bacteria to common broad-spectrum antibiotics was high, but susceptibility of Gram-positive bacteria to these antibiotics was lower and more variable.
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Affiliation(s)
- Karolien Termote
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C.; Cornea, Cataract and Refractive Surgery Unit, Department of Ophthalmology, University Hospital Brussels, Brussels, Belgium.
| | - Aaron W Joe
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Andrea L Butler
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C.; Providence Health Care, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Martin McCarthy
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Joseph M Blondeau
- Department of Clinical Microbiology, Royal University Hospital Saskatoon, Saskatchewan, Sask
| | - Alfonso Iovieno
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Simon P Holland
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Sonia N Yeung
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
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Kim DJ, Park JH, Kim M, Park CY. The Antibiofilm efficacy of nitric oxide on soft contact lenses. BMC Ophthalmol 2017; 17:206. [PMID: 29162075 PMCID: PMC5696802 DOI: 10.1186/s12886-017-0604-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/15/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To investigate the antibiofilm efficacy of nitric oxide (NO) on soft contact lenses. METHODS Nitrite (NO precursor) release from various concentrations (0-1000 μM) of sodium nitrite (NaNO2, NO donor) was measured by Griess Assay. Cell viability assay was performed using human corneal epithelial cell under various concentration (0-1000 μM) of NaNO2. Biofilm formation on soft contact lenses was achieved by adding Staphylococcus aureus or Pseudomonas aeruginosa to the culture media. Various concentrations of NaNO2 (0-1000 μM) were added to the culture media, each containing soft contact lens. After incubation in NaNO2 containing culture media for 1, 3, or 7 days, each contact lens was transferred to a fresh, bacteria-free media without NaNO2. The bacteria in the biofilm were dispersed in the culture media for planktonic growth. After reculturing the lenses in the fresh media for 24 h, optical density (OD) of media was measured at 600 nm and colony forming unit (CFU) was counted by spreading media on tryptic soy agar plate for additional 18 h. RESULTS Nitrite release from NaNO2 showed dose-dependent suppressive effect on biofilm formation. Most nitrite release from NaNO2 tended to occur within 30 min. The viability of human corneal epithelial cells was well maintained at tested NaNO2 concentrations. The bacterial CFU and OD showed dose-dependent decrease in the NaNO2 treated samples on days 1, 3 and 7 for both Staphylococcus aureus and Pseudomonas aeruginosa. CONCLUSIONS NO successfully inhibited the biofilm formation by Staphylococcus aureus or Pseudomonas aeruginosa on soft contact lenses in dose-dependent manner.
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Affiliation(s)
- Dong Ju Kim
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Gyunggido, 410-773, South Korea
| | - Joo-Hee Park
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Gyunggido, 410-773, South Korea
| | - Marth Kim
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Gyunggido, 410-773, South Korea
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, Gyunggido, 410-773, South Korea.
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Casciaro B, Dutta D, Loffredo MR, Marcheggiani S, McDermott AM, Willcox MD, Mangoni ML. Esculentin-1a derived peptides kill Pseudomonas aeruginosa biofilm on soft contact lenses and retain antibacterial activity upon immobilization to the lens surface. Biopolymers 2017; 110. [PMID: 29086910 DOI: 10.1002/bip.23074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/14/2017] [Accepted: 10/04/2017] [Indexed: 12/18/2022]
Abstract
Contact lens (CL) wear is a risk factor for development of microbial keratitis, a vision threatening infection of the eye. Adverse events associated with colonization of lenses, especially by the multi-drug resistant and biofilm forming bacterium Pseudomonas aeruginosa remain a major safety issue. Therefore, novel strategies and compounds to reduce the onset of CL-associated ocular infections are needed. Recently, the activity of the frog skin-derived antimicrobial peptide Esc(1-21) and its diastereomer Esc(1-21)-1c was evaluated against both planktonic and sessile forms of this pathogen. Furthermore, Esc(1-21) was found to significantly reduce the severity of P. aeruginosa keratitis in a mouse model and preserve antipseudomonal activity in the presence of human basal tears. Here, we have analyzed the activity of the peptides on P. aeruginosa biofilm formed on soft CLs. Microbiological assays and scanning electron microscopy analysis indicated that the peptides were able to disrupt the bacterial biofilm, with the diastereomer having the greater efficacy (up to 85% killing vs no killing at 4 μM for some strains). Furthermore, upon covalent immobilization to the CL, the two peptides were found to cause more than four log reduction in the number of bacterial cells within 20 minutes and to reduce bacterial adhesion to the CL surface (77%-97% reduction) in 24 hours. Importantly, peptide immobilization was not toxic to mammalian cells and did not affect the lens characteristics. Overall, our data suggest that both peptides have great potential to be developed as novel pharmaceuticals for prevention and treatment of CL-associated P. aeruginosa keratitis.
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Affiliation(s)
- Bruno Casciaro
- Laboratory affiliated to Pasteur Italia-Fondazione Cenci Bolognetti, Department of Biochemical Sciences, Sapienza University of Rome, Rome, Italy
| | - Debarun Dutta
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Maria Rosa Loffredo
- Laboratory affiliated to Pasteur Italia-Fondazione Cenci Bolognetti, Department of Biochemical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Alison M McDermott
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Mark Dp Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Maria Luisa Mangoni
- Laboratory affiliated to Pasteur Italia-Fondazione Cenci Bolognetti, Department of Biochemical Sciences, Sapienza University of Rome, Rome, Italy
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Temporal Stability and Composition of the Ocular Surface Microbiome. Sci Rep 2017; 7:9880. [PMID: 28852195 PMCID: PMC5575025 DOI: 10.1038/s41598-017-10494-9] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/10/2017] [Indexed: 02/03/2023] Open
Abstract
To determine if there is a core ocular surface microbiome and whether there are microbial community changes over time, the conjunctiva of 45 healthy subjects were sampled at three time points over three months and processed using culture-dependent and -independent methods. Contaminant taxa were removed using a linear regression model using taxa abundances in negative controls as predictor of taxa abundances in subject samples. Both cultured cell counts and sequencing indicated low microbial biomass on the ocular surface. No cultured species was found in all subjects at all times or in all subjects at any one time. After removal of contaminant taxa identified in negative controls using a statistical model, the most commonly detected taxon was Corynebacterium (11.1%). No taxa were found in all subjects at all times or in all subjects in any one time, but there were 26 taxa present in at least one or more subjects at all times including Corynebacterium and Streptococcus. The ocular surface contains a low diversity of microorganisms. Using culture dependent and independent methods, the ocular surface does not appear to support a substantial core microbiome. However, consistently present taxa could be observed within individuals suggesting the possibility of individual-specific core microbiomes.
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Infectious keratitis and orthokeratology lens use: a systematic review. Infection 2017; 45:727-735. [PMID: 28534320 DOI: 10.1007/s15010-017-1023-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Myopia is a prevalent condition among Asians. Orthokeratology lens has gained popularity as a method of myopia control. This systematic review is to summarize the clinical profile of infectious keratitis in association with orthokeratology lens wear. METHODS We searched in the PubMed and EMBASE for articles adopting the search strategy "(orthokeratology lens OR orthokeratology) AND (bacterial eye infection OR keratitis OR cornea ulcer OR microbial keratitis OR bacterial keratitis)", from the start date of the databases to August 23, 2016. Articles reporting infectious keratitis in orthokeratology lens users with data of individual cases were considered eligible for this systematic review. We recorded the outcome measures including method of diagnosis, etiological agents, duration and mode of treatment and treatment outcomes. RESULTS Our literature search yielded 172 papers. After removing duplicated and irrelevant reports, we included 29 articles for data analysis, involving 173 eyes. Among all reported cases, the mean age at presentation was 15.4 ± 6.2 years, with a female preponderance (male-to-female ratio 1:1.7). Positive microbiological cultures were reported in 69.4% of cases, with Pseudomonas aeruginosa and Acanthamoeba being the most common etiological agents. The mean duration of hospitalization was 7.7 ± 6.7 days. Mean LogMAR visual acuity at presentation was 1.17 ± 0.78, increased to 0.33 ± 0.41 at final visit (p < 0.001). CONCLUSIONS Despite early intervention and treatment, the majority of infections resulted in the formation of corneal scars and almost 10% of eyes needed surgical treatment. Timely awareness and treatment of keratitis should be emphasized to the users.
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Twelve-year analysis of microbial keratitis trends at a UK tertiary hospital. Eye (Lond) 2017; 31:1229-1236. [PMID: 28452995 DOI: 10.1038/eye.2017.55] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/12/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeTo investigate the frequencies, trends, and in vitro drug susceptibilities of the causative pathogens in microbial keratitis in Manchester Royal Eye Hospital.Patients and methodsCorneal scrape results recorded by the microbiology service between 2004 and 2015 were extracted from an established database. A total of 4229 corneal scrape specimens were identified from an established database. First-line antibiotic treatment in our centre during the study period was ofloxacin and second line was cefuroxime and gentamicin.ResultsMean age was 45.9±21.0. A total of 1379 samples (32.6%) were culture positive. One hundred forty-eight (10.7%) specimens cultured multiple organisms. Of the 1539 organisms identified, 63.3% were Gram-positive bacteria, 27.3% Gram-negative bacteria, 7.1% fungi, and 2.3% Acanthamoebae. A decreasing trend in Gram-positive isolates was found together with a stable trend in Gram negatives and an increasing trend in Acanthamoeba and fungi. There appeared to be a significant increasing trend of Moraxella infection (P=0.001). In all, 83.1 and 90.8% of Gram-positive and -negative isolates tested were susceptible to ofloxacin, respectively. Cefuroxime covered 86.6% of Gram-positive and 61.4% of Gram-negative isolates, whereas gentamicin covered 88.8 and 96.5% of Gram-positive and -negative isolates, respectively.ConclusionWe found a change in the type of Gram-negative organisms isolated over time, with the Moraxella species on the rise. Reassuringly, no significant increase in resistance was observed in vitro for any of the commonly used antibiotics. Ofloxacin remains a good first-line antibiotic treatment but duo-therapy does have broader coverage and should be considered in non-responsive cases.
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Jin H, Parker WT, Law NW, Clarke CL, Gisseman JD, Pflugfelder SC, Wang L, Al-Mohtaseb ZN. Evolving risk factors and antibiotic sensitivity patterns for microbial keratitis at a large county hospital. Br J Ophthalmol 2017; 101:1483-1487. [DOI: 10.1136/bjophthalmol-2016-310026] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 11/04/2022]
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Clinical Features, Antibiotic Susceptibility Profiles, and Outcomes of Infectious Keratitis Caused by Achromobacter xylosoxidans. Cornea 2016; 35:626-30. [PMID: 26989957 DOI: 10.1097/ico.0000000000000798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Reports on Achromobacter xylosoxidans ocular infections are increasing, drawing attention to its emerging role in infectious keratitis. The purpose of this study is to report the clinical features, antibiotic sensitivities, and visual outcomes of infectious keratitis secondary to Achromobacter xylosoxidans. METHODS A microbiology database and clinical chart review was performed in all patients diagnosed with A. xylosoxidans keratitis at the Bascom Palmer Eye Institute between the years 1987 and 2014. Initial presentation, antimicrobial susceptibilities, minimum inhibitory concentrations (MICs), treatment course, and outcomes were recorded. RESULTS Twenty-eight patients were identified. The main risk factors were corneal graft (n = 8, 28.6%) and contact lens wear (n = 8, 28.6%). On presentation, visual acuity was 20/100 or worse in 20 (71.2%) patients. Hypopyon was present in 7 (25.0%) patients. In most cases, topical fluoroquinolones or tobramycin were the initial treatment, often accompanied by vancomycin. High susceptibility rates were found for piperacillin [100%, minimum inhibitory concentration for 90% of isolates (MIC90) = 8] and ticarcillin (100%, MIC90 = 16). Low susceptibility rates were documented for ciprofloxacin (46.7%, MIC90 = 8), tobramycin (26.7%, MIC90 = 16), and gentamicin (20%, MIC90 = 16). One (3.6%) patient suffered endophthalmitis. Six (21.4%) patients underwent therapeutic penetrating keratoplasty, and 2 (7.1%) patients had conjunctival flap surgery. Visual acuity at final follow-up was 20/100 or worse in 16 (57.1%) patients. CONCLUSIONS Infectious keratitis caused by A. xylosoxidans is associated with poor visual outcomes. Fluoroquinolones and aminoglycosides are not appropriate treatments for these ocular infections. Further studies are needed to define the clinical application of compound piperacillin and ticarcillin eye drops.
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Abstract
Purpose: To document the time course and resolution of contact lens–related corneal infiltrative events (CIEs) comparing slit-lamp images with anterior segment ocular coherence tomography (AS-OCT) images. Methods: Six silicone hydrogel (SiHy) soft contact lens (SCL) wearers presenting with newly diagnosed symptomatic CIEs were monitored with slit-lamp images, detailed drawings, and AS-OCT until the resolution of the CIE. A final follow-up visit was completed 4 weeks after CIE resolution to determine whether scar formation was present. Positive controls were 2 SiHy SCL wearers with established (inactive) corneal scars, and negative controls were 2 SiHy SCL wearers with clear corneas. High- and low-contrast logMAR visual acuities were measured, and subjective symptom questionnaires were completed at all visits. Results: Clinical signs, vision, and symptoms improved in tandem with the resolution of the CIEs as measured by imaging methods. Calibrated measures of infiltrate width from a slit-lamp biomicroscope appear to be similar to calibrated images from AS-OCT. Conclusions: Although further studies are needed to develop standardized procedures, AS-OCT can be a useful tool to characterize the development, progression, and resolution of corneal infiltrates as an objective measure of resolution and scar formation.
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Clinical Presentation and Antibiotic Susceptibility of Contact Lens Associated Microbial Keratitis. J Pathog 2016; 2015:152767. [PMID: 26770828 PMCID: PMC4681797 DOI: 10.1155/2015/152767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/29/2015] [Accepted: 11/02/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. In recent years, the number of contact lens wearers has dramatically increased in Iran, particularly in youngsters. The purpose of current study was to assess the clinical presentation and antibiotic susceptibility of contact lens related microbial keratitis in Ahvaz, southwest of Iran. Methodology. A cross-sectional investigation of 26 patients (33 eyes) with contact lens induced corneal ulcers who were admitted to Imam Khomeini Hospital, Ahwaz City, from June 2012 to June 2013 was done. In order to study microbial culture and susceptibility of corneal ulcers, all of them were scraped. Results. Eight samples were reported as sterile. Pseudomonas aeruginosa (80%) in positive cultures was the most widely recognized causative organism isolated. This is followed by Staphylococcus aureus 12% and Enterobacter 8%. The results showed that 84% of the microorganism cases were sensitive to ciprofloxacin, while imipenem, meropenem, and ceftazidime were the second most effective antibiotics (76%). Conclusion. Results of current study show the importance of referring all contact lens wearers with suspected corneal infection to ophthalmologists for more cure. The corneal scraping culture and contact lens solution should be performed to guide antibiotic therapy.
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Abstract
Advanced purulent corneal ulcer, as well as abscess, is a serious vision-threatening condition notable for its fulminant course and possible loss of the eye due to endophthalmitis. Its leading causes, pathogenesis, and classifications are described and analyzed in this paper.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - Evg A Kasparova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
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Effect of Daily Contact Lens Cleaning on Ocular Adverse Events during Extended Wear. Optom Vis Sci 2015; 92:157-66. [DOI: 10.1097/opx.0000000000000479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Darouiche MH, Baccari T, Hammami KJ, Triki L, Masmoudi ML. Keratitis after Corneal Projection of Biological Fluids: A Possible Occupational Prejudice? Workplace Health Saf 2014; 62:400-2. [DOI: 10.3928/21650799-20140918-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 07/09/2014] [Indexed: 11/20/2022]
Abstract
This article describes a case of Pseudomonas aeruginosa keratitis resulting from projection of biological fluids (bronchial secretions) on the face, mainly in the right eye. The employee presented with keratitis complicated by a corneal abscess. Consequently, the employee had a chronic and severe ocular surface and stoma destruction, possibly due to microbial proliferation into the surface tissues exacerbated by contact lenses. The infection was determined to be work related by experts.
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Choi HJ, Yum JH, Lee JH, Lee DH, Kim JH. Clinical Features and Compliance in Patients with Cosmetic Contact Lens-Related Complications. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.10.1445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hun Jin Choi
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jung Hoon Yum
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Hyun Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Do Hyung Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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