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Alsarhani WK, Almulhim A, Alkhalifah MI, Alromaih AZ, AlQahtani E, Al Malawi RM, Alkharashi MS. Pediatric bacterial keratitis: clinical features, causative organisms, and outcome during a 13-year study period. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00104-2. [PMID: 38768651 DOI: 10.1016/j.jcjo.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/12/2024] [Accepted: 04/01/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To review the clinical features, causative organisms, complications, and outcomes of patients with pediatric bacterial keratitis at a tertiary care eye hospital. METHODS We conducted a retrospective study at a tertiary care eye centre on clinically diagnosed pediatric patients with bacterial keratitis between 2007 and 2019. Poor outcomes were labelled if any of the following were present: final best-corrected visual acuity worse than 20/200, a drop in best-corrected visual acuity by 1 line or more, perforated corneas, endophthalmitis, and graft failure. RESULTS The study included 43 cases of bacterial keratitis. Female and male patients represented 60.5% and 39.5% of the sample, respectively, with a mean age of 9.3 ± 5.9 years. The rate of culture positivity was 60.5%. The most common causative organisms were coagulase-negative Staphylococcus (23.1%), Pseudomonas (23.1%), and Streptococcus pneumoniae (19.2%). Culture-positive bacterial keratitis was associated with infiltrates ≥2 mm (p = 0.039), as determined by the results of multivariate analysis. Gram-positive and gram-negative bacteria exhibited 100% sensitivity to the tested fluoroquinolones. Complications included visually significant scars (55.8%), cataracts (14.0%), perforations (9.3%), corneal neovascularization (7.0%), nonhealing epithelial defects (7.0%), and endophthalmitis (4.7%). Corneal perforation was associated with the development of endophthalmitis (p < 0.001). On multivariate analysis, the only factor associated with a poor outcome was poor presenting visual acuity (p = 0.020). CONCLUSION Gram-positive bacteria were the most common cause of pediatric microbial keratitis. Positive cultures were associated with larger infiltrates. The only adverse prognostic factor was poor presenting vision.
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Affiliation(s)
- Waleed K Alsarhani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Abdulmohsen Almulhim
- Department of Ophthalmology, College of Medicine, Jouf University, Sakakah, Al-Jouf, Saudi Arabia
| | - Muhannad I Alkhalifah
- Anterior Segment Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Arwa Z Alromaih
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Elham AlQahtani
- Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Rahaf M Al Malawi
- College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Majed S Alkharashi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Nanayakkara U, Khan MA, Hargun DK, Sivagnanam S, Samarawickrama C. Ocular streptococcal infections: A clinical and microbiological review. Surv Ophthalmol 2023:S0039-6257(23)00036-X. [PMID: 36764397 DOI: 10.1016/j.survophthal.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
Streptococcus is a diverse bacterial genus that is part of the ocular surface microbiome implicated in conjunctivitis, keratitis, endophthalmitis, dacryocystitis, and orbital cellulitis which can lead to decreased visual acuity and require surgical intervention. The pathophysiology of S. pneumoniae is well established and the role of the polysaccharide capsule, pneumolysin, neuraminidases, and zinc metalloproteinases in ocular infections described. Additionally, key virulence factors of the viridans group streptococci such as cytolysins and proteases have been outlined, but there is a paucity of research on the remaining streptococcus species. These virulence factors tend to result in aggressive disease. Clinically, S. pneumoniae is implicated in 2.7-41.2% of bacterial conjunctivitis cases, more predominant in the pediatric population, and is implicated in 1.8-10.7% of bacterial keratitis isolates. Streptococcus bacteria are significantly implicated in acute postoperative, post-intravitreal, and bleb-associated endophthalmitis, responsible for 10.3-37.5, 29.4, and 57.1% of cases, respectively. Group A and B streptococcus endogenous endophthalmitis is rare, but has a very poor prognosis. Inappropriate prescription of antibiotics in cases of non-bacterial aetiology has contributed to increasing resistance, and a clinical index is needed to more accurately monitor this. Furthermore, there is an increasing need for prospective, surveillance studies of antimicrobial resistance in ocular pathogens, as well as point-of-care testing using molecular techniques.
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Affiliation(s)
| | | | | | - Shobini Sivagnanam
- Blacktown Hospital, Sydney, Australia; Australian Clinical Labs, Bella Vista, Sydney, Australia
| | - Chameen Samarawickrama
- University of Sydney, Australia; Translational Ocular Research and Immunology Consortium (TORIC), Westmead Institute for Medical Research, Australia.
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Tuft S, Somerville TF, Li JPO, Neal T, De S, Horsburgh MJ, Fothergill JL, Foulkes D, Kaye S. Bacterial keratitis: identifying the areas of clinical uncertainty. Prog Retin Eye Res 2021; 89:101031. [PMID: 34915112 DOI: 10.1016/j.preteyeres.2021.101031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis is a common corneal infection that is treated with topical antimicrobials. By the time of presentation there may already be severe visual loss from corneal ulceration and opacity, which may persist despite treatment. There are significant differences in the associated risk factors and the bacterial isolates between high income and low- or middle-income countries, so that general management guidelines may not be appropriate. Although the diagnosis of bacterial keratitis may seem intuitive there are multiple uncertainties about the criteria that are used, which impacts the interpretation of investigations and recruitment to clinical studies. Importantly, the concept that bacterial keratitis can only be confirmed by culture ignores the approximately 50% of cases clinically consistent with bacterial keratitis in which investigations are negative. The aetiology of these culture-negative cases is unknown. Currently, the estimation of bacterial susceptibility to antimicrobials is based on data from systemic administration and achievable serum or tissue concentrations, rather than relevant corneal concentrations and biological activity in the cornea. The provision to the clinician of minimum inhibitory concentrations of the antimicrobials for the isolated bacteria would be an important step forward. An increase in the prevalence of antimicrobial resistance is a concern, but the effect this has on disease outcomes is yet unclear. Virulence factors are not routinely assessed although they may affect the pathogenicity of bacteria within species and affect outcomes. New technologies have been developed to detect and kill bacteria, and their application to bacterial keratitis is discussed. In this review we present the multiple areas of clinical uncertainty that hamper research and the clinical management of bacterial keratitis, and we address some of the assumptions and dogma that have become established in the literature.
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Affiliation(s)
- Stephen Tuft
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Tobi F Somerville
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Ji-Peng Olivia Li
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Timothy Neal
- Department of Clinical Microbiology, Liverpool Clinical Laboratories, Liverpool University Hospital NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK.
| | - Surjo De
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, UK.
| | - Malcolm J Horsburgh
- Department of Infection and Microbiomes, University of Liverpool, Crown Street, Liverpool, L69 7BX, UK.
| | - Joanne L Fothergill
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Daniel Foulkes
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
| | - Stephen Kaye
- Department of Eye and Vision Sciences, University of Liverpool, 6 West Derby Street, Liverpool, L7 8TX, UK.
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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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Watson SL, Gatus BJ, Cabrera-Aguas M, Armstrong BH, George CR, Khoo P, Lahra MM. Bacterial Ocular Surveillance System (BOSS) Sydney, Australia 2017-2018. ACTA ACUST UNITED AC 2020; 44. [PMID: 33278871 DOI: 10.33321/cdi.2020.44.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract This study investigated antimicrobial resistance (AMR) profiles from a cohort of patients with bacterial keratitis treated at Sydney Eye Hospital, 1 January 2017 - 31 December 2018. These AMR profiles were analysed in the context of the current Australian empiric regimens for topical therapy: ciprofloxacin/ofloxacin monotherapy versus combination therapy of cefalotin/cephazolin plus gentamicin. At our Centre, combinations of (i) chloramphenicol plus gentamicin and (ii) chloramphenicol plus ciprofloxacin are alternatively used, so were also analysed. Three hundred and seventy-four isolates were cultured prospectively: 280/374 (75%) were gram positive, and 94/374 (25%) were gram negative. Coagulase-negative staphylococci comprised 173/374 (46%). Isolates included Staphylococcus aureus (n = 43/374) 11%; Streptococcus pneumoniae (n = 14/374) 3.7%; and Pseudomonas aeruginosa (n = 50/374) 13%. Statistical comparison was performed. There was no significant difference between cover provided either of the current Australian recommendations: ciprofloxacin/ofloxacin vs cefalotin/cephazolin plus gentamicin (5.3% vs 4.8%, respectively; p = 0.655). However, the combination of chloramphenicol plus an anti-pseudomonal agent (ciprofloxacin/ofloxacin or gentamicin) had significantly improved cover. Chloramphenicol plus gentamicin was superior to ciprofloxacin/ofloxacin (1.9% vs 5.3% resistance respectively; p = 0.007), and cefalotin/cephazolin plus gentamicin (1.9% vs 4.8%; p = 0.005). Chloramphenicol plus ciprofloxacin was superior to ciprofloxacin/ofloxacin monotherapy (1.3% vs 5.3%; p ≤ 0.001), and to cefalotin/cephazolin plus gentamicin (1.3% vs 4.8%; p = 0.003). Chloramphenicol plus gentamicin versus chloramphenicol plus ciprofloxacin/ofloxacin were equivalent (p = 0.48). There was no demonstrated in vitro superiority of either the current empiric antibiotic regimens. For our setting, for bacterial keratitis, chloramphenicol in combination offered superior in vitro cover. Broadened surveillance for ocular AMR is urgently needed across jurisdictions.
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Affiliation(s)
- Stephanie L Watson
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Barrie J Gatus
- WHOCC for STI and AMR, NSW Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, NSW, Australia
| | - Maria Cabrera-Aguas
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Benjamin H Armstrong
- WHOCC for STI and AMR, NSW Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, NSW, Australia
| | - Cr Robert George
- NSW Health Pathology Microbiology John Hunter Hospital, NSW, Australia
| | - Pauline Khoo
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Monica M Lahra
- WHOCC for STI and AMR, NSW Health Pathology Microbiology, The Prince of Wales Hospital, Randwick, NSW, Australia.,School of Medical Sciences, University of New South Wales, NSW, Australia
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Pediatric Microbial Keratitis: Experience From Tertiary Referral Centers in New South Wales, Australia. Pediatr Infect Dis J 2020; 39:883-888. [PMID: 32427646 DOI: 10.1097/inf.0000000000002723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS The purpose of this study was to report the epidemiology, etiology, microbiologic profile and management of pediatric microbial keratitis in a quaternary and 3 tertiary ophthalmic referral centers across Sydney, New South Wales, Australia. METHODS This is a retrospective cohort study of patients ≤ 18 years of age with a clinical diagnosis of microbial keratitis presenting between 1 January 2010 and 31 December 2016 identified from hospital coding and pathology databases. Data were extracted from the medical records. Epidemiology, predisposing factors, referral patterns, microbial profile and treatment outcomes were analyzed. RESULTS Eighty eyes from 80 pediatric patients with microbial keratitis were included in the study (10% had bilateral disease). The mean age was 11 ± 5.3 years (range 0-18 years), and 44 were male (55%). Thirty-six percent of patients had ocular and 13.5% systemic comorbidities. The most common risk factor overall was contact lens wear in 26%, trauma (24%), and external lid and eye disease (20%). Overall, 74 organisms were identified, and of those, the most common isolates were Gram-positive organism. Antimicrobial resistance to common antibiotics was low across all isolates. Visual acuity following treatment was worse than 6/60 for 7 patients (11.3%%), 6/15-6/60 for 15 patients (24.2%) and better than 6/12 for 40 patients (64.5%). Preexisting corneal disease and delay of presentation were associated with worse visual prognosis. Serious complications were noted in 16 (21.3%) of patients. CONCLUSIONS Contact lens wear, trauma and existing ocular disease remain the most significant risk factors in the pediatric population. Preexisting corneal disease and delay in presentation were associated with poor visual acuity. The majority of patients have a good visual outcome although serious complications are not uncommon and may cause lifelong visual disability.
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Di Zazzo A, Antonini M, Fernandes M, Varacalli G, Sgrulletta R, Coassin M. A global perspective of pediatric non-viral keratitis: literature review. Int Ophthalmol 2020; 40:2771-2788. [PMID: 32500305 DOI: 10.1007/s10792-020-01451-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This focused review aims to explore pediatric non-viral keratitis and to compare associated risk factors, etiologies, antibiotic susceptibilities, empiric treatments and outcomes. METHODS The authors performed a literature research for articles, published on PubMed, Google Scholar, Scopus and Embase online library, relevant to pediatric keratitis etiology, risk factors, antibiotic susceptibilities, treatment and outcomes. From the bibliography of selected articles, additional relevant articles were also considered. Of 34 articles identified, 21 were suitable for the purpose of this review. RESULTS Several risk factors are noted in the field of pediatric keratitis. Trauma is the most common in developing countries, while contact lenses wear is seen in developed economies. Previous ocular conditions and systemic diseases also contribute. Associated malnourishment and vitamin A deficit are fraught with a catastrophic prognosis. Among causative organisms, bacteria are more common than fungi and protozoa. Gram-positive organisms are predominant where contact lenses use is infrequent. Pseudomonas aeruginosa is often the leading pathogen in developed countries and is strongly associated with contact lens wear or malnourishment. Fungi are common in the tropics and associated with trauma. Levofloxacin seems the more effective empirical treatment when bacteria are suspected, but there is no agreement on a standard of care. CONCLUSION There are differences in etiologic patterns between developing and developed countries and different regions globally. Risk factors follow the same trend; however, there is no standard regimen being followed for empirical treatment of pediatric infectious keratitis. Associated malnourishment and vitamin A deficiency result in poorer outcomes.
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Affiliation(s)
- Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Antonini
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Merle Fernandes
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, GMR Varalakshmi Campus, Hanumanthawaka Jn, Visakhapatnam, Andhra Pradesh, 530040, India.
| | - Giuseppe Varacalli
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Roberto Sgrulletta
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
| | - Marco Coassin
- Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy
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In Vitro Biofilm Formation and Antibiotic Susceptibility Patterns of Bacteria from Suspected External Eye Infected Patients Attending Ophthalmology Clinic, Southwest Ethiopia. Int J Microbiol 2020; 2020:8472395. [PMID: 32318110 PMCID: PMC7155758 DOI: 10.1155/2020/8472395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/10/2020] [Accepted: 02/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background Ocular disease with its complications is a major public health problem which has significant impacts on the quality of life particularly in developing countries. An eye infection due to bacterial agents can lead to reduced vision and blindness. This study was aimed to assess the antimicrobial susceptibility pattern and biofilm-forming potential of bacteria isolated from suspected external eye infected patients in Jimma. Method A cross-sectional facility-based study was conducted on 319 suspect patients with external eye infections from March to June 2017 at Jimma University Medical Center (JUMC) Ophthalmology Department in Ethiopia. External ocular specimens were collected and standard operating procedures were followed to handle and culture throughout the study period. Antimicrobial susceptibility was determined by the disk diffusion method according to CLSI guidelines. Microtiter (96 wells) plate method was used to screen biofilm formation by ELISA reader at 570 nm. Results Out of 319 study participants with an external eye infection, the prevalence of bacterial pathogens was 46.1%. The predominant bacterial isolates were coagulase-negative staphylococcus (CoNS) (27.7%) followed by Staphylococcus aureus (19.7%). Among Gram-negative groups, Pseudomonas aeruginosa (6.8%) was the leading isolate. Increased antimicrobial resistance was observed for tetracycline (64%), erythromycin (66.7%), and penicillin (77.1%). Amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin were the most effective drugs for external eye infections due to susceptibility ranging from 70 to 100% among both Gram-negative and Gram-positive groups. Methicillin-resistant S. aureus (MRSA) accounted for 13.8%. Multidrug resistance (MDR) accounted for 68.7%. The overall biofilm formation rate of bacterial ocular pathogens was 66.1%, where P. aeruginosa (40%), CoNS (34.1%), and S. aureus (31%) formed strong biofilm phenotype. Conclusion The prevalence rate of bacterial isolates was high. Almost all bacterial isolates were resistant to at least one or more drugs. MDR pathogens were observed increasingly among biofilm formers or vice versa.
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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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Lin L, Duan F, Yang Y, Lou B, Liang L, Lin X. Nine-year analysis of isolated pathogens and antibiotic susceptibilities of microbial keratitis from a large referral eye center in southern China. Infect Drug Resist 2019; 12:1295-1302. [PMID: 31190918 PMCID: PMC6527795 DOI: 10.2147/idr.s206831] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/16/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose: To analyze the genus profile of isolated pathogens and antibiotic susceptibility trends of microbial keratitis over nine years at a large referral eye center in southern China. Methods: Data of corneal specimens from January 2010 to August 2018 of patients clinically diagnosed with infectious keratitis were obtained from the center’s microbiology database. Results with positive cultures along with antibiotic susceptibility were reviewed and analyzed. Results: We collected and reviewed 7,229 specimens, including 3,092 with positive cultures. Among them, 1,630 (52.72%) were bacterial, 1781 (57.60%) were fungal, and 319 (10.32%) were coinfected. A significant decreasing trend was observed in the isolates of Gram-positive cocci (r =−0.711, P=0.032), among which the proportion of coagulase-negative staphylococcus (CNS) was also reduced (r =−0.883, P=0.002). In contrast, an increasing trend in the proportion of Gram-negative bacilli was observed (r=0.661, P=0.053). The susceptibility rates of Gram-positive cocci to cephalosporins were near 90%, which was relatively high compared to fluoroquinolones. Fluoroquinolones represented the antibiotics to which Gram-negative bacilli were the most susceptible. Their susceptibility to moxifloxacin was 78.79%. The overall performance of aminoglycosides and vancomycin was both around 70%. The susceptibility of Gram-positive cocci to several antibiotics including levofloxacin (r=−0.717, P=0.03), tobramycin (r= −0.933, P<0.001), cefazolin (r= −0.964, P<0.001), ceftazidime (r=−0.929, P=0.003), chloramphenicol (r=−0.929, P=0.003), and cefuroxime (r=−0.829, P=0.042) decreased over time. The susceptibility of Gram-negative bacilli to ofloxacin increased over time (r=0.854, P=0.004), whereas that to cefazolin (r=−0.833, P=0.005) and chloramphenicol (r=−0.886, P=0.019) decreased over time. Conclusion: From 2010 to 2018 in Zhongshan Ophthalmic Center, most isolates from infectious keratitis were Gram-positive cocci (mainly CNS), which decreased over time, with an increase in Gram-positive bacilli. More than half of the antibiotics showed reducing trend of susceptibilities, and the antibiotic resistance situation in southern China was not encouraging.
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Affiliation(s)
- Lixia Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Fang Duan
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yao Yang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Bingsheng Lou
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lingyi Liang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaofeng Lin
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, People's Republic of China
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Ozkan J, Coroneo M, Willcox M, Wemheuer B, Thomas T. Identification and Visualization of a Distinct Microbiome in Ocular Surface Conjunctival Tissue. Invest Ophthalmol Vis Sci 2019; 59:4268-4276. [PMID: 30140925 DOI: 10.1167/iovs.18-24651] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Knowledge of whether microorganisms reside in protected niches of the conjunctiva is potentially significant in terms of minimizing risks of contact lens inflammation/infection and endophthalmitis. We define if and how microbial communities from limbal and forniceal conjunctival tissue differ from those on the conjunctival surface. Methods Human limbal and forniceal conjunctival tissue was obtained from 23 patients undergoing pterygium surgery and analyzed with data from a recent study of conjunctival surface swabs (n = 45). Microbial communities were analyzed by extracting total DNA from tissue samples and surface swabs and sequencing the 16S rRNA gene using the Illumina MiSeq platform. Sequences were quality filtered, clustered into operational taxonomic units (OTUs) at 97% similarity. OTUs associated with blank extraction and sampling negative controls were removed before analysis. Fluorescent in situ hybridization (FISH) was performed on cyrosections of limbal and forniceal conjunctival tissue. Results There was a significant difference in bacterial community structure between the conjunctival surface and fornix (P = 0.001) and limbus (P = 0.001) tissue. No difference was found in bacterial communities between the limbus and fornix (P = 0.764). Fornix and limbal samples were dominated by OTUs classified to the genus Pseudomonas (relative abundance 79.9%), which were found only in low relative abundances on conjunctival surfaces (6.3%). Application of FISH showed the presence of Pseudomonas in the forniceal tissue sample. Conclusions There is a discrete tissue-associated microbiome in freshly-collected human limbal and fornix tissue, which is different from the microbial community structure and composition of the ocular surface microbiome.
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Affiliation(s)
- Jerome Ozkan
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia
| | - Minas Coroneo
- Department of Ophthalmology, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Mark Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Bernd Wemheuer
- School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia.,Department of Genomic and Applied Microbiology, University of Göttingen, Göttingen, Germany
| | - Torsten Thomas
- School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia
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Watson S, Cabrera-Aguas M, Khoo P, Pratama R, Gatus BJ, Gulholm T, El-Nasser J, Lahra MM. Keratitis antimicrobial resistance surveillance program, Sydney, Australia: 2016 Annual Report. Clin Exp Ophthalmol 2018; 47:20-25. [PMID: 30047184 DOI: 10.1111/ceo.13364] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 06/04/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
IMPORTANCE Antimicrobial resistance data from bacterial keratitis in Australia are lacking. BACKGROUND Antimicrobial resistance is a global health threat. Bacterial keratitis is an ophthalmic emergency requiring immediate and effective treatment. DESIGN Retrospective cohort study of bacterial isolates and antibiotic susceptibility profiles at a quaternary hospital in Sydney, Australia. PARTICIPANTS Two hundred and twenty-four corneal scrapes from patients from January 1 to December 31, 2016. METHODS Matrix assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry identified bacteria. The Calibrated Dichotomous Sensitivity (CDS) method determined antibiotic susceptibilities. MAIN OUTCOME MEASURES Isolated organisms and antibiotic susceptibilities. RESULTS One hundred and sixty-eight scrapes of 224 (75%) were culture positive. One hundred and thirty-one patients had a single organism isolated and 21 had mixed bacterial growth. Of the 157 organisms isolated, 131 (83%) were Gram-positive and 27 (17%) Gram-negative. Of the Gram-positive organisms, 75 (57%) were coagulase-negative Staphylococci (CoNS), 15 (11%) Staphylococcus aureus (including one methicillin-resistant Staphylococcus aureus [MRSA]) and 8 (6%) Corynebacterium spp. Of the Gram-negative organisms, 15 (58%) were Pseudomonas aeruginosa. With methicillin-sensitive Staphylococcus aureus (MSSA) resistance to chloramphenicol was 21%, ciprofloxacin 7% and gentamicin 7%. With CoNS resistance to cefalotin was 9%, gentamicin 9% and ciprofloxacin 9%. With Corynebacterium spp. resistance was 40% to cefalotin, chloramphenicol 25% and ciprofloxacin 14%. CONCLUSIONS AND RELEVANCE Staphyloccocus spp. and Pseudomonas spp. were the most common microorganisms isolated. There was low resistance to cefalotin and ciprofloxacin for these isolates. More than 90% of these would be covered by current therapeutic recommendations for empiric therapy in Australia.
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Affiliation(s)
- Stephanie Watson
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Cabrera-Aguas
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Pauline Khoo
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Ryanbi Pratama
- New South Wales Health Pathology East Microbiology, University of New South Wales, Sydney, New South Wales, Australia
| | - Barrie J Gatus
- New South Wales Health Pathology East Microbiology, University of New South Wales, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Trine Gulholm
- New South Wales Health Pathology East Microbiology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmin El-Nasser
- New South Wales Health Pathology East Microbiology, University of New South Wales, Sydney, New South Wales, Australia
| | - Monica M Lahra
- New South Wales Health Pathology East Microbiology, University of New South Wales, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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Zhu H, Kochevar IE, Behlau I, Zhao J, Wang F, Wang Y, Sun X, Hamblin MR, Dai T. Antimicrobial Blue Light Therapy for Infectious Keratitis: Ex Vivo and In Vivo Studies. Invest Ophthalmol Vis Sci 2017; 58:586-593. [PMID: 28129422 PMCID: PMC5283079 DOI: 10.1167/iovs.16-20272] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose To investigate the effectiveness of antimicrobial blue light (aBL) as an alternative or adjunctive therapeutic for infectious keratitis. Methods We developed an ex vivo rabbit model and an in vivo mouse model of infectious keratitis. A bioluminescent strain of Pseudomonas aeruginosa was used as the causative pathogen, allowing noninvasive monitoring of the extent of infection in real time via bioluminescence imaging. Quantitation of bacterial luminescence was correlated to colony-forming units (CFU). Using the ex vivo and in vivo models, the effectiveness of aBL (415 nm) for the treatment of keratitis was evaluated as a function of radiant exposure when aBL was delivered at 6 or 24 hours after bacterial inoculation. The aBL exposures calculated to reach the retina were compared to the American National Standards Institute standards to estimate aBL retinal safety. Results Pseudomonas aeruginosa keratitis fully developed in both the ex vivo and in vivo models at 24 hours post inoculation. Bacterial luminescence in the infected corneas correlated linearly to CFU (R2 = 0.921). Bacterial burden in the infected corneas was rapidly and significantly reduced (>2-log10) both ex vivo and in vivo after a single exposure of aBL. Recurrence of infection was observed in the aBL-treated mice at 24 hours after aBL exposure. The aBL toxicity to the retina is largely dependent on the aBL transmission of the cornea. Conclusions Antimicrobial blue light is a potential alternative or adjunctive therapeutic for infectious keratitis. Further studies of corneal and retinal safety using large animal models, in which the ocular anatomies are similar to that of humans, are warranted.
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Affiliation(s)
- Hong Zhu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States 2Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Irene E Kochevar
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Irmgard Behlau
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, United States 4School of Medicine, Tufts University, Boston, Massachusetts, United States
| | - Jie Zhao
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yucheng Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States 5Department of Laser Medicine, Chinese PLA General Hospital, Beijing, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Tianhong Dai
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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15
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Lin L, Lan W, Lou B, Ke H, Yang Y, Lin X, Liang L. Genus Distribution of Bacteria and Fungi Associated with Keratitis in a Large Eye Center Located in Southern China. Ophthalmic Epidemiol 2016; 24:90-96. [DOI: 10.1080/09286586.2016.1254250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lixia Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Weizhong Lan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Bingsheng Lou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hongmin Ke
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuanzhe Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lingyi Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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17
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Pediatric microbial keratitis in Taiwan: clinical and microbiological profiles, 1998-2002 versus 2008-2012. Am J Ophthalmol 2014; 157:1090-6. [PMID: 24487048 DOI: 10.1016/j.ajo.2014.01.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/17/2014] [Accepted: 01/17/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify the change in clinical and microbiological profiles of pediatric microbial keratitis in Taiwan between 1998-2002 and 2008-2012. DESIGN Retrospective, observational study. METHOD setting: Chang Gung Memorial Hospital, a referral center in Taiwan. patient population: We retrospectively reviewed the medical records of 68 eyes of 67 children aged 16 years or younger who were diagnosed with microbial keratitis and treated at our hospital between July 2008 and December 2012. main outcomes and measures: Predisposing factors, isolated organisms, antibiotic susceptibility, and clinical outcomes. The findings were compared with the results of our previous study conducted between July 1998 and December 2002. RESULTS As in 1998-2002, the leading risk factor for microbial keratitis during 2008-2012 was contact lens use, and the infection rate significantly increased from 40.7% to 52.9% (P = .024), which was mainly attributable to the recent increase in the rate of orthokeratology-related keratitis from 9.9% to 19.1% (P = .011). Pseudomonas aeruginosa remained the most commonly isolated organism (30.6%), but the number of isolated coagulase-negative Staphylococcus cases increased significantly in the 2008-2012 cases (P = .04). Antibiotic susceptibility of organisms did not change significantly between the 2 study periods. By using multiple linear stepwise regression analysis, we found that gram-negative bacterial infection played a crucial role in poor visual outcome. CONCLUSIONS Contact lens-related microbial keratitis increased in Taiwanese children over time, especially because of the use of overnight orthokeratology. Clinicians must understand the infection background and pay further attention to contact lens use in pediatric patients.
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Antimicrobial Agents in Ophthalmology. OCULAR INFECTIONS 2014. [PMCID: PMC7123564 DOI: 10.1007/978-3-662-43981-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Many types of antimicrobial agents have been introduced for the treatment of ocular infectious diseases. Some ocular infections have been eradicated such as smallpox, while others have been controlled by public health measures such as trachoma. The resilience of viruses and the tenacity of bacteria have led to the evolution of old diseases and the emergence of new infections. Continuous search for new antimicrobial agents for the treatment of infectious diseases is, therefore, highly desirable. New infectious agents are discovering the human race, and the ecological changes are exposing mankind to new viruses and bacteria. In addition, air travel and disruption of geographic barriers are leading to new forms of infectious diseases. In the twentieth century, there was a widespread false optimism that infectious diseases are eradicated by antimicrobial agents. It was soon discovered that many infections require new strategies for the treatment of ocular infections. The new antimicrobial agents that have been introduced over the past century can be classified into four major categories including (1) antibiotics that inhibit cell wall synthesis and integrity, (2) antibiotics that inhibit and suppress cell membrane functions, (3) antibiotics that interfere the protein synthesis, and (4) antibiotics that modulate nucleic acid synthesis. The selection of antimicrobial agents for the treatment of ocular infectious diseases is based on the most frequently encountered organisms, the pharmacokinetics of the antibiotics, the dosage required, the ocular penetration, and the cost of therapy. The stumbling blocks to safe and effective antimicrobial therapy in ocular infections include the resistance of the microorganisms, toxicity of the drug, and poor ocular penetration of antimicrobial agents.
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Richoz O, Gatzioufas Z, Francois P, Schrenzel J, Hafezi F. Impact of Fluorescein on the Antimicrobial Efficacy of Photoactivated Riboflavin in Corneal Collagen Cross-linking. J Refract Surg 2013; 29:842-5. [DOI: 10.3928/1081597x-20131115-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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