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Delshad SD, Ferraro R. Arteriovenous Graft Infection Due to Granulicatella adiacens. Cureus 2024; 16:e61622. [PMID: 38966446 PMCID: PMC11222331 DOI: 10.7759/cureus.61622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 07/06/2024] Open
Abstract
Granulicatella adiacens is a gram-positive coccus that is normally found in the human oral cavity and gastrointestinal and urogenital tracts but can rarely cause infection. When it does cause infection, Granulicatella adiacens has been most associated with bacteremia and endovascular infection, but to our knowledge, there are no previously documented cases of arteriovenous graft (AVG) infection. We present a case of Granulicatella adiacens bacteremia with associated AVG infection.
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Affiliation(s)
- Sean D Delshad
- Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Regan Ferraro
- Radiology, Rolling Oaks Radiology, Thousand Oaks, USA
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2
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Jitvaropas R, Mayuramart O, Sawaswong V, Kaewsapsak P, Payungporn S. Classification of salivary bacteriome in asymptomatic COVID-19 cases based on long-read nanopore sequencing. Exp Biol Med (Maywood) 2022; 247:1937-1946. [PMID: 36082397 PMCID: PMC9742750 DOI: 10.1177/15353702221118091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The coronavirus (COVID-19) global pandemic has impacted the health of almost everyone, including changes in their salivary microbiota. Since 2019, there has been an increase in the number of new COVID-19 cases in Thailand. Therefore, COVID-19 active case finding is important for early detection and epidemic control. Moreover, the dynamic changes of salivary bacteriome in asymptomatic COVID-19 cases are largely unknown. This research aimed to investigate and compare the salivary bacteriome and the co-infectious bacterial pathogens in the asymptomatic COVID-19 positive group to the negative group, based on novel nanopore sequencing. This cohort was a cross-sectional study including saliva samples collected from 82 asymptomatic participants (39 COVID-19 positive and 43 COVID-19 negative cases). All samples were sequenced for the full-length bacterial 16S rDNA. The alpha and beta diversity analyses were not significantly different between groups. The three major species in salivary bacteriome including Veillonella parvula, Streptococcus mitis, and Prevotella melaninogenica were observed in both groups. Interestingly, Lautropia mirabilis was a significantly enriched species in the saliva of the asymptomatic COVID-19-positive cases based on linear discriminant analysis effect size (LEfSe) analysis. The results suggested that L. mirabilis was a co-infectious agent in the asymptomatic COVID-19 group. However, the potential role of L. mirabilis should be validated in further experimental studies.
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Affiliation(s)
- Rungrat Jitvaropas
- Division of Biochemistry, Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathum Thani 10120, Thailand
| | - Oraphan Mayuramart
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Vorthon Sawaswong
- Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok 10330, Thailand
| | - Pornchai Kaewsapsak
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand,Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sunchai Payungporn
- Research Unit of Systems Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand,Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand,Sunchai Payungporn.
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3
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Purohit G, Mishra B, Sahoo S, Mahapatra A. Granulicatella adiacens as an Unusual Cause of Empyema: A Case Report and Review of Literature. J Lab Physicians 2022; 14:343-347. [PMID: 36119420 PMCID: PMC9473932 DOI: 10.1055/s-0042-1744236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Granulicatella adiacens
, a nutritionally variant
Streptococcus
(NVS), is part of the normal commensal flora of human mouth, genital, and intestinal tracts and rarely causes disease. It has been mostly reported from bacteremia and endocarditis cases, but rarely can cause vertebral osteomyelitis, pancreatic abscess, otitis media, and endovascular, central nervous system, ocular, oral, bone and joint, and genitourinary infections. Due to requirement of fastidious culture conditions and non-specific colony morphology, serious diagnostic difficulties may arise in cases of NVS infections. Here, we are reporting a rare fatal infection of
G. adiacens
presented with empyema complicated to sepsis and necrotizing fasciitis.
Clinicians should be aware of the pathogenic potential of
Granulicatella adiacens
(a normal commensal flora of human mouth, genital and intestinal tracts). Appropriate supplemented media and a reliable detection system should be used to identify these fastidious organisms. We present this rare case to bring awareness among clinicians regarding such a rare but potentially fatal infection.
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Affiliation(s)
- Geetarani Purohit
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
- Department of Microbiology and Infection Control, Vikash Multispeciality Hospital, Bargarh, Odisha, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Satyajeet Sahoo
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ashoka Mahapatra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
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4
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Cho SY, Cho E, Park CH, Kim HJ, Koo JY. Septic shock due to Granulicatella adiacens after endoscopic ultrasound-guided biopsy of a splenic mass: A case report. World J Gastroenterol 2021; 27:751-759. [PMID: 33716452 PMCID: PMC7934004 DOI: 10.3748/wjg.v27.i8.751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/18/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy (EUS-FNA or FNB) has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety. To the best of our knowledge, no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described. Herein, we report a rare case of septic shock after EUS-FNB of a splenic mass.
CASE SUMMARY A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass. A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging. EUS of the spleen showed a 6 cm-sized, relatively well-demarcated, heterogeneous mass, and EUS-FNB with a 22G needle was performed. Ten days after the procedure patient developed septic shock and a splenic abscess was identified. Blood culture revealed growth of Granulicatella adiacens. After the treatment with antibiotics the patient underwent surgical resection, and the pathological examination showed diffuse large B-cell lymphoma. The patient received chemotherapy and he is in complete remission.
CONCLUSION Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.
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Affiliation(s)
- Seo-Yeon Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, South Korea
| | - Eunae Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, South Korea
| | - Chang-Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju 61469, South Korea
| | - Hee-Joon Kim
- Department of Surgery, Chonnam National University Hospital, Gwangju 61469, South Korea
| | - Joo-Yeon Koo
- Department of Pathology, Chonnam National University Hospital, Gwangju 61469, South Korea
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5
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Saadaoui M, Singh P, Al Khodor S. Oral microbiome and pregnancy: A bidirectional relationship. J Reprod Immunol 2021; 145:103293. [PMID: 33676065 DOI: 10.1016/j.jri.2021.103293] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/28/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
The oral cavity contains the second most complex microbial population within the human body, with more than 700 bacterial organisms. Recent advances in Next Generation Sequencing technology have unraveled the complexities of the oral microbiome and provided valuable insights into its role in health and disease. The human oral microbiome varies dramatically during the different stages of life, including pregnancy. The total viable microbial counts in pregnant women are known to be higher compared to non-pregnant women, especially in the first trimester of pregnancy. A balanced oral microbiome is vital for a healthy pregnancy, as perturbations in the oral microbiome composition can contribute to pregnancy complications. On the other hand, physiological changes and differences in hormonal levels during pregnancy, increase susceptibility to various oral diseases such as gingivitis and periodontitis. A growing body of evidence supports the link between the composition of the oral microbiome and adverse pregnancy outcomes such as preterm birth, preeclampsia, low birth weight among others. This review aims to summarize the dynamics of oral microbiome during pregnancy and to discuss the relationship between a dysbiotic oral microbiome and pregnancy complications.
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Affiliation(s)
| | - Parul Singh
- Research Department, Sidra Medicine, Doha, Qatar
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Al-Lozi A, Cai S, Chen X, Perez VL, Venkateswaran N. Granulicatella Adiacens as an Unusual Cause of Microbial Keratitis and Endophthalmitis: A Case Series and Literature Review. Ocul Immunol Inflamm 2021; 30:1181-1185. [PMID: 33426987 DOI: 10.1080/09273948.2020.1860233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To report two cases of microbial keratitis and/or endophthalmitis involving Granulicatella adiacens.Methods: Case series.Results: 24-year-old female with a history of Herpes simplex virus 1 (HSV-1) and Candida parapsilosis keratitis presented with a geographic epithelial defect and infiltrate in the left eye. Cultures were positive for HSV-1 and G. adiacens. Keratitis resolved with topical vancomycin and oral valacyclovir. A 65-year-old female with a history of type II diabetes and failed therapeutic penetrating keratoplasty presented with inferior corneal graft haze and vitreous inflammation of the right eye. Therapeutic penetrating keratoplasty and pars plana vitrectomy were performed, and the corneal button returned positive for G. adiacens. The patient was treated with topical and intravitreal vancomycin as well as topical and systemic steroids.Conclusions: These cases expand the literature on G. adiacens keratitis and endophthalmitis and corroborate the role of steroid use and prior surgery as paramount risk factors.
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Affiliation(s)
- Amal Al-Lozi
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Sophie Cai
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Xi Chen
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Victor L Perez
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - Nandini Venkateswaran
- Department of Ophthalmology, Duke University, Durham, NC, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Tennert C, Reinmuth AC, Bremer K, Al-Ahmad A, Karygianni L, Hellwig E, Vach K, Ratka-Krüger P, Wittmer A, Woelber JP. An oral health optimized diet reduces the load of potential cariogenic and periodontal bacterial species in the supragingival oral plaque: A randomized controlled pilot study. Microbiologyopen 2020; 9:e1056. [PMID: 32419378 PMCID: PMC7424251 DOI: 10.1002/mbo3.1056] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 11/07/2022] Open
Abstract
This study aimed to investigate the effects of an oral health optimized diet on the composition of the supragingival oral plaque in a randomized controlled trial. Participants of the standard diet group (n = 5) had a diet high in processed carbohydrates and did not change their dietary behavior during the observation. The healthy diet group (n = 9) had to change the diet after 2 weeks from a diet high in processed carbohydrates to a diet low in carbohydrates, rich in omega‐3 fatty acids, rich in vitamins C and D, antioxidants and fiber for 4 weeks. Saliva and supragingival plaque samples were taken at the end of week two and eight of the observation period to investigate the composition of microbiota in saliva and supragingival plaque. Data were subjected to an exploratory analysis to identify significant differences. Statistically significant differences were only found in the healthy diet group between the baseline (week 2) and the final sample (week 8) for specific species in plaque and saliva samples. A reduction of the total counts of Streptococcus mitis group, Granulicatella adiacens, Actinomyces spp., and Fusobacterium spp. was found in plaque samples of the healthy diet group. In saliva samples of the healthy diet group, the total counts of Actinomyces spp. and Capnocytophaga spp. decreased. A diet low in carbohydrates, rich in omega‐3 fatty acids, rich in vitamins C and D, and rich in fiber reduced Streptococcus mitis group, Granulicatella adiacens, Actinomyces spp., and Fusobacterium spp. in the supragingival plaque.
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Affiliation(s)
- Christian Tennert
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland.,Department of Operative Dentistry and Periodontology, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ann-Christin Reinmuth
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Bremer
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Lamprini Karygianni
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Kirstin Vach
- Department of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Petra Ratka-Krüger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Annette Wittmer
- Department of Microbiology and Hygiene, Institute of Medical Microbiology and Hygiene, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Johan Peter Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
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8
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Elfessi Z, Liu E, Dukarevich Y, Caniff K, Marquez K, Shabbir Z. Sepsis induced bacterial peritonitis caused by Granulicatella adiacens. Am J Emerg Med 2019; 37:2263.e1-2263.e3. [DOI: 10.1016/j.ajem.2019.158428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
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9
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Nutritionally Variant Streptococcal Bacteremia in the 21st Century. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Bakhsh W, Childs S, Ikpeze T, Mesfin A. Lumbar Spine Infection by Granulicatella and Abiotrophia Species. World Neurosurg 2017; 108:997.e1-997.e3. [PMID: 28939536 DOI: 10.1016/j.wneu.2017.09.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Granulicatella and Abiotrophia species are streptococci and natural inhabitants of the oral and urogenital flora. They are uncommonly associated with human pathology, although they can cause septicemia, endocarditis, or bacteremia. These microorganisms are difficult to culture and identify due to particular microenvironment requirements. Rarely, presentation is osteomyelitis or infections of the spine. CASE DESCRIPTION The case report referenced patient notes, laboratory values, and imaging from the electronic health record. In this 48-year-old male with a history of hepatitis C and intravenous drug use, back pain was a relatively common presentation of an uncommon infection. His hospital course was significant for low back pain that did not resolve with conservative measures. Imaging was concerning for infection of the lumbar spine. Biopsies, negative early on, were ultimately positive for Granulicatella and Abiotrophia species, a rare infectious etiology. This infection uncommonly affects the lumbar spine and has not been previously documented in IV drug users. Intravenous antibiotics were prescribed for 6 weeks, after which the patient demonstrated significant clinical improvement. CONCLUSION With such an uncommon pathogen, there are no universal protocol changes indicated. However, awareness of such unusual microbes and their potential role as the etiology of more common infections, such as lumbar osteomyelitis, is crucial in developing a thorough infectious workup in cases resistant to treatment targeting typical microorganisms.
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Affiliation(s)
- Wajeeh Bakhsh
- Orthopaedic Surgery, University of Rochester, Rochester, New York, USA
| | - Sean Childs
- Orthopaedic Surgery, University of Rochester, Rochester, New York, USA
| | - Tochukwu Ikpeze
- Orthopaedic Surgery, University of Rochester, Rochester, New York, USA
| | - Addisu Mesfin
- Orthopaedic Surgery, University of Rochester, Rochester, New York, USA.
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Subirats J, Triadó-Margarit X, Mandaric L, Acuña V, Balcázar JL, Sabater S, Borrego CM. Wastewater pollution differently affects the antibiotic resistance gene pool and biofilm bacterial communities across streambed compartments. Mol Ecol 2017; 26:5567-5581. [DOI: 10.1111/mec.14288] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Jèssica Subirats
- Catalan Institute for Water Research (ICRA); Scientific and Technological Park of the University of Girona; Girona Spain
| | - Xavier Triadó-Margarit
- Integrative Freshwater Ecology Group; Centre d'Estudis Avançats de Blanes; CEAB-CSIC; Blanes Girona Spain
- Group of Molecular Microbial Ecology; Institute of Aquatic Ecology; University of Girona; Girona Spain
| | - Ladislav Mandaric
- Catalan Institute for Water Research (ICRA); Scientific and Technological Park of the University of Girona; Girona Spain
| | - Vicenç Acuña
- Catalan Institute for Water Research (ICRA); Scientific and Technological Park of the University of Girona; Girona Spain
| | - José Luis Balcázar
- Catalan Institute for Water Research (ICRA); Scientific and Technological Park of the University of Girona; Girona Spain
| | - Sergi Sabater
- Catalan Institute for Water Research (ICRA); Scientific and Technological Park of the University of Girona; Girona Spain
- GRECO; Institute of Aquatic Ecology; University of Girona; Girona Spain
| | - Carles M. Borrego
- Catalan Institute for Water Research (ICRA); Scientific and Technological Park of the University of Girona; Girona Spain
- Group of Molecular Microbial Ecology; Institute of Aquatic Ecology; University of Girona; Girona Spain
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Cincotta MC, Coffey KC, Moonah SN, Uppal D, Hughes MA. Case Report of Granulicatella adiacens as a Cause of Bacterascites. Case Rep Infect Dis 2015; 2015:132317. [PMID: 26618012 PMCID: PMC4649103 DOI: 10.1155/2015/132317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022] Open
Abstract
Granulicatella adiacens is a Gram-positive coccus, formerly grouped with nutritionally variant Streptococcus, often found as commensal bacteria of the human oral cavity, urogenital tract, and gastrointestinal tract. Prior case reports have demonstrated Granulicatella spp. as a pathogen that can cause bacteremia and infective endocarditis particularly of prosthetic valves and pacemaker leads. Here, we report on a unique case of Granulicatella adiacens bacterascites in a 50-year-old male.
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Affiliation(s)
- Molly C. Cincotta
- School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - K. C. Coffey
- Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Shannon N. Moonah
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Dushant Uppal
- Division of Gastroenterology, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Molly A. Hughes
- Division of Infectious Diseases, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
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13
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Balikoglu-Yilmaz M, Yilmaz T, Esen AB, Engin KN, Taskapili M. Pasteurella canis and Granulicatella adiacens conjunctivitis outbreak resistant to empirical treatment in a child welfare agency. J Pediatr Ophthalmol Strabismus 2012; 49:314-9. [PMID: 22800794 DOI: 10.3928/01913913-20120710-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 05/30/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate pathogens associated with bacterial conjunctivitis resistant to the empirical treatment and their antibiotic resistance in a child welfare agency. METHODS Twenty-eight eyes in 14 children with a median age of 3 months with conjunctivitis resistant to the empirical treatment were included in this study. Samples were taken three times from the inferior fornix in both eyes using cotton swabs, cultured onto chocolate and blood agar, and prepared for Gram staining. Antibiograms were evaluated according to the Clinical and Laboratory Standards Institute criteria by disc diffusion method. RESULTS The conjunctival culture positivity rate was 35.7% in eyes with conjunctivitis resistant to the empirical treatment. The most common isolated bacteria were Pasteurella canis (25%), penicillin-nonsusceptible Streptococcus pneumoniae (7.1%), and Granulicatella adiacens (3.6%). According to culture results, ophthalmic solutions of vancomycin (50 mg/mL) or gentamicin (30 mg/mL) were applied in eyes with positive conjunctival culture. Previously applied multiple treatments were stopped in eyes with negative conjunctival culture. All eyes improved clinically during follow-up. CONCLUSION Because unusual pathogens may cause a conjunctivitis outbreak, physicians should not insist on empirical treatment. Taking conjunctival culture and antibiotic switching according to antibiogram may be helpful.
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