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Tong WY, Tan WN, Kamarul Azizi MA, Leong CR, El Azab IH, Lim JW, Mahmoud MHH, Dailin DJ, Ibrahim MM, Chuah LF. Nanoparticle-laden contact lens for controlled release of vancomycin with enhanced antibiotic efficacy. CHEMOSPHERE 2023; 338:139492. [PMID: 37451643 DOI: 10.1016/j.chemosphere.2023.139492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Vancomycin is the last resort antibiotic for the treatment of severe bacterial keratitis. Its clinical application is limited due to its hydrophilicity and high molecular weight. To overcome this, this study aims to develop nanoparticles-laden contact lens for controlled ocular delivery of vancomycin. Polyvinyl alcohol (PVA) was used as encapsulant material. The nanoparticles had a negative surface charge and an average size of 147.6 nm. A satisfactory encapsulation efficiency (61.24%) was obtained. The release profile was observed to be slow and sustained, with a release rate of 1.29 μL mg-1 h-1 for 48 h. Five out of 6 test bacteria were suppressed by vancomycin nanoparticles-laden contact lens. Vancomycin is generally ineffective against Gram-negative bacteria and unable to pass through the outer membrane barrier. In this study, vancomycin inhibited Proteus mirabilis and Pseudomonas aeruginosa. Nano-encapsulation enables vancomycin to penetrate the Gram-negative cell wall and further destroy the bacterial cells. On Hohenstein challenge test, all test bacteria exhibited significant reduction in growth when exposed to vancomycin nanoparticles-laden contact lens. This study created an effective and long-lasting vancomycin delivery system via silicone hydrogel contact lenses, by using PVA as encapsulant. The antibiotic efficacy and vancomycin release should be further studied using ocular in vivo models.
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Affiliation(s)
- Woei Yenn Tong
- Universiti Kuala Lumpur, Branch Campus Institute of Medical Science Technology, A1, 1, Jalan TKS 1, Taman Kajang Sentral, 43000, Kajang, Selangor, Malaysia; Universiti Kuala Lumpur, Branch Campus Malaysian Institute of Chemical and Bioengineering Technology, Lot 1988 Kawasan Perindustrian Bandar Vendor, Taboh Naning, Alor Gajah, Melaka, Malaysia.
| | - Wen-Nee Tan
- School of Distance Education, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
| | - Muhammad Afif Kamarul Azizi
- Universiti Kuala Lumpur, Branch Campus Malaysian Institute of Chemical and Bioengineering Technology, Lot 1988 Kawasan Perindustrian Bandar Vendor, Taboh Naning, Alor Gajah, Melaka, Malaysia
| | - Chean Ring Leong
- Universiti Kuala Lumpur, Branch Campus Malaysian Institute of Chemical and Bioengineering Technology, Lot 1988 Kawasan Perindustrian Bandar Vendor, Taboh Naning, Alor Gajah, Melaka, Malaysia
| | - Islam H El Azab
- Department of Food Science and Nutrition, College of Science, Taif University, P.O. box 11099, Taif, 21944, Saudi Arabia
| | - Jun Wei Lim
- HICoE-Centre for Biofuel and Biochemical Research, Institute of Self Sustainable Building, Department of Fundamental and Applied Sciences, Universiti Teknologi PETRONAS, Seri Iskandar, 32610, Perak Darul Ridzuan, Malaysia; Department of Biotechnology, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, 602105, India
| | - M H H Mahmoud
- Department of Chemistry, College of Science, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Daniel Joe Dailin
- Institute of Bioproduct Development, Universiti Teknologi Malaysia, Johor, Malaysia; Department of Bioprocess and Polymer Engineering, Faculty of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Johor, Malaysia.
| | - Mohamed M Ibrahim
- Department of Chemistry, College of Science, Taif University, P.O. Box 11099, Taif, 21944, Saudi Arabia
| | - Lai Fatt Chuah
- Faculty of Maritime Studies, Universiti Malaysia Terengganu, Terengganu, Malaysia.
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Ung L, Chodosh J. Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis. Ocul Surf 2023; 28:378-400. [PMID: 34461290 PMCID: PMC10721114 DOI: 10.1016/j.jtos.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Staphylococcus aureus Keratitis in Taiwan: Genotyping, Antibiotic Susceptibility, and Clinical Features. Int J Mol Sci 2022; 23:ijms231911703. [PMID: 36233005 PMCID: PMC9570272 DOI: 10.3390/ijms231911703] [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: 08/31/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Staphylococcus aureus is an important pathogen for keratitis, a vision-threatening disease. We aimed to investigate the genotyping, antibiotic susceptibility, and clinical features of S. aureus keratitis, and to explore the possible role of Panton–Valentine leucocidin (PVL), a major virulence factor of S. aureus. We recruited 49 patients with culture-proven S. aureus keratitis between 2013 and 2017 at Chang Gung Memorial Hospital, Taiwan. PVL gene, multilocus sequence type (MLST), staphylococcal cassette chromosome mec (SCCmec), and pulsed-field gel electrophoresis (PFGE) were performed. Antibiotic susceptibility was verified using disk diffusion/E test. There were 49 patients with S. aureus keratitis; 17 (34.7%) were caused by methicillin-resistant S. aureus (MRSA) and 9 (18.4%) isolates had PVL genes. The predominant genotyping of MRSA isolates was CC59/PFGE type D/SCCmec VT/PVL (+). All methicillin-sensitive S. aureus (MSSA) and approximately 60% MRSA were susceptible to fluoroquinolones. No significant differences in clinical features, treatments, and visual outcomes were observed between MRSA/MSSA or PVL(+)/PVL(−) groups. In Taiwan, approximately one third of S. aureus keratitis was caused by MRSA, mainly community-associated MRSA. Although MRSA isolates were more resistant than MSSA, clinical characteristics were similar between two groups. Fluoroquinolones could be good empiric antibiotics for S. aureus keratitis.
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Lim J, Cho CH, Lee SB. Microbiological Profile and Clinical Characteristics of Bacterial Keratitis with Poor Visual Outcome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.7.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare clinical characteristics between the poor visual outcome (PVO) and good visual outcome (GVO) groups in culture-proven bacterial keratitis.Methods: A total of 230 cases (44 and 186 eyes in the PVO and GVO groups, respectively) of culture-proven bacterial keratitis, treated between January 2007 and December 2020, were reviewed retrospectively. The PVO group included cases with the final best-corrected visual acuity (BCVA) of less than 0.1 and no improvement compared to the initial BCVA. The remaining cases were included in the GVO group. The microbiological profiles, epidemiology, predisposing factors, and clinical characteristics were compared between the PVO and GVO groups, and the risk factors for PVO were analyzed.Results: Staphylococcus spp. and Pseudomonas spp. were common isolates in both the PVO and GVO groups, with no significant differences in the distribution of isolates. There were no significant differences between the groups in terms of sex, seasonal distribution, corneal trauma, and prior topical steroid use, but contact lens wear was significantly less in the PVO group. Significant risk factors for PVO were age ≥60 years (Z = 4.22, two-proportion Z-test), central corneal lesions (Z = 3.80), epithelial defect size ≥5 mm<sup>2</sup> (Z = 3.74), prior ocular surgery (Z = 3.63), hypopyon (Z = 3.42), previous ocular surface disease (Z = 3.32), and diabetes (Z = 3.12).Conclusions: In patients with bacterial keratitis, PVO was associated with older age, severe initial corneal findings, previous ocular disease history, and diabetes, but not with the causative pathogen itself.
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Afzal M, Vijay AK, Stapleton F, Willcox M. Virulence Genes of Staphylococcus aureus Associated With Keratitis, Conjunctivitis, and Contact Lens-Associated Inflammation. Transl Vis Sci Technol 2022; 11:5. [PMID: 35802366 PMCID: PMC9279920 DOI: 10.1167/tvst.11.7.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose Staphylococcus aureus, cause a range of ocular diseases in humans, including noninfectious corneal infiltrative events (niCIE), infectious conjunctivitis and sight threatening microbial keratitis (MK). This study aimed to determine the possession of known virulence genes of S. aureus associated with MK and conjunctivitis, in strains isolated from these conditions and niCIE. Methods Sixty-three S. aureus strains—23 from MK, 26 from conjunctivitis, and 14 from niCIE—were evaluated for possession of genes. Polymerase chain reaction was used for the detection of mecA and 10 known virulence genes involved in MK (clfA, fnbpA, eap, coa, scpA, sspB, sspA, hla, hld, and hlg), 2 associated with conjunctivitis (pvl and seb). Results mecA was present in 35% of infections and 7% of niCIE strains (P = 0.05). It was not seen in infection strains from Australia. Adhesion genes were found in all strains except clfA, which was found in 75% of infection and 93% of niCIE strains. Invasion genes were found in higher frequency in infections strains—hlg (100% vs. 85%; P = 0.04) and hld (94% vs. 50%; P = 0.005)—compared with niCIE strains. Evasion genes were common in infection strains except scpA, which was found at a significantly higher frequency in niCIE strains (86%) compared with infection strains (45%; P = 0.001). Conclusions The higher rates of hlg and hld in strains isolated from infections than niCIE may have a role in pathogenesis, whereas scpA may be an important virulence factor during niCIEs. Translational Relevance This study has identified virulence factors involved in the ocular pathogenesis of S. aureus infections and niCIE.
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Affiliation(s)
- Madeeha Afzal
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Ajay Kumar Vijay
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Mark Willcox
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, NSW, Australia
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Nasr M, Saber S, Bazeed AY, Ramadan HA, Ebada A, Ciorba AL, Cavalu S, Elagamy HI. Advantages of Cubosomal Formulation for Gatifloxacin Delivery in the Treatment of Bacterial Keratitis: In Vitro and In Vivo Approach Using Clinical Isolate of Methicillin-Resistant Staphylococcus aureus. MATERIALS 2022; 15:ma15093374. [PMID: 35591708 PMCID: PMC9104145 DOI: 10.3390/ma15093374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
The objective of this study was to enhance the corneal permeation of gatifloxacin (GTX) using cubosomal nanoparticle as a delivery system. Cubosomal nanoparticle loaded with GTX was prepared and subjected for in vitro and in vivo investigations. The prepared GTX-loaded cubosomal particles exhibited nanoparticle size of 197.46 ± 9.40 nm and entrapment efficiency of 52.8% ± 2.93. The results of ex vivo corneal permeation of GTX-loaded cubosomal dispersion show approximately 1.3-fold increase compared to GTX aqueous dispersion. The incorporation of GTX into cubosomal particles resulted in a fourfold reduction in the minimum inhibitory concentration (MIC) value for the GTX cubosomal particles relative to GTX aqueous dispersion. Furthermore, the enhanced corneal penetration of GTX-loaded cubosomal dispersion compared was evident by a significant decrease in the area % of corneal opacity in MRSA infected rats. Moreover, these results were confirmed by photomicrographs of histological structures of corneal tissues from rats treated with GTX-cubosomal dispersion which did not present any change compared to that of the normal rat corneas. In conclusion, treatment of ocular bacterial infections and reduction in the probability of development of new resistant strains of MRSA could be accomplished with GTX-loaded cubosomal nanoparticles.
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Affiliation(s)
- Mohamed Nasr
- Department of Pharmaceutics, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa 35712, Egypt; (A.Y.B.); (H.I.E.)
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Helwan University, Cairo 11790, Egypt
- Correspondence: (M.N.); (A.L.C.)
| | - Sameh Saber
- Department of Pharmacology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa 35712, Egypt;
| | - Alaa Y. Bazeed
- Department of Pharmaceutics, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa 35712, Egypt; (A.Y.B.); (H.I.E.)
| | - Heba A. Ramadan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa 11152, Egypt; (H.A.R.); (A.E.)
| | - Asmaa Ebada
- Department of Microbiology and Immunology, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa 11152, Egypt; (H.A.R.); (A.E.)
| | - Adela Laura Ciorba
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania;
- Correspondence: (M.N.); (A.L.C.)
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania;
| | - Heba I. Elagamy
- Department of Pharmaceutics, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa 35712, Egypt; (A.Y.B.); (H.I.E.)
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Cabrera-Aguas M, Khoo P, Watson SL. Outcomes of Microbial Keratitis Cases Resistant to Antimicrobials in Sydney, Australia. Cornea 2022; 41:572-578. [PMID: 34369390 DOI: 10.1097/ico.0000000000002803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/07/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe demographics, predisposing factors, clinical features, treatment, and outcomes of microbial keratitis cases resistant to antimicrobials. METHODS A retrospective case series was conducted. All patients with microbial keratitis resistant to antimicrobials who underwent a corneal scrape and culture from 2012 to December 2016 at the Sydney Eye Hospital were included. Cases were identified from pathology and hospital coding data. Coagulase-negative staphylococci (CoNS), Staphylococcus aureus (S. aureus), and Corynebacterium spp. resistant to cefalotin, chloramphenicol, ciprofloxacin, or gentamicin were analyzed. RESULTS One hundred fifteen episodes had a resistant CoNS, 24 S. aureus, and 12 Corynebacterium spp. Antimicrobial resistance was associated with older women (67%, median age 83 years) with Corynebacterium spp. (P < 0.001), corneal graft, and previous topical steroid use. Larger epithelial defects (P = 0.203) and infiltrates (P = 0.180) were more likely to be associated with Corynebacterium spp., but not statistically significant. At the initial and final visits, resistant S. aureus (75% vs. 67%) and Corynebacterium spp. (78% vs. 80%) cases were more likely to be classified as blind (>3/60) compared with CoNS (45% vs. 28%) (P = 0.011 vs. P = 0.004). Corneal perforation occurred more often in resistant S. aureus cases (P < 0.001), whereas slow and nonhealing epithelial defects needing other procedures were more likely to occur with resistant Corynebacterium spp. (P < 0.001). CONCLUSIONS Patients with resistant CoNS were younger and presented with smaller ulcers and moderate vision loss. Visual and clinical outcomes were significantly better for resistant CoNS than for those with resistant S. aureus or Corynebacterium spp.
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Affiliation(s)
- Maria Cabrera-Aguas
- The University of Sydney, Sydney, Australia; and
- Corneal Unit, Sydney Eye Hospital, Sydney, Australia
| | - Pauline Khoo
- The University of Sydney, Sydney, Australia; and
- Corneal Unit, Sydney Eye Hospital, Sydney, Australia
| | - Stephanie L Watson
- The University of Sydney, Sydney, Australia; and
- Corneal Unit, Sydney Eye Hospital, Sydney, Australia
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Vidal Oliver L, Bayo Calduch P, Forqué Rodríguez L, Navarro Ortega D, Duch Samper AM, Colomina Rodríguez J. [Methicillin-resistant Staphylococcus epidermidis infectious keratitis: Clinical and microbiological profile]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:171-177. [PMID: 35067009 PMCID: PMC8972698 DOI: 10.37201/req/128.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction Staphylococcus epidermidis (SE) is a common cause of bacterial keratitis in certain geographic areas. A high percentage of resistance to methicillin is shown, which gives it cross resistance to beta-lactams and sometimes resistance to other antibacterial groups. We analyzed clinical and microbiological variables in patients with infectious keratitis due to SE. Methods Medical records of 43 patients with suspected infectious keratitis and microbiological confirmation for SE, between October 2017 and October 2020, were retrospectively studied. Clinical characteristics (risk factors, size of lesions, treatment, evolution) and microbiological (susceptibility to antibiotics) were analyzed, and groups of patients with methicillin-resistant (MRSE) and methicillin-susceptible (MSSE) infection were compared. Results MRSE was present in 37.2% of infectious keratitis. All isolates were sensitive to vancomycin and linezolid. Rates of resistance to tetracyclines and ciprofloxacin were 50% and 56% in the MRSE group, and 11% and 7% in the MSSE group. The clinical characteristics, including size of lesion, visual axis involvement, inflammation of anterior chamber, presence of risk factors and follow-up time, did not show statistically significant differences between groups. Conclusions MRSE is a common cause of infectious keratitis caused by SE and shows a high rate of multidrug resistance. Clinically, it does not differ from MSSE keratitis. Additional work is needed to confirm these findings.
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Affiliation(s)
| | | | | | | | | | - J Colomina Rodríguez
- Javier Colomina Rodriguez. Servicio de Microbiología, Hospital Clínico Universitario de Valencia. Spain.
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Manente R, Santella B, Pagliano P, Santoro E, Casolaro V, Borrelli A, Capunzo M, Galdiero M, Franci G, Boccia G. Prevalence and Antimicrobial Resistance of Causative Agents to Ocular Infections. Antibiotics (Basel) 2022; 11:antibiotics11040463. [PMID: 35453215 PMCID: PMC9032492 DOI: 10.3390/antibiotics11040463] [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] [Received: 02/15/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
Bacterial ocular infections are a worldwide health problem and, if untreated, can damage the structure of the eye and contribute to permanent disability. Knowledge of the prevalence and antimicrobial susceptibility patterns of the main causative agents involved in ocular infections is necessary for defining an optimal antibiotic therapy. The aim of this study was to analyse bacterial species involved in ocular infections and the antimicrobial susceptibility patterns. Conjunctival swab samples were collected from patients with bacterial conjunctivitis at the University Hospital San Giovanni di Dio e Ruggi d’Aragona between January 2015 and December 2019. The identification and antibiotic sensitivity tests were performed using the VITEK 2 system. A total of 281 causative agents of ocular infections were isolated, 81.8% of which were Gram-positive bacteria. Coagulase-negative staphylococci (CoNS) were the most commonly isolated species among Gram-positive bacteria, followed by Staphylococcus aureus. In contrast, Pseudomonas spp. and Escherichia coli were the main species isolated among Gram-negative bacteria (18.2%). Overall, linezolid, teicoplanin, tigecycline and vancomycin were the most effective antimicrobials. Analysis of resistance rates over time highlighted increasing resistance for azithromycin, clarithromycin and erythromycin among CoNS, and clindamycin and erythromycin among Staphylococcus aureus. This study has identified the profiles of the major pathogens involved in ocular infection and their susceptibility patterns, which will help improve the treatments and the choice of antibiotics in ocular infections.
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Affiliation(s)
- Roberta Manente
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (R.M.); (B.S.); (M.G.)
| | - Biagio Santella
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (R.M.); (B.S.); (M.G.)
| | - Pasquale Pagliano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
| | - Emanuela Santoro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
| | - Vincenzo Casolaro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
| | - Anna Borrelli
- Azienda Ospedaliero Universitaria San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy;
| | - Mario Capunzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica e Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy
| | - Massimiliano Galdiero
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (R.M.); (B.S.); (M.G.)
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica e Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy
- Correspondence: (G.F.); (G.B.)
| | - Giovanni Boccia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica e Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy
- Correspondence: (G.F.); (G.B.)
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Nishida T, Sugioka K, Fukuda K, Murakami J. Pivotal Role of Corneal Fibroblasts in Progression to Corneal Ulcer in Bacterial Keratitis. Int J Mol Sci 2021; 22:ijms22168979. [PMID: 34445684 PMCID: PMC8396668 DOI: 10.3390/ijms22168979] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 01/05/2023] Open
Abstract
The shape and transparency of the cornea are essential for clear vision. However, its location at the ocular surface renders the cornea vulnerable to pathogenic microorganisms in the external environment. Pseudomonas aeruginosa and Staphylococcus aureus are two such microorganisms and are responsible for most cases of bacterial keratitis. The development of antimicrobial agents has allowed the successful treatment of bacterial keratitis if the infection is diagnosed promptly. However, no effective medical treatment is available after progression to corneal ulcer, which is characterized by excessive degradation of collagen in the corneal stroma and can lead to corneal perforation and corneal blindness. This collagen degradation is mediated by both infecting bacteria and corneal fibroblasts themselves, with a urokinase-type plasminogen activator (uPA)-plasmin-matrix metalloproteinase (MMP) cascade playing a central role in collagen destruction by the host cells. Bacterial factors stimulate the production by corneal fibroblasts of both uPA and pro-MMPs, released uPA mediates the conversion of plasminogen in the extracellular environment to plasmin, and plasmin mediates the conversion of secreted pro-MMPs to the active form of these enzymes, which then degrade stromal collagen. Bacterial factors also stimulate expression by corneal fibroblasts of the chemokine interleukin-8 and the adhesion molecule ICAM-1, both of which contribute to recruitment and activation of polymorphonuclear neutrophils, and these cells then further stimulate corneal fibroblasts via the secretion of interleukin-1. At this stage of the disease, bacteria are no longer necessary for collagen degradation. In this review, we discuss the pivotal role of corneal fibroblasts in corneal ulcer associated with infection by P. aeruginosa or S. aureus as well as the development of potential new modes of treatment for this condition.
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Affiliation(s)
- Teruo Nishida
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan;
- Division of Cornea and Ocular Surface, Ohshima Eye Hospital, Fukuoka 812-0036, Japan
| | - Koji Sugioka
- Department of Ophthalmology, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan;
| | - Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan
- Correspondence:
| | - Junko Murakami
- Division of Ophthalmology, Sakibana Hospital, Izumi, Osaka 594-1105, Japan;
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Ucgul AY, Ucgul RK, Behcet M. Intrastromal Administration of Vancomycin to Maximize Its Early Effect on Methicillin-resistant Staphylococcus Aureus Keratitis: A Rabbit Study. Ocul Immunol Inflamm 2021; 30:1430-1435. [PMID: 33974478 DOI: 10.1080/09273948.2021.1887280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To evaluate the early efficacy of intrastromal injection of vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA).Methods: Twenty-four eyes of 24 New-Zealand White rabbits were included in the study. MRSA keratitis was induced in the right eye of each rabbit. On the 24th hour after the inoculation of MRSA, eight rabbits received topical vancomycin therapy, eight rabbits received intrastromal vancomycin therapy, and eight rabbits received balanced salt solution and served as the control group.Results: The pre-post differences in epithelial erosion score and total clinical score were higher in the topical vancomycin group than in the intrastromal vancomycin group (p = .033 and 0.016, respectively). The eyes treated topically had higher bacterial load compared with those treated intrastromally (6.97 ± 0.82 vs. 6.14 ± 0.63 log10 CFU/g, p = .039).Conclusion: A single dose of intrastromal vancomycin is more effective than the standard loading dose of topical vancomycin in reducing bacterial load.
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Affiliation(s)
- Ahmet Yucel Ucgul
- Department of Ophthalmology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
| | - Rukiye Kilic Ucgul
- Department of Ophthalmology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
| | - Mustafa Behcet
- Department of Medical Microbiology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
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12
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Ross C, Syed B, Pak J, Jhanji V, Yamaki J, Sharma A. Stability Evaluation of Extemporaneously Compounded Vancomycin Ophthalmic Drops: Effect of Solvents and Storage Conditions. Pharmaceutics 2021; 13:pharmaceutics13020289. [PMID: 33672310 PMCID: PMC7926595 DOI: 10.3390/pharmaceutics13020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
Vancomycin is the drug of choice for methicillin-resistant Staphylococcus aureus keratitis and other ocular infections. Vancomycin ophthalmic drops are not commercially available and require compounding. The present study was designed to investigate the stability of vancomycin ophthalmic drops in normal saline, phosphate-buffered saline (PBS), and balanced salt solution (BSS) while stored at room temperature or under refrigeration. Vancomycin ophthalmic drops (50 mg/mL) were aseptically prepared from commercially available intravenous powder using PBS, BSS, and saline. Solutions were stored at room temperature and in a refrigerator for 28 days. The vancomycin stability was tested by a microbiology assay and high-performance liquid chromatography HPLC analysis immediately after formulation and at days 7, 14, and 28 after storage at room temperature or under refrigeration. The pH, turbidity was also tested. Vancomycin formulations in PBS, BSS and normal saline had initial pH of 5; 5.5; 3 respectively. The formulation in PBS developed turbidity and a slight decrease in pH upon storage. Microbiological assay did not show any change in zone of inhibition with any of the formulation upon storage either at room temperature or under refrigeration. HPLC analysis did not detect any decrease in vancomycin concentration or the accumulation of degraded products in any of the formulations upon storage either at room temperature or under refrigeration. Vancomycin ophthalmic drops prepared using PBS, BSS, and normal saline were stable up to the tested time point of 28 days, irrespective of their storage temperature.
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Affiliation(s)
- Christopher Ross
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
| | - Basir Syed
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
| | - Joanna Pak
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
| | - Vishal Jhanji
- Department of Ophthalmology School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Jason Yamaki
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
| | - Ajay Sharma
- Chapman University School of Pharmacy, Chapman University Irvine, Room 267, 9401 Jeronimo Road, Irvine, CA 92618, USA; (C.R.); (B.S.); (J.P.); (J.Y.)
- Correspondence: ; Tel.: +1-714-516-5498
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13
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Lee JW, Somerville T, Kaye SB, Romano V. Staphylococcus aureus Keratitis: Incidence, Pathophysiology, Risk Factors and Novel Strategies for Treatment. J Clin Med 2021; 10:jcm10040758. [PMID: 33668633 PMCID: PMC7918096 DOI: 10.3390/jcm10040758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
Bacterial keratitis is a devastating condition that can rapidly progress to serious complications if not treated promptly. Certain causative microorganisms such as Staphylococcus aureus and Pseudomonas aeruginosa are notorious for their resistance to antibiotics. Resistant bacterial keratitis results in poorer outcomes such as scarring and the need for surgical intervention. Thorough understanding of the causative pathogen and its virulence factors is vital for the discovery of novel treatments to avoid further antibiotic resistance. While much has been previously reported on P. aeruginosa, S. aureus has been less extensively studied. This review aims to give a brief overview of S. aureus epidemiology, pathophysiology and clinical characteristics as well as summarise the current evidence for potential novel therapies.
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Affiliation(s)
- Jason W. Lee
- School of Medicine, University of Liverpool, Liverpool L69 3GE, UK;
| | - Tobi Somerville
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK; (T.S.); (S.B.K.)
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Stephen B. Kaye
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK; (T.S.); (S.B.K.)
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK; (T.S.); (S.B.K.)
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
- Correspondence:
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14
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Comparison of the effect of teicoplanin and vancomycin on experimental methicillin-resistant staphylococcus aureus keratitis. Int Ophthalmol 2021; 41:1395-1402. [PMID: 33506369 DOI: 10.1007/s10792-021-01696-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the early efficacy and safety of intrastromal injection of teicoplanin as the alternative treatment for the methicillin-resistant Staphylococcus aureus (MRSA) keratitis by comparing it with vancomycin. MATERIALS AND METHODS Twenty-four eyes of 24 New Zealand white rabbits were included in the study. MRSA keratitis was induced in the right eye of each rabbit by injecting 0.1 mL MRSA suspension containing 1000 colony-forming units (CFU) intrastromally to the central cornea. The rabbits were divided into three treatment groups 24 h after the inoculation of MRSA. Eight rabbits received intrastromal teicoplanin therapy, eight received intrastromal vancomycin therapy, and eight received balanced salt solution and served as the control group. Nine hours after the treatment, all rabbits were sacrificed and corneal tissues were collected for microbiological analysis. We also examined and scored all the rabbits clinically before and after the treatment. RESULTS The control group scored higher with regard to conjunctival injection, iritis, fibrin, hypopyon, epithelial erosion, and corneal infiltrate than the vancomycin and teicoplanin groups (p = 0.031, 0.010, < 0.001, 0.029, 0.009, and < 0.001, respectively). Chemosis and corneal oedema were similar in all groups (p = 0.731 and 0.075, respectively). The severity of all clinical parameters was similar in both the vancomycin and teicoplanin groups after the treatment. The bacterial load was the highest (7.83 ± 0.71 log10 CFU/g) in the control group. The eyes treated with vancomycin and teicoplanin had similar bacterial loads (6.40 ± 0.69 vs. 6.31 ± 0.75 log10 CFU/g, p = 0.809). CONCLUSION The efficiency of teicoplanin seems to be comparable to that of vancomycin when administered intrastromally in the early treatment of MRSA keratitis. The former may be preferred in the treatment of selected cases with vancomycin hypersensitivity or resistance.
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15
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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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16
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Topical Vancomycin 5% Is More Efficacious Than 2.5% and 1.25% for Reducing Viable Methicillin-Resistant Staphylococcus aureus in Infectious Keratitis. Cornea 2020; 39:250-253. [PMID: 31658169 DOI: 10.1097/ico.0000000000002186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Topical vancomycin 5% (50 mg/mL) has been used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) keratitis, but patient comfort has many clinicians using lower concentrations. We compared the efficacy of different concentrations of vancomycin in the treatment of experimental MRSA keratitis. METHODS The corneas of 45 rabbits were infected with 2000 colony-forming units (CFUs) of MRSA. Corneal epithelium was abraded in the left eyes to mimic corneal ulceration. After 4 hours, the corneal CFUs were determined at the onset of treatment. The remaining rabbits were divided into 4 treatment groups (n = 9): 1) vancomycin 5%, 2) vancomycin 2.5%, 3) vancomycin 1.25%, and 4) saline. The rabbits were treated topically in both eyes every 15 minutes for 5 hours. One hour after treatment, the rabbits were clinically examined and euthanized, corneas were removed, and CFUs were determined to analyze vancomycin penetration, treatment efficacy, and bactericidal effect. RESULTS Ocular toxicity was concentration dependent from mild to moderate. For the abraded corneas, the CFUs of the vancomycin 5% group were lower than 2.5% and 1.25%, and all vancomycin groups were lower than saline. The CFUs of 2.5% were lower but similar to 1.25%. The vancomycin 5% group demonstrated a bactericidal effect and the best penetration. The CFUs of the abraded corneas treated with saline were lower than those of the intact corneas, indicating a possible antibacterial effect from the ocular surface. CONCLUSIONS Vancomycin 5% was most potent for treating experimental MRSA keratitis. The clinician may need to reassess treatment regarding antibacterial efficacy and patient comfort.
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17
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Garner I, Vichare R, Paulson R, Appavu R, Panguluri SK, Tzekov R, Sahiner N, Ayyala R, Biswal MR. Carbon Dots Fabrication: Ocular Imaging and Therapeutic Potential. Front Bioeng Biotechnol 2020; 8:573407. [PMID: 33102456 PMCID: PMC7546398 DOI: 10.3389/fbioe.2020.573407] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/07/2020] [Indexed: 01/25/2023] Open
Abstract
Vision loss is a major complication in common ocular infections and diseases such as bacterial keratitis, age-related macular degeneration (AMD) and diabetic retinopathy (DR). The prevalence of such ophthalmic diseases represents an urgent need to develop safe, effective, and long-term treatments. Current therapies are riddled with drawbacks and limitations which calls for the exploration of alternative drug delivery mechanisms. Toxicity of the inorganic metals and metal oxides used for drug delivery raise safety concerns that are alleviated with the alternate use of, a natural and organic polymer which is both biocompatible and environmentally friendly. Carbon dots (CDs) represent a great potential in novel biomedical applications due to their tunable fluorescence, biocompatibility, and ability to be conjugated with diverse therapeutic materials. There is a growing interest on the exploitation of these properties for drug delivery with enhanced bio-imaging. However, there are limited reports of CD applications for ophthalmic indications. In this review, we focus on the CD potential and the development of translational therapies for ophthalmic diseases. The current review presents better understanding of fabrication of CDs and how it may be useful in delivering anti-bacterial agents, anti-VEGF molecules as well as imaging for ophthalmic applications.
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Affiliation(s)
- Inyoung Garner
- MSPN Graduate Programs, Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States
| | - Riddhi Vichare
- MSPN Graduate Programs, Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States
| | - Ryan Paulson
- Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States
| | - Rajagopal Appavu
- Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States
| | - Siva K Panguluri
- Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States
| | - Radouil Tzekov
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Nurettin Sahiner
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Department of Chemistry, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ramesh Ayyala
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Manas R Biswal
- MSPN Graduate Programs, Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States.,Department of Pharmaceutical Sciences, Taneja College of Pharmacy, University of South Florida, Tampa, FL, United States.,Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
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18
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The Effect of Antimicrobial Peptides on the Viability of Human Corneal Epithelial Cells. Probiotics Antimicrob Proteins 2020; 13:518-526. [PMID: 32748327 DOI: 10.1007/s12602-020-09692-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Antimicrobial peptides are polypeptides composed of less than 100 amino acids and are a class of antibiotics with strong activity against some infectious bacteria. This study examined the safety of four chosen antimicrobial peptides using primary human corneal epithelial cells (HCEC) and explored their potential therapeutic use. The efficacy of the peptides was also studied by evaluating the minimum inhibitory concentrations (MIC) against Gram-negative and Gram-positive bacteria. One of the peptides (polymyxin E) was found to have antibacterial efficacy against a common Gram-negative bacterium (MIC 1.56 μg/mL for Pseudomonas aeruginosa), and another one (nisin) was found to have antibacterial efficacy against a common Gram-positive bacterium (MIC 125 μg/mL for Staphylococcus aureus). Metabolic activity and live/dead/apoptotic effects were measured with fluorescent dyes after HCEC were exposed to the peptides for 30 min. Three of the peptides exhibited lower toxicity against HCEC than a currently marketed eye drop product. Regarding both efficacy and safety, two of the peptides (polymyxin E and nisin) were found to have potential use for treating ocular infections.
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19
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Durrani AF, Atta S, Bhat AK, Mammen A, Dhaliwal D, Kowalski RP, Jhanji V. Methicillin-Resistant Staphylococcus aureus Keratitis: Initial Treatment, Risk Factors, Clinical Features, and Treatment Outcomes. Am J Ophthalmol 2020; 214:119-126. [PMID: 32209347 DOI: 10.1016/j.ajo.2020.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyze the clinical characteristics, management choices, and outcomes of cases of methicillin-resistant Staphylococcus aureus (MRSA) keratitis. DESIGN Retrospective interventional case series. METHODS Fifty-two culture-proven (52 eyes) cases of MRSA keratitis diagnosed and treated at the University of Pittsburgh Medical Center were identified and reviewed. RESULTS The mean age was 66.6 ± 19.2 years with a median follow-up time of 147 days. The most prevalent risk factors included a history of ocular surgery (62.5%), topical corticosteroid use (35.4%), and dry eye syndrome (37.5%). There was a high burden of systemic disease (95.8%). The average presenting logarithm of minimal angle of resolution visual acuity was 1.7 ± 0.8 and the average final logarithm of minimal angle of resolution visual acuity was 1.2 + 1.0. Initial antibiotic treatment varied, with 20.8% receiving moxifloxacin alone, 20.8% receiving fortified cefazolin and fortified tobramycin together, and 12.5% receiving fortified vancomycin and fortified tobramycin, although other antibiotics were used during treatment if warranted. Surgical management was often required as 17.3% of eyes perforated: 13.5% required tarsorrhaphy, 5.8% required penetrating keratoplasty, and 1 eye was enucleated. When patients treated with fourth-generation fluoroquinolones were compared with those treated with fortified vancomycin, no difference in final visual acuity, treatment duration, or need for surgery was found. CONCLUSION MRSA causes fulminant keratitis often requiring surgical management with poor visual acuity outcomes. Poor ocular surface, topical corticosteroid use, previous ocular surgery, and/or a high burden of systemic disease were identified as common risk factors. Patients treated with fluoroquinolones in our study had comparable outcomes to those treated with fortified vancomycin; however, those treated with fortified vancomycin tended to have more severe ulcers at presentation.
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Affiliation(s)
- Asad F Durrani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sarah Atta
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amar K Bhat
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alex Mammen
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Deepinder Dhaliwal
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; The Charles T. Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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20
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Chang-Sotomayor M, Llorens Bellés V, Latasiewicz M, Torras-Sanvicens J, Blanco-Domínguez I, Sabater-Cruz N, Sainz-de-la-Maza M, Bosch-Mestres J, Palma-Carvajal F. Comparison of two methods for obtaining and transporting corneal samples in suspected infectious keratitis. J Fr Ophtalmol 2020; 43:477-483. [PMID: 32444133 DOI: 10.1016/j.jfo.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study is to compare two alternative methods of collecting and transporting media for the diagnosis of corneal ulcers, as not all clinical settings have conventional culture materials and transport media available. METHODS In this open-label, prospective, comparative, and randomized study, patients with clinical suspicion of infectious keratitis with high risk of loss of vision had corneal specimens collected using two methods and transport media: Eswab scraping with Amies transport medium and 23-gauge needle scraping in BACTEC Peds broth. The order of each collection method was randomized. The samples were processed by standard methods, comparing the positivity frequencies for both by parametric and nonparametric tests, according to normality criteria. RESULTS Corneal infiltrates from 40 eyes of 40 patients were analyzed. Culture positivity rate was 50% for Eswab and 35% for 23-gauge needle (P=0.258). The overall growth rate of the two methods combined was not higher than with the swab alone. The results obtained with a swab were not influenced by the collection sequence (P=0.112); however, the positivity rate was significantly higher when the sample taken with the needle was performed first (P=0.046). CONCLUSIONS The single sample Eswab method of collection and transportation for the diagnosis of high risk corneal ulcers is a valid alternative and can be used in cases in which, for various reasons, there is no access to the full set of traditional culture materials.
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Affiliation(s)
- M Chang-Sotomayor
- Institut Clinic d'Oftalmologia, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
| | - V Llorens Bellés
- Institut Clinic d'Oftalmologia, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
| | - M Latasiewicz
- Institut Clinic d'Oftalmologia, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
| | - J Torras-Sanvicens
- Institut Clinic d'Oftalmologia, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
| | - I Blanco-Domínguez
- Institut Clinic d'Oftalmologia, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
| | - N Sabater-Cruz
- Institut Clinic d'Oftalmologia, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
| | - M Sainz-de-la-Maza
- Institut Clinic d'Oftalmologia, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
| | - J Bosch-Mestres
- Microbiology Department Hospital Clínic de Barcelona, ISGlobal, Carrer de Villarroel, 170, 08036 Barcelona, Spain.
| | - F Palma-Carvajal
- Institut Clinic d'Oftalmologia, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
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Clinical Review of Microbial Corneal Ulcers Resulting in Enucleation and Evisceration in a Tertiary Eye Care Center in Hungary. J Ophthalmol 2020; 2020:8283131. [PMID: 32509342 PMCID: PMC7254073 DOI: 10.1155/2020/8283131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To analyse the clinical and microbiological characteristics and preexisting ophthalmic and systemic conditions of infectious keratitis resulting in enucleation/evisceration in a large tertiary referral center in a developed country (Hungary) over a period of 12 years. Patients and Methods. A retrospective review of enucleated/eviscerated eyes undergoing surgery between 2007 and 2018 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary, with infectious keratitis as the primary indication for enucleation or evisceration. For each subject, clinical history, B-scan ultrasound report, and microbiological analyses were reviewed. Results There were 48 enucleated/eviscerated eyes from 47 patients (29 females (61.7%), age at the time of surgery 66.4 ± 18.5 years). Indication for surgery was hopeless, unmanageable keratitis (62.5%), and keratitis with endophthalmitis (37.5%). The most common preexisting ophthalmic conditions were previous cataract surgery (60.4%), previous therapeutic penetrating keratoplasty (PKP) (56.3%), corneal perforation (52.1%), glaucoma (41.7%), and long-term topical steroid usage (31.3%). In order to treat keratitis, before enucleation or evisceration, 20 eyes (41.7%) underwent PKP, 12 eyes (25.0%) amniotic membrane transplantation, 8 eyes (16.7%) conjunctival autograft transplantation, 6 eyes (12.5%) tarsorrhaphy, and 4 eyes (8.3%) vitrectomy to salvage the eye prior to the final treatment of enucleation or evisceration. The most frequent preexisting systemic diseases were hypertension (62.5%), cardiac disease (20.8%), diabetes mellitus (20.8%), and rheumatoid arthritis (14.6%). Staphylococcus aureus (17.0%) and Propionibacterium acnes (12.8%) were the most commonly isolated gram-positive bacteria, and Pseudomonas aeruginosa was the most frequently isolated gram-negative pathogen bacterium (10.6%). Six globes (12.5%) had positive fungal cultures (1 case of Candida albicans, Candida parapsilosis, Trichosporon inkin, Acremonium sp., Fusarium sp., and Penicillium sp.). Conclusions Staphylococcus aureus, Propionibacterium acnes, and Pseudomonas aeruginosa keratitis with or without endophthalmitis represent the most common indication for ocular enucleation/evisceration in patients with microbial keratitis in a tertiary referral center in Hungary. The incidence of enucleation and evisceration related to mycotic keratitis does not seem to have increased within the last decade. Most frequent preexisting systemic diseases in cases of enucleation and evisceration are hypertension, cardiac disease, diabetes mellitus, and rheumatoid arthritis.
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Abstract
Purpose: The aim of the current review was to summarize the current applications, the latest advances and importantly, highlight research gaps in the use of quantum dots in the eye. Quantum dots are nanoscale semiconductor crystals with characteristic size and tunable optical properties, which deliver bright and stable fluorescence suitable for bioimaging and labelling. Methods: A systematic search was conducted following the PRISMA guidelines. This review systematically searched published data to summarize the characteristics and applications of quantum dots in ophthalmology. Two hundred and eighty published articles were initially selected for this review following searches using the criteria quantum dots AND nanoparticles AND ophthalmology in the databases PubMed, MEDLINE, Scopus, Embase and Web of Science. Results: After duplicates were removed, a total of 22 eligible articles were included for the review. Quantum dots potentially provide a range of diagnostic and therapeutic applications in ophthalmology. Quantum dots offer visible and near-infrared emission, which is highly desirable for bioimaging, due to reduced light scattering and low tissue absorption. Their applications include in vivo bioimaging, labelling of cells and tissues, delivery of genes or drugs and as antimicrobial composites. Conclusion: Quantum dots have been used in ophthalmology for bioimaging, electrical stimulation and tracking of gene/stems cells, and ocular lymphatics. However, there is no detailed description of their desirable characteristics for use in ophthalmology, and there is limited information about their cytotoxicity to ocular cells and tissues.
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Affiliation(s)
- Sidra Sarwat
- School of Optometry and Vision Science, University of New South Wales (UNSW) , Sydney , Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales (UNSW) , Sydney , Australia
| | - Mark Willcox
- School of Optometry and Vision Science, University of New South Wales (UNSW) , Sydney , Australia
| | - Maitreyee Roy
- School of Optometry and Vision Science, University of New South Wales (UNSW) , Sydney , Australia
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Okumura Y, Inomata T, Miyamoto S, Nakatani S, Hiratsuka Y, Yamaguchi M, Iwamoto S, Murakami A. Donor characteristics and risk factors for methicillin-resistant Staphylococcus aureus contamination in storage medium for corneal transplantation: A 10-year retrospective study. Transpl Infect Dis 2019; 21:e13123. [PMID: 31165536 DOI: 10.1111/tid.13123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study investigated the donor characteristics of methicillin-resistant Staphylococcus aureus (MRSA) contamination in storage medium before transfer of corneas to preservation medium for corneal transplantation, in order to identify donor characteristic risk factors for MRSA contamination. METHODS This retrospective, cross-sectional study was performed using Juntendo Eye Bank records for all corneal transplantation procedures. Storage medium (EP-II® ) cultures for right eyes were included for the period between July 2008 and December 2017. The following donor characteristics were collected: age, sex, cause of death, history of cataract surgery, death-to-enucleation interval, death-to-preservation interval, and endothelial cell density (ECD). Donor characteristics were compared between MRSA and non-MRSA contamination groups. Odds ratios (ORs) for donor-related risk factors for MRSA contamination were determined using logistic regression. RESULTS In total, 370 storage medium samples were examined; 222 were positive for bacterial cultures (60.0%) and 36 were MRSA-positive (9.7%). Donor age was significantly higher in the MRSA contamination group than in the non-MRSA contamination group (86.1 ± 9.5 years vs 75.9 ± 15.9 years, P < 0.001). Univariate logistic regression analysis showed that MRSA contamination risk factors were older age (OR = 1.07; 95% confidence interval [95% CI]: 1.03-1.11) and decreased ECD (OR = 0.9993; 95% CI: 0.9986-0.9992). The fully adjusted OR for every year of age as a risk factor for MRSA contamination was 1.07 (95% CI: 1.03-1.11). CONCLUSIONS Aging was a risk factor for MRSA contamination in storage medium. Careful pre-banking assessment of elderly donor corneas is needed to prevent intractable postoperative MRSA infection.
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Affiliation(s)
- Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Strategic Operating Room Management and Improvement, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Strategic Operating Room Management and Improvement, Juntendo University Faculty of Medicine, Tokyo, Japan.,Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shizuka Miyamoto
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoru Nakatani
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masahiro Yamaguchi
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Satoshi Iwamoto
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
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Thareja T, Kowalski RP, Jhanji V, Kamyar R, Dhaliwal DK. MRSA Keratitis and Conjunctivitis: What Does It Mean Practically? CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00206-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Peterson JC, Durkee H, Miller D, Maestre-Mesa J, Arboleda A, Aguilar MC, Relhan N, Flynn HW, Amescua G, Parel JM, Alfonso E. Molecular epidemiology and resistance profiles among healthcare- and community-associated Staphylococcus aureus keratitis isolates. Infect Drug Resist 2019; 12:831-843. [PMID: 31043797 PMCID: PMC6469469 DOI: 10.2147/idr.s190245] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To characterize the molecular, epidemiological, and resistance profiles of methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) keratitis isolates. PATIENTS AND METHODS We used a combination of standard microbiological techniques and DNA microarray analysis to characterize the molecular and antibiotic resistance profiles of 75 Staphylococcus aureus keratitis isolates collected over an 11-year period (2006-2016). RESULTS Two major USA clonal complexes (CC), CC5 (n=30, 40%) and CC8 (n=28, 37.3%), accounted for 77.3% of the collected S. aureus isolates. USA100, traditionally healthcare associated (n=18/47, 38.3%), and USA300, traditionally community associated (n=12/47, 25.5%), were the dominant MRSA strains. Four (22.2%) of the USA100 MRSA isolates were recovered from patients with no prior healthcare exposure. Eleven (91.7%) of the USA300 isolates were recovered from patients with documented healthcare risk factors. MSSA isolates were polyclonal (n=13). Ninety-three percent of MSSA infections were of healthcare origin. Thirty-seven of 61 (60.6%) healthcare- and 11 of 14 (78.6%) community-associated strains were resistant to three or more antibiotic classes. Sixty-eight percent (n=51) of isolates harbored three of more resistance determinants (genes). The Panton-Valentine Leucocidin gene was detected in 11 (14.7%) of the study isolates. The majority (72.7%) of the strains were members of the USA300 MRSA clone. CONCLUSION Clonal complexes CC5 and CC8 were the most frequent clones detected among both the MSSA and the MRSA keratitis isolates. USA100 and USA300 clones were the dominant MRSA genotypes. The USA300 MRSA clone has become a leading cause of healthcare-associated keratitis in South Florida. The USA100 MRSA clone has emerged as an increasing cause of community-associated corneal infections in our outpatient population. This shifting epidemiology coupled with the increasing prevalence of multidrug resistance among both MSSA and MRSA keratitis is a cause of concern.
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Affiliation(s)
- Jeffrey C Peterson
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Heather Durkee
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
| | - Darlene Miller
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
- Ocular Microbiology Laboratory, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Jorge Maestre-Mesa
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
- Ocular Microbiology Laboratory, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Alejandro Arboleda
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mariela C Aguilar
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidhi Relhan
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Guillermo Amescua
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
| | - Eduardo Alfonso
- Anne Bates Leach Eye Center, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA,
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Ibrahim Al-Mashahedah AM, Kanwar RK, Kanwar JR. Utility of nanomedicine targeting scar-forming myofibroblasts to attenuate corneal scarring and haze. Nanomedicine (Lond) 2019; 14:1049-1072. [DOI: 10.2217/nnm-2017-0305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Corneal scarring refers to the loss of normal corneal tissue, replaced by fibrotic tissue (during wound repair) thereby affecting corneal transparency and vision quality. The corneal wound healing process involves a complex series of physiological events resulting in the transformation of transparent keratocytes into opaque myofibroblasts; the prominent cause of irregular extracellular matrix synthesis leading to the development of corneal opacity/hazy vision. Globally, corneal scarring/haze is one of the most prevalent causes of blindness. Ocular trauma (physical and chemical) and microbial infections induce corneal tissue damage. Although great progress has been made in the clinical management of ocular diseases, the global rates of corneal blindness remain high, nonetheless. The topical conventional modalities treating corneal wounds/injuries have inherent limitations/side effects such as low bioavailability of a therapeutic agent, upregulation of the intraocular pressure and the toxicity/allergy of the drug. These limitations/side effects rather than treating the wound, often negatively affect the healing process, especially, when applied frequently for longer periods. Recently, there has been an increasing evidence provided by the preclinical studies that nanotechnology-based drug-delivery systems can improve drug bioavailability, through controlled drug release and targeted delivery. After reviewing the epidemiology, risk factors of corneal scarring/haze and the conventional ocular medicines, we review here the different nanodrug-delivery systems and potential drug candidates including nanoherbal formulations investigated for their efficacy to heal the damaged cornea. Finally, we discuss the challenges of using these nanomedicinal platforms.
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Affiliation(s)
- Aseel Mahmood Ibrahim Al-Mashahedah
- Nanomedicine-Laboratory of Immunology & Molecular Biomedical Research (NLIMBR), School of Medicine (SOM), Faculty of Health, Deakin University, Waurn Ponds, Geelong 3216, Australia
| | - Rupinder Kaur Kanwar
- Nanomedicine-Laboratory of Immunology & Molecular Biomedical Research (NLIMBR), School of Medicine (SOM), Faculty of Health, Deakin University, Waurn Ponds, Geelong 3216, Australia
| | - Jagat Rakesh Kanwar
- Nanomedicine-Laboratory of Immunology & Molecular Biomedical Research (NLIMBR), School of Medicine (SOM), Faculty of Health, Deakin University, Waurn Ponds, Geelong 3216, Australia
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Choi N, Cho CH, Lee SB. Clinical Analysis of StaphylococcusKeratitis According to Coagulase Positivity. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.10.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Namhyeon Choi
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Chan Ho Cho
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Yarmamedov D, Lipatov V, Medvedeva M, Zaharova K. Study of the pharmacological impact of polymeric membranes with antibacterial effect in traumatic lesions of cornea. RESEARCH RESULTS IN PHARMACOLOGY 2018. [DOI: 10.3897/rrpharmacology.4.31006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The most common pathology among patients with acute eye infection is conjunctivitis – 78%, keratitis accounts for 14%. The most common infectious agent causing acute infection of the eye is Staphylococcus (55%). The opacity of the cornea in the overall structure of the causes of blindness in the world in 2015 accounted for 3.25% of total blindness and 1.14% in the structure of moderate or severe decline in vision.
Materials and methods: The object of the study is antibacterial polymer films based on sodium carboxymethylcellulose, levofloxacin and poludan. In the in vivo experiment was modeled on the adult rabbits, an infected corneal injury in three groups. An infected corneal injury was modeled by removing the corneal epithelium and applying a suspension of microorganisms in the amount of 1 million colonies of Staphylococcus aureus ATCC 25923 to the affected area. In the experiment, 3 groups were studied: the control group (“placebo” treatment – instillation of distilled water 4 times a day), the comparison group (treatment with levofloxacin 0.5% in the form of instillations 4 times a day and poludan twice a day), the experimental group (treatment using antibacterial polymer films with immunomodulating effect once a day). The area of the defect on the cornea was evaluated by staining with a 1% solution of sodium fluorescein. The scoring of the clinical course of the post-traumatic infection of the cornea was performed using the semantic differential method after injury and infection, after 1 hour, 1 day, 3 days, 5 days, 7 days.
Results and Discussion: In the study of the rates of resorption of the antibacterial membrane, as well as the release of active substances from the polymer, complete dissolution of the sample was detected within 30 hours. Based on the results of the study of the rate of resorption of the volume of the polymer membrane, a decrease in the index over a period of 24 hours in a physiological solution was found to be 4.5-fold. A weak dependence of the adhesion force on the parameters of the microrelief of the polymer membrane was revealed. The fastest rates of complete restoration of the integrity of the epithelium of the cornea were revealed in the experimental group. In the comparison group, the cornea was completely regenerated on the 7th day.
Conclusions: Under the conditions of the in vitro experiment, it was found that the antibacterial polymer membrane gradually dissolves, releasing the active components within 24 hours. When assessing the area of the defect of the cornea after an infected traumatic lesion, it was found that the treatment with polymeric antibacterial membranes with immunomodulating effect resulted in the reduction in the duration of treatment to 5 days.
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The Brief Case: A "Fresh" Pair of Contact Lenses. J Clin Microbiol 2018; 56:56/5/e00790-17. [PMID: 29695542 DOI: 10.1128/jcm.00790-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Naylor NR, Atun R, Zhu N, Kulasabanathan K, Silva S, Chatterjee A, Knight GM, Robotham JV. Estimating the burden of antimicrobial resistance: a systematic literature review. Antimicrob Resist Infect Control 2018; 7:58. [PMID: 29713465 PMCID: PMC5918775 DOI: 10.1186/s13756-018-0336-y] [Citation(s) in RCA: 277] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/14/2018] [Indexed: 01/02/2023] Open
Abstract
Background Accurate estimates of the burden of antimicrobial resistance (AMR) are needed to establish the magnitude of this global threat in terms of both health and cost, and to paramaterise cost-effectiveness evaluations of interventions aiming to tackle the problem. This review aimed to establish the alternative methodologies used in estimating AMR burden in order to appraise the current evidence base. Methods MEDLINE, EMBASE, Scopus, EconLit, PubMed and grey literature were searched. English language studies evaluating the impact of AMR (from any microbe) on patient, payer/provider and economic burden published between January 2013 and December 2015 were included. Independent screening of title/abstracts followed by full texts was performed using pre-specified criteria. A study quality score (from zero to one) was derived using Newcastle-Ottawa and Philips checklists. Extracted study data were used to compare study method and resulting burden estimate, according to perspective. Monetary costs were converted into 2013 USD. Results Out of 5187 unique retrievals, 214 studies were included. One hundred eighty-seven studies estimated patient health, 75 studies estimated payer/provider and 11 studies estimated economic burden. 64% of included studies were single centre. The majority of studies estimating patient or provider/payer burden used regression techniques. 48% of studies estimating mortality burden found a significant impact from resistance, excess healthcare system costs ranged from non-significance to $1 billion per year, whilst economic burden ranged from $21,832 per case to over $3 trillion in GDP loss. Median quality scores (interquartile range) for patient, payer/provider and economic burden studies were 0.67 (0.56-0.67), 0.56 (0.46-0.67) and 0.53 (0.44-0.60) respectively. Conclusions This study highlights what methodological assumptions and biases can occur dependent on chosen outcome and perspective. Currently, there is considerable variability in burden estimates, which can lead in-turn to inaccurate intervention evaluations and poor policy/investment decisions. Future research should utilise the recommendations presented in this review. Trial registration This systematic review is registered with PROSPERO (PROSPERO CRD42016037510).
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Affiliation(s)
- Nichola R. Naylor
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
| | - Rifat Atun
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
- Harvard University, 665 Huntington Avenue, Boston, MA 02115 USA
| | - Nina Zhu
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
| | - Kavian Kulasabanathan
- Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London, UK
| | - Sachin Silva
- Harvard University, 665 Huntington Avenue, Boston, MA 02115 USA
| | - Anuja Chatterjee
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
| | - Gwenan M. Knight
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
| | - Julie V. Robotham
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
- Modelling and Economics Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ UK
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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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Jian HJ, Wu RS, Lin TY, Li YJ, Lin HJ, Harroun SG, Lai JY, Huang CC. Super-Cationic Carbon Quantum Dots Synthesized from Spermidine as an Eye Drop Formulation for Topical Treatment of Bacterial Keratitis. ACS NANO 2017; 11:6703-6716. [PMID: 28677399 DOI: 10.1021/acsnano.7b01023] [Citation(s) in RCA: 239] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We have developed a one-step method to synthesize carbon quantum dots (CQDPAs) from biogenic polyamines (PAs) as an antibacterial agent for topical treatment of bacterial keratitis (BK). CQDs synthesized by direct pyrolysis of spermidine (Spd) powder through a simple dry heating treatment exhibit a solubility and yield much higher than those from putrescine and spermine. We demonstrate that CQDs obtained from Spds (CQDSpds) possess effective antibacterial activities against non-multidrug-resistant Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Salmonella enterica serovar Enteritidis bacteria and also against the multidrug-resistant bacteria, methicillin-resistant S. aureus. The minimal inhibitory concentration (MIC) of CQDSpds is ∼2500-fold lower than that of spermidine alone, demonstrating their strong antibacterial capabilities. Investigation of the possible mechanisms behind the antibacterial activities of the as-synthesized CQDSpds indicates that the super-cationic CQDSpds with small size (diameter ca. 6 nm) and highly positive charge (ζ-potential ca. +45 mV) cause severe disruption of the bacterial membrane. In vitro cytotoxicity, hemolysis, hemagglutination, genotoxicity, and oxidative stress and in vivo morphologic and physiologic cornea change evaluations show the good biocompatibility of CQDSpds. Furthermore, topical ocular administration of CQDSpds can induce the opening of the tight junction of corneal epithelial cells, thereby leading to great antibacterial treatment of S. aureus-induced BK in rabbits. Our results suggest that CQDSpds are a promising antibacterial candidate for clinical applications in treating eye-related bacterial infections and even persistent bacteria-induced infections.
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Affiliation(s)
- Hong-Jyuan Jian
- Institute of Biochemical and Biomedical Engineering, Chang Gung University , Taoyuan 33302, Taiwan
| | - Ren-Siang Wu
- Department of Bioscience and Biotechnology, National Taiwan Ocean University , Keelung 20224, Taiwan
| | - Tzu-Yu Lin
- Institute of Biochemical and Biomedical Engineering, Chang Gung University , Taoyuan 33302, Taiwan
| | - Yu-Jia Li
- Institute of Biochemical and Biomedical Engineering, Chang Gung University , Taoyuan 33302, Taiwan
| | - Han-Jia Lin
- Department of Bioscience and Biotechnology, National Taiwan Ocean University , Keelung 20224, Taiwan
| | - Scott G Harroun
- Department of Chemistry, Université de Montréal , Montréal, Québec H3C 3J7, Canada
| | - Jui-Yang Lai
- Institute of Biochemical and Biomedical Engineering, Chang Gung University , Taoyuan 33302, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital , Taoyuan 33305, Taiwan
- Department of Materials Engineering, Ming Chi University of Technology , New Taipei City 24301, Taiwan
| | - Chih-Ching Huang
- Department of Bioscience and Biotechnology, National Taiwan Ocean University , Keelung 20224, Taiwan
- Center of Excellence for the Oceans, National Taiwan Ocean University , Keelung 20224, Taiwan
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University , Kaohsiung 80708, Taiwan
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Oydanich M, Dingle TC, Hamula CL, Ghisa C, Asbell P. Retrospective report of antimicrobial susceptibility observed in bacterial pathogens isolated from ocular samples at Mount Sinai Hospital, 2010 to 2015. Antimicrob Resist Infect Control 2017; 6:29. [PMID: 28344783 PMCID: PMC5360068 DOI: 10.1186/s13756-017-0185-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance has emerged as a major threat to global public health. Thus, the surveillance of changes in antimicrobial resistance in local and global settings is a paramount necessity. While many studies have tracked antimicrobial resistance, only a small percentage surveyed ocular isolates. The purpose of this study was to report the in vitro susceptibility of bacterial pathogens isolated from ocular samples in New York, NY from 2010 to 2015. METHODS A retrospective review of ocular isolates was conducted. All organisms were collected by 25 separate inpatient wards and outpatient clinics, and were analyzed by the clinical microbiology laboratory at Mount Sinai Hospital. Clinical Laboratory and Standards Institute (CLSI) guidelines were followed for susceptibility testing and breakpoint interpretations. RESULTS A total of 549 bacterial organisms were isolated from 1664 cultures (33%) during the 6-year study period. Of these, 358 isolates (65.2%) underwent susceptibility testing. 182 (50.8%) isolates were Gram-positive. The most common Gram-positive bacterium was Staphylococcus aureus (62.1%). Methicillin-resistance decreased in S. aureus isolates (31.3% in 2010, 14.1% in 2015) but was without significant change (p = 0.25). When analyzing all S. aureus isolates recovered during the study period, there were significantly more methicillin-resistant S. aureus (MRSA) isolates resistant to fluoroquinolones (p <0.0001), erythromycin (p <0.0001), and trimethoprim/sulfamethoxazole (TMP/SMZ; p <0.05). Overall, Streptococcus pneumoniae isolates showed reduced susceptibility to erythromycin, but were otherwise susceptible to the other antimicrobials tested. Haemophilus influenzae (26.1%) and Pseudomonas aeruginosa (23.9%) were the most common Gram-negative bacteria isolated. Resistance to ampicillin and TMP/SMZ was observed in several of the H. influenzae isolates. P. aeruginosa isolates did not show high resistance overall, however, it was noted that isolates resistant to meropenem were also resistant to other antimicrobials (p < 0.01). CONCLUSION Overall, antimicrobial resistance was infrequent for the Gram-negative and Gram-positive bacteria analyzed. While the MRSA isolates demonstrated increased resistance to multiple antimicrobial classes, this is expected for this pathogen. Due to the continued use of broad-spectrum oral and systemic antimicrobials to treat ocular infections, findings of this study and other surveillance studies specific to ocular isolates should be used as resources in effective decision making in the treatment of ocular disease.
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Affiliation(s)
- Marko Oydanich
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Tanis C Dingle
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Camille L Hamula
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Claudia Ghisa
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Penny Asbell
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Ahn JH, Lee SB. Clinical Analysis of Staphylococcus aureus Keratitis according to Methicillin-resistance. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.8.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jang Hwan Ahn
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang-Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Broekema NM, Larsen IV, Naruzawa ES, Filutowicz M, Kolb AW, Teixeira LBC, Brandt CR. A Mouse Model of Multi-Drug Resistant Staphylococcus aureus-induced Ocular Disease. ACTA ACUST UNITED AC 2016; 4. [PMID: 27896297 PMCID: PMC5123590 DOI: 10.13188/2334-2838.1000026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Staphylococcus aureus infection of the cornea is a significant threat to vision. The percentage of bacterial isolates resistant to antibiotics is increasing as is the percentage of infections caused by methicillin resistant isolates. There is a critical need for additional therapeutic approaches and their development will require the use of animal models to test efficacy. Two mouse models of S. aureus keratitis have been described but only quantified stromal keratitis (corneal clouding and perforation). We have extended these models using the methicillin resistant S. aureus USA300 LAC strain and show that eyelid inflammation and swelling (blepharitis) and corneal neovascularization can be quantified. This expanded model should prove useful in assessing additional effects of antibacterial therapies and additional pathological mechanisms involved in bacterial ocular infection.
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Affiliation(s)
| | - Inna V Larsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA
| | | | - Marcin Filutowicz
- Amebagone, Inc.; Department of Bacteriology, University of Wisconsin-Madison, Wisconsin, USA
| | - Aaron W Kolb
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA
| | - Leandro B C Teixeira
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Wisconsin, USA
| | - Curtis R Brandt
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA; Department of Medical Microbiology and Immunology, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin, USA; McPherson Eye Research Institute - University of Wisconsin-Madison, Wisconsin, USA
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Suzuki T, Yamamoto T, Kaito C, Miyamoto H, Ohashi Y. Impact ofpsm-mecin Methicillin-ResistantStaphylococcus aureus(ST764) Strains Isolated from Keratitis Patients. Microb Drug Resist 2016; 22:589-597. [DOI: 10.1089/mdr.2015.0315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takashi Suzuki
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Toshihiro Yamamoto
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Chikara Kaito
- Laboratory of Microbiology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Hitoshi Miyamoto
- Department of Clinical Laboratory, Ehime University Hospital, Toon, Japan
| | - Yuichi Ohashi
- Department of Ophthalmology, Ehime University Graduate School of Medicine, Toon, Japan
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Ocular Pathogens and Antibiotic Sensitivity in Bacterial Keratitis Isolates at King Khaled Eye Specialist Hospital, 2011 to 2014. Cornea 2016; 35:789-94. [DOI: 10.1097/ico.0000000000000844] [Citation(s) in RCA: 22] [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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Abstract
PURPOSE We compared the resistance patterns of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) keratitis isolates with the common topically applied ophthalmic antimicrobials. METHODS We reviewed the antibiotic susceptibility results of 122 MRSA and 276 MSSA keratitis isolates from January 1993 to November 2012. In vitro susceptibility testing of each Staphylococcus aureus (SA) isolate was performed using Kirby-Bauer disk diffusion based on modified serum interpretations for cefoxitin, bacitracin, cefazolin, ciprofloxacin, gatifloxacin, gentamicin, moxifloxacin, ofloxacin, polymyxin B, sulfamethoxazole, tobramycin, and trimethoprim. RESULTS MRSA represented 30.7% (122 of 398) of the total SA isolates. All the SA isolates were susceptible to vancomycin, whereas they were less susceptible to the fluoroquinolones than to the non-fluoroquinolones. In comparison with MSSA, MRSA was significantly more resistant to all the antibiotics tested other than polymyxin B (both equally resistant) and vancomycin (both equally susceptible) (P < 0.001). Besides vancomycin, MRSA demonstrated the best susceptibilities to sulfamethoxazole (94.3%), bacitracin (89.3%), trimethoprim (88.5%), and gentamicin (86.1%). Additionally, MRSA was found to be significantly more resistant to the second-generation fluoroquinolones (ciprofloxacin and ofloxacin) than to the fourth-generation fluoroquinolones (moxifloxacin and gatifloxacin). An increase in resistance to the fourth-generation fluoroquinolones was detected for both MRSA and MSSA over the study period. CONCLUSIONS The in vitro susceptibilities of commonly used topical antibiotics differ for MRSA and MSSA isolates; thus, successful treatment of bacterial keratitis should be supported with laboratory studies. Vancomycin remains the treatment of choice for MRSA keratitis. The empiric use of second-generation fluoroquinolones seems to be contraindicated in the treatment of MRSA keratitis.
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Kuroda T, Kinoshita Y, Niwa H, Mizobe F, Ueno T, Kuwano A, Hatazoe T, Hobo S. Methicillin-resistant Staphylococcus aureus ulcerative keratitis in a Thoroughbred racehorse. J Equine Sci 2015; 26:95-8. [PMID: 26435683 PMCID: PMC4591416 DOI: 10.1294/jes.26.95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/06/2015] [Indexed: 11/25/2022] Open
Abstract
We report the first case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in a racehorse. A 5-year-old mare developed punctate keratitis after racing. The corneal ulcer continued to expand despite ophthalmic antimicrobial therapy. On day 6, a conjunctival graft surgery was performed. The mare was euthanized, following colitis and laminitis development on day 10. MRSA was isolated from the corneal swab taken at the time of euthanasia. Immunohistochemical analysis demonstrated gram-positive and anti-S. aureus monoclonal antibody-positive cocci infiltration of the corneal stroma; and a diagnosis of MRSA ulcerative keratitis was made. An ophthalmic antimicrobial against the isolated MRSA did not improve the ocular lesion. The MRSA strain was found to be staphylococcal cassette chromosome mec type II, a strain frequently isolated from humans in Japan.
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Affiliation(s)
- Taisuke Kuroda
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi 320-0856, Japan
| | - Yuta Kinoshita
- Epizootic Research Center, Equine Research Institute, Japan Racing Association, Tochigi 329-0412, Japan
| | - Hidekazu Niwa
- Epizootic Research Center, Equine Research Institute, Japan Racing Association, Tochigi 329-0412, Japan
| | - Fumiaki Mizobe
- Racehorse Hospital, Ritto Training Center, Japan Racing Association, Shiga 520-3085, Japan
| | - Takanori Ueno
- Epizootic Research Center, Equine Research Institute, Japan Racing Association, Tochigi 329-0412, Japan
| | - Atsutoshi Kuwano
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi 320-0856, Japan
| | - Takashi Hatazoe
- Kyushu Stallion Station, The Japan Bloodhorse Breeders' Association, Kagoshima 899-8313, Japan
| | - Seiji Hobo
- Joint Faculty of Veterinary Medicine, Kagoshima University, Kagoshima 890-0065, Japan
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Akova Budak B, Baykara M, Kıvanç SA, Yilmaz H, Cicek S. Comparing the ocular surface effects of topical vancomycin and linezolid for treating bacterial keratitis. Cutan Ocul Toxicol 2015; 35:126-30. [PMID: 26100380 DOI: 10.3109/15569527.2015.1058273] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Vancomycin is the gold standard in combination therapy for severe and resistant gram-positive keratitis and in particular for Methicillin-resistant Staphylococcus aureus (MRSA) infections. The aim of this study was to report the ocular surface toxicity and scoring in patients whose treatment shifted to topical linezolid/ceftazidime from topical vancomycin/ceftazidime due to their vancomycin intolerance. METHODS A retrospective, interventional case series of bacterial keratitis was treated with topical linezolid (one drop of 0.2% solution per eye), administered hourly until epithelization and then gradually decreased. The number and extent of punctate epithelial erosions were noted across the entire surface of the cornea. Ocular discomfort was assessed by means of (a) patient-reported pain upon instillation of the medication (vancomycin/linezolid), (b) reported burning sensation between doses and (c) reported foreign-body sensation. No ocular surface toxicity related to linezolid use was noted. Patients were followed for at least 2 months after treatment between April and December 2013. RESULTS Of the seven patients included in the study (age range: 2-88 years; five females, two males), complete epithelization and resolution was achieved in five patients. One patient was treated with linezolid after penetrating keratoplasty. The second culture of another patient with impending perforation despite linezolid/ceftazidime therapy yielded Fusarium spp., so he underwent tectonic keratoplasty. The mean ocular surface score was 9.4 ± 1.6 during vancomycin treatment and 5.9 ± 1.3 during linezolid treatment after discontinuation of vancomycin. The topical linezolid score was significantly lower (p = 0.027). CONCLUSIONS Topical linezolid may be better tolerated, according to the mean ocular surface score, than topical vancomycin by some patients and can be considered an alternative for patients who do not well tolerate vancomycin.
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Affiliation(s)
- Berna Akova Budak
- a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey
| | - Mehmet Baykara
- a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey
| | - Sertaç Argun Kıvanç
- a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey
| | - Hakan Yilmaz
- a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey
| | - Serhat Cicek
- a Department of Ophthalmology , School of Medicine, Uludag University , Bursa , Turkey
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A Comparison of Clinical Features between Community-Associated and Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Keratitis. J Ophthalmol 2015; 2015:923941. [PMID: 25653870 PMCID: PMC4306370 DOI: 10.1155/2015/923941] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/24/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose. To compare the clinical features of community-associated (CA) and healthcare-associated (HA) methicillin-resistant Staphylococcus aureus (MRSA) keratitis. Methods. Patients presenting with culture-proven MRSA keratitis between January 1, 2006, and December 31, 2010, at Chang Gung Memorial Hospital, Taiwan, were included in this study. The patients' demographic and clinical information were reviewed retrospectively. Antibiotic susceptibility was verified using the disk diffusion method. Results. Information on 26 patients with MRSA keratitis was collected, including 12 cases of CA-MRSA and 14 cases of HA-MRSA. All MRSA isolates were susceptible to vancomycin; the only difference in drug susceptibility was that CA-MRSA isolates were more susceptible to trimethoprim/sulfamethoxazole than HA-MRSA (P = .034). The most common risk factor for MRSA keratitis was ocular surface disease. No significant differences were observed between the 2 groups in terms of clinical features, treatments, and visual outcomes. Conclusion. In Taiwan, CA-MRSA rivals HA-MRSA as a critical cause of MRSA keratitis. Furthermore, CA-MRSA isolates are multidrug resistant. CA-MRSA and HA-MRSA keratitis are clinically indistinguishable, although larger studies are warranted to further evaluate this association.
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Abbouda A, Abicca I, Alió JL. Infectious Keratitis Following Corneal Crosslinking: A Systematic Review of Reported Cases: Management, Visual Outcome, and Treatment Proposed. Semin Ophthalmol 2014; 31:485-91. [PMID: 25392046 DOI: 10.3109/08820538.2014.962176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To describe the infectious complications and the group of pathogens involved in the infection following corneal crosslinking, the visual outcome, and the treatment proposed. METHODS A Medline (National Library of Medicine, Bethesda, MD, USA) search from October 2000 to October 2013 was performed to identify all articles describing infectious keratitis following corneal crosslinking treatment. Nineteen articles were selected. Ten articles reported infectious complications of corneal crosslinking treatment were included. Nine articles were excluded, because seven described sterile keratitis, one article was in German, and one reported general complication without describing the infection complication. RESULTS A total number of infections reported included 10 eyes. The infectious keratitis was associated with bacteria in five eyes (50%): gram-positive bacteria in three eyes (30%) (staphylococcus epidermidis, S. aureus and streptococcus salivarius plus S. oralis, respectively) and gram-negative bacteria in two eyes (20%) (E. coli; P. aeruginosa); there was herpes virus in two eyes, fungus in two eyes (Fusarium and Microsporidia) (20%), and Acanthamoeba in one eye (10%). CONCLUSIONS Only 10 cases of infectious keratitis following corneal crosslinking are published. The most virulent pathogens were Pseudomonas aeruginosa and Acanthamoeba. Less virulent organisms were Escherichia coli and S. epidermidis. Two cases of herpes keratitis were described, suggesting the possibility of systemic antiviral prophylaxis before corneal crosslinking treatment. The most common risk factor of infections identified was postoperative incorrect patient behavior.
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Affiliation(s)
- A Abbouda
- a Vissum Corporación Oftalmológica , Alicante , Spain .,b Division of Ophthalmology , University of Rome Sapienza , Rome , Italy , and
| | - I Abicca
- b Division of Ophthalmology , University of Rome Sapienza , Rome , Italy , and
| | - J L Alió
- a Vissum Corporación Oftalmológica , Alicante , Spain .,c Division of Ophthalmology , Universidad Miguel Hernández , Alicante , Spain
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Kim MR, Lee SB. Clinical and Microbiological Analysis of Gram-Positive Bacterial Keratitis, a 15-Year Review. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.10.1432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mi Rae Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Bumm Lee
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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