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Alkan Y, Kaymaz A, Behcet M, Bayrak A. Topical Vancomycin is More Efficient than Povidone-Iodine Treatment in Controlling Bacterial Growth in Methicillin-Resistant Staphylococcus Aureus Keratitis Model in Rabbits. Curr Eye Res 2024; 49:923-929. [PMID: 38708825 DOI: 10.1080/02713683.2024.2349661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 03/04/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
To evaluate the efficacy of topical vancomycin and povidone iodine (PI) application on methicillin-resistant Staphylococcus aureus (MRSA) keratitis model in rabbits. MRSA keratitis was induced by injecting 0.1 mL MRSA containing 1000 colony-forming units (CFU) into central cornea of right eyes of 24 New Zealand White rabbits. Animals were divided into four groups (n = 6): control (treated with balanced salt solution), 50 mg/mL topical vancomycin, 5% topical PI, and combination; examined before and after treatment, and corneal tissues were harvested for analysis at 9th hour of treatment. Bacterial load was determined as: 7.63 ± 0.82 log10 CFU/g in control group, 6.95 ± 1.66 log10 CFU/g in PI group, 4.67 ± 0.77 log10 CFU/g in combination group, and 4.33 ± 0.71 log10 CFU/g in vancomycin group (p = 0.001). Median of total clinical score increased significantly from 7 [range: 5-8] to 11.5 [range: 11-15] (p = 0.001) in control group, did not change (6 [range: 5-8] to 7 [range: 5-7]; p = 0.695) in vancomycin group, increased significantly from 7 [range: 5-8] to 12.5 [range: 10-14] (p < 0.001) in PI group, increased significantly from 6.5 [range: 5-7] to 8 [range: 7-9] in combination group (p = 0.002). Post-treatment clinical scores for chemosis, conjunctival injection, iritis, hypopyon, epithelial erosion, and corneal infiltrate were significantly lower in vancomycin-treated groups compared to others (p < 0.05). In PI-treated groups, especially scores for chemosis, conjunctival injection, epithelial erosion and corneal infiltrate were significantly higher than vancomycin (p < 0.05). Topical vancomycin significantly inhibited bacterial growth in MRSA keratitis. However, PI was ineffective in controlling this growth; additionally, exerted toxic effect on ocular surface. When vancomycin was combined with PI, no additional increase in efficacy of treatment was detected compared to only vancomycin.
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Affiliation(s)
- Yunus Alkan
- Department of Ophthalmology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
- Department of Ophthalmology, Derik State Hospital, Mardin, Turkey
| | - Abdulgani Kaymaz
- 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
| | - Abdullah Bayrak
- Department of Ophthalmology, Bolu Abant Izzet Baysal University, Training and Research Hospital, Bolu, Turkey
- Department of Ophthalmology, Macuria-Die Makulaexperten, Meckenbeuren, Germany
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Zhong R, Xu Z, Zhang S, Zeng M, Li H, Liu S, Lin S. Development of novel bisphenol derivatives with a membrane-targeting mechanism as potent gram-positive antibacterial agents. Eur J Med Chem 2024; 274:116544. [PMID: 38850855 DOI: 10.1016/j.ejmech.2024.116544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/18/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
Antibiotic resistance is becoming increasingly severe. The development of small molecular antimicrobial peptides is regarded as a promising design strategy for antibiotics. Here, a series of bisphenol derivatives with amphiphilic structures were designed and synthesized as antibacterial agents by imitating the design strategy of antimicrobial peptides. After a series of structural optimizations, lead compound 43 was identified, which exhibited excellent antibacterial activity against Gram-positive bacterial strains (MICs = 0.78-1.56 μg/mL), poor hemolytic activity (HC50 > 200 μg/mL), and low cytotoxicity (CC50 > 100 μg/mL). Further biological evaluation results indicated that 43 exerted antibacterial effects by directly destroying bacterial cell membranes and displayed rapid bactericidal properties (within 0.5-1 h), leading to a very low probability of drug resistance. Moreover, in a murine model of corneal infection, 43 exhibited a strong in vivo antibacterial efficacy. These findings indicate that 43 is a promising candidate compound for the treatment of bacterial infections.
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Affiliation(s)
- Rongcui Zhong
- Affiliated Qingyuan Hospital, Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, State Key Laboratory of Respiratory Disease, and School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, 511436, China
| | - Zikai Xu
- Affiliated Qingyuan Hospital, Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, State Key Laboratory of Respiratory Disease, and School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, 511436, China
| | - Shujun Zhang
- Affiliated Qingyuan Hospital, Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, State Key Laboratory of Respiratory Disease, and School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, 511436, China
| | - Minghui Zeng
- Affiliated Qingyuan Hospital, Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, State Key Laboratory of Respiratory Disease, and School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, 511436, China
| | - Haizhou Li
- Affiliated Qingyuan Hospital, Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, State Key Laboratory of Respiratory Disease, and School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, 511436, China
| | - Shouping Liu
- Affiliated Qingyuan Hospital, Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, State Key Laboratory of Respiratory Disease, and School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, 511436, China.
| | - Shuimu Lin
- Affiliated Qingyuan Hospital, Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, State Key Laboratory of Respiratory Disease, and School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, 511436, China.
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Zhou C, Wang Q, Cao H, Jiang J, Gao L. Nanozybiotics: Advancing Antimicrobial Strategies Through Biomimetic Mechanisms. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2403362. [PMID: 38874860 DOI: 10.1002/adma.202403362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/09/2024] [Indexed: 06/15/2024]
Abstract
Infectious diseases caused by bacterial, viral, and fungal pathogens present significant global health challenges. The rapid emergence of antimicrobial resistance exacerbates this issue, leading to a scenario where effective antibiotics are increasingly scarce. Traditional antibiotic development strategies are proving inadequate against the swift evolution of microbial resistance. Therefore, there is an urgent need to develop novel antimicrobial strategies with mechanisms distinct from those of existing antibiotics. Nanozybiotics, which are nanozyme-based antimicrobials, mimic the catalytic action of lysosomal enzymes in innate immune cells to kill infectious pathogens. This review reinforces the concept of nanozymes and provides a comprehensive summary of recent research advancements on potential antimicrobial candidates. Initially, nanozybiotics are categorized based on their activities, mimicking either oxidoreductase-like or hydrolase-like functions, thereby highlighting their superior mechanisms in combating antimicrobial resistance. The review then discusses the progress of nanozybiotics in treating bacterial, viral, and fungal infections, confirming their potential as novel antimicrobial candidates. The translational potential of nanozybiotic-based products, including hydrogels, nanorobots, sprays, bandages, masks, and protective clothing, is also considered. Finally, the current challenges and future prospects of nanozybiotic-related products are explored, emphasizing the design and antimicrobial capabilities of nanozybiotics for future applications.
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Affiliation(s)
- Caiyu Zhou
- CAS Engineering Laboratory for Nanozyme, Key Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Chaoyang, Beijing, 100101, China
- School of Life Sciences, University of Chinese Academy of Sciences, Haidian, Beijing, 100049, China
| | - Qian Wang
- CAS Engineering Laboratory for Nanozyme, Key Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Chaoyang, Beijing, 100101, China
- School of Life Sciences, University of Chinese Academy of Sciences, Haidian, Beijing, 100049, China
| | - Haolin Cao
- CAS Engineering Laboratory for Nanozyme, Key Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Chaoyang, Beijing, 100101, China
- School of Life Sciences, University of Chinese Academy of Sciences, Haidian, Beijing, 100049, China
| | - Jing Jiang
- CAS Engineering Laboratory for Nanozyme, Key Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Chaoyang, Beijing, 100101, China
| | - Lizeng Gao
- CAS Engineering Laboratory for Nanozyme, Key Laboratory of Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Chaoyang, Beijing, 100101, China
- Nanozyme Laboratory in Zhongyuan, Henan Academy of Innovations in Medical Science, Zhengzhou, Henan, 450052, China
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Ji M, Park JH, Ha A, Jeong J. Microbial keratitis in the subtropical region of Korea: a comprehensive 12-year retrospective review at a single referral center. BMJ Open 2024; 14:e082793. [PMID: 38969381 PMCID: PMC11227792 DOI: 10.1136/bmjopen-2023-082793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVES To investigate the epidemiological characteristics and clinical outcomes of culture-proven bacterial and fungal keratitis at a single tertiary referral centre on Jeju Island, South Korea. DESIGN A retrospective study design. SETTING Data from a solitary referral centre on Jeju Island spanning January 2011 to December 2022. PARTICIPANTS Among the 245 patients clinically diagnosed with infectious microbial keratitis, 110 individuals had culture-positive results. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the identification of causative microbial profiles and epidemiological characteristics, while the secondary outcome was the correlation of these factors with treatment outcomes. RESULTS Of 245 patients, 110 (44.9%) had culture-positive infectious keratitis, showing 69 bacterial, 32 fungal, 4 superimposed bacterial and 5 cases with coinfection by bacteria and fungus. The most common pathogen was Pseudomonas species in 14.4% of the bacterial keratitis cases, followed by Staphylococcus epidermidis (9%), Staphylococcus aureus (8%) and Moraxella species (7%). The total treatment success rate for bacterial keratitis was 67.5%. The frequency of methicillin-resistant Staphylococcus on Jeju Island did increase during the study period. Fusarium species had the highest incidence at 22.2%, followed by Candida (16.7%) and Colletotrichum species (11.1%). 56.7% of fungal keratitis patients were successfully treated. An initial large corneal lesion (>3 mm) showed a statistically significant association with treatment failure. CONCLUSION The incidence of Moraxella and Colletotrichum species in our study was higher than that reported in other districts with different climates and environments. The results reported here reflect the unique environmental features of Jeju Island, characterised by high humidity and temperatures.
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Affiliation(s)
- Man Ji
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Joong Hyun Park
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Ahnul Ha
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jinho Jeong
- Department of Ophthalmology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
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Jiang X, Jin Y, Zeng Y, Shi P, Li W. Self-Implantable Core-Shell Microneedle Patch for Long-Acting Treatment of Keratitis via Programmed Drug Release. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2310461. [PMID: 38396201 DOI: 10.1002/smll.202310461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/20/2024] [Indexed: 02/25/2024]
Abstract
Bacteria-induced keratitis is a major cause of corneal blindness in both developed and developing countries. Instillation of antibiotic eyedrops is the most common management of bacterial keratitis but usually suffers from low bioavailability (i.e., <5%) and frequent administration, due to the existence of corneal epithelial barrier that prevents large and hydrophilic drug molecules from entering the cornea, and the tear film on corneal surface that rapidly washes drug away from the cornea. Here, a self-implantable core-shell microneedle (MN) patch with programmed drug release property to facilitate bacterial keratitis treatment is reported. The pH-responsive antimicrobial nanoparticles (NPs), Ag@ZIF-8, which are capable of producing antibacterial metal ions in the infected cornea and generating oxidative stress in bacteria, are loaded in the dissolvable core, while the anti-angiogenic drug, rapamycin (Rapa), is encapsulated in the biodegradable shell, thereby enabling rapid release of Ag@ZIF-8 NPs and sustained release of Rapa after corneal insertion. Owing to the programmed release feature, one single administration of the core-shell MN patch in a rat model of bacterial keratitis, can achieve satisfactory antimicrobial activity and superior anti-angiogenic and anti-inflammation effects as compared to daily topical eyedrops, indicating a great potential for the infectious keratitis therapy in clinics.
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Affiliation(s)
- Xue Jiang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Yinli Jin
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Yongnian Zeng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
| | - Peng Shi
- Department of Biomedical Engineering, The City University of Hong Kong, Kowloon, Hong Kong SAR, 999077, China
| | - Wei Li
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, School of Pharmaceutical Sciences, Wuhan University, Wuhan, 430071, China
- TaiKang Center for Life and Medical Sciences, Wuhan University, Wuhan, 430071, China
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Nayel AA, Hamdy NA, Massoud TH, Mohamed NM. A comparison of antimicrobial regimen outcomes and antibiogram development in microbial keratitis: a prospective cohort study in Alexandria, Egypt. Graefes Arch Clin Exp Ophthalmol 2024; 262:1865-1882. [PMID: 38240778 PMCID: PMC11106157 DOI: 10.1007/s00417-023-06362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/12/2023] [Accepted: 12/23/2023] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance in microbial keratitis has not been previously explored in Alexandria. We aim to recommend effective therapies through identification of etiological agents, determination of antimicrobial susceptibilities, and comparing outcomes of empiric topical antimicrobials. METHODS In this 2022 prospective cohort conducted in Alexandria Main University Hospital cornea clinic, antimicrobial susceptibilities of isolated microorganisms from corneal scrapings were detected and antibiograms were developed. Bacterial (BK), fungal (FK), or mixed fungal/bacterial keratitis (MFBK) patients on empiric regimens were compared for ulcer healing, time-to-epithelialization, best-corrected visual acuity, interventions, and complications. RESULTS The prevalent microorganisms in 93 positive-cultures were coagulase-negative staphylococci (CoNS, 30.1%), Pseudomonas aeruginosa (14%), and Aspergillus spp. (12.9%). CoNS were susceptible to vancomycin (VAN, 100%) and moxifloxacin (MOX, 90.9%). Gram-negative bacteria showed more susceptibility to gatifloxacin (90.9%) than MOX (57.1%), and to gentamicin (GEN, 44.4%) than ceftazidime (CAZ, 11.8%). Methicillin-resistance reached 23.9% among Gram-positive bacteria. Fungi exhibited 10% resistance to voriconazole (VRC). Percentages of healed ulcers in 49 BK patients using GEN + VAN, CAZ + VAN and MOX were 85.7%, 44.4%, and 64.5%, respectively (p = 0.259). Their median time-to-epithelialization reached 21, 30, and 30 days, respectively (log-rank p = 0.020). In 51 FK patients, more ulcers (88.9%) healed with natamycin (NT) + VRC combination compared to VRC (39.1%) or NT (52.6%) (p = 0.036). Their median time-to-epithelialization was 65, 60, and 22 days, respectively (log-rank p < 0.001). The VRC group required more interventions (60.9%) than NT + VRC-treated group (11.1%) (p = 0.018). In 23 MFBK patients, none healed using NT + CAZ + VAN, while 50% healed using VRC + CAZ + VAN (p = 0.052). Regimens had comparable visual outcomes and complications. CONCLUSION Based on the higher detected susceptibility, we recommend empiric MOX in suspected Gram-positive BK, gatifloxacin in Gram-negative BK, and GEN + VAN in severe BK. Due to better outcomes, we recommend NT + VRC in severe FK. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT05655689. Registered December 19, 2022- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05655689?cond=NCT05655689.&draw=2&rank=1.
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Affiliation(s)
- Amira A Nayel
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
- Clinical Pharmacy Department, Alexandria Ophthalmology Hospital, Ministry of Health and Population of Egypt, Alexandria, Egypt
| | - Noha A Hamdy
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
| | - Tamer H Massoud
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nelly M Mohamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Bălășoiu AT, Bălășoiu M, Zlatian OM, Ghenea AE. Bacterial and Fungal Keratitis in a Tertiary Care Hospital from Romania. Microorganisms 2024; 12:787. [PMID: 38674731 PMCID: PMC11052338 DOI: 10.3390/microorganisms12040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/16/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Infectious keratitis is a significant global problem that can lead to corneal blindness and visual impairments. This study aimed to investigate the etiology of infectious bacterial and fungal keratitis, identify the causative pathogens and their antimicrobial resistance patterns, and analyze the risk factors associated with the development of infectious keratitis. The study was observational and retrospective, involving 226 eyes from 223 patients presented at the Ophthalmology Clinic of the County Clinical Emergency Hospital of Craiova, Romania. The inclusion criteria included corneal ulceration/abscess/infiltrate present on slit-lamp examination and positive microbiological sampling for bacteria or fungi. The study found that the most common causes of infectious keratitis were coagulase-negative staphylococci (35.40%), Staphylococcus aureus (11.06%), and Pseudomonas aeruginosa (14.16%). The Gram-positive bacteria showed high resistance rates to penicillin, moderate rates to gentamycin and clindamycin, and low resistance to chinolones. The Gram-negative bacteria were highly resistant to ampicillin and amoxicillin-clavulanic acid, while third-generation cephalosporins, quinolones, and carbapenems were effective. Systemic antibiotics, such as vancomycine, piperacillin-tazobactam, amikacin, and ceftazidime, show promise against keratitis with low resistance rates, whereas carbapenems and topical aminoglycosides had higher resistance, leaving moxifloxacin as a potential topical option for Gram-positive bacteria and Pseudomonas aeruginosa, albeit with resistance concerns for Klebsiella spp. Although fungal keratitis was rare, Fusarium spp. and Candida albicans were the leading fungal pathogens, with incidences of 2.65% and 2.21%, respectively. Candida albicans was broadly susceptible to most antifungals, while Fusarium solani, Curvularia lunata, and Alternaria alternata exhibited resistance to many antifungals. Amphotericin B and caspofungin can be used as systemic antifungals in fungal keratitis. The study also identified risk factors for keratitis such as ocular trauma (65.92%, OR: 2.5), contact lens wear (11.94%, OR: 1.8), and corneal scarring/leukoma (10.17%, OR: 1.6). Keratitis was more frequent in individuals over 60 years old. The findings of this study have implications for the development of effective diagnostic, therapeutic, and preventive strategies for infectious keratitis.
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Affiliation(s)
- Andrei Theodor Bălășoiu
- Ophtalmology Department, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania;
- Ophtalmology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Maria Bălășoiu
- Medical Laboratory, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania; (M.B.); (A.E.G.)
- Microbiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ovidiu Mircea Zlatian
- Medical Laboratory, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania; (M.B.); (A.E.G.)
- Microbiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Alice Elena Ghenea
- Medical Laboratory, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania; (M.B.); (A.E.G.)
- Microbiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Zhang J, Li Y, Xie S, Lou H, Chen H, Zhang G. Baicalein glycymicelle ophthalmic solution: Preparation, in vitro antimicrobial activities, and antimicrobial mechanism evaluations. Int J Pharm 2024; 654:123964. [PMID: 38430948 DOI: 10.1016/j.ijpharm.2024.123964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
The purpose of this study was to develop a novel baicalein (BAI) loaded glycymicelle ophthalmic solution with small molecule phytochemical glycyrrhizin as nanocarriers and to explore this solution's potential as an antimicrobial agent against ocular infections. The optimized BAI glycymicelles had a high encapsulation efficiency (98.76 ± 1.25 %), a small particle size (54.38 ± 2.41 nm), a uniform size distribution (polydispersity index = 0.293 ± 0.083), and a zeta potential of -28.3 ± 1.17 mV. The BAI glycymicelle ophthalmic solution exhibited an excellent short-term storage stability. BAI glycymicelles significantly increased the apparent solubility and in vitro release capability of BAI. The BAI glycymicelle ophthalmic solution exhibited no hen's egg-chorioallantoic membrane' irritation and strong in vivo ocular tolerance in rabbits. The BAI glycymicelles noticeably enhanced the in vivo corneal permeation. The BAI glycymicelles also precipitated increased in vitro antioxidant activity and significantly improved in vitro antipathogen activities. Various antimicrobial mechanisms, including the destruction of the bacterial cell wall, damage to the bacterial cell membranes, interruptions to the biofilm structure, and the apoptosis of bacteria, were inflicted on BAI glycymicelles. These findings provided useful knowledge regarding the development of a novel ophthalmic solution and formulation of BAI.
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Affiliation(s)
- Jing Zhang
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Yuhang Li
- The Eighth People's Hospital of Qingdao, Qingdao, China
| | - Sibin Xie
- Qingdao Central Medical Group, Qingdao, China
| | - Huadong Lou
- The Eighth People's Hospital of Qingdao, Qingdao, China
| | - Hao Chen
- School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China.
| | - Guowen Zhang
- The Eighth People's Hospital of Qingdao, Qingdao, China.
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Ch S, Mishra P, Padaga SG, Ghosh B, Roy S, Biswas S. 3D-Printed Inherently Antibacterial Contact Lens-Like Patches Carrying Antimicrobial Peptide Payload for Treating Bacterial Keratitis. Macromol Biosci 2024; 24:e2300418. [PMID: 38258356 DOI: 10.1002/mabi.202300418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Delivery of therapeutic agents through contact lenses-like patches is a promising strategy to achieve significant bioavailability with negligible eye drainage. The present study investigates the preparation and 3D printing of mucoadhesive gelatin methacryloyl (GelMA)/chitosan methacryloyl (ChiMA) hydrogels to fabricate them as contact lens-like patches (CLP) loaded with antimicrobial peptide, S100A12 (AMP) for treating bacterial keratitis (BK). Extrusion technology is used to print the patches layer by layer to form a hemispherical scaffold suitable for eyewear, and 3D-printed CLP is crosslinked using Irgacure 2959 under UV light. The results from the in vivo experiment conducted on Pseudomonas aeruginosa-infected BK rabbit model after the treatment with AMP-loaded CLP have shown a significant decrease in bacterial load when plated for CFU. The newly developed delivery system containing AMP has great potential to overcome the treatment challenges of multidrug resistance (MDR) in bacteria and eliminate the frequent dosing associated with eye drops. The presence of chitosan in the formulation provides a synergetic effect on the AMP in disrupting bacterial biofilms. The ease of using 3D printing will open new avenues for optimizing the dosage depending on the severity of the BK in the patients, which can be used as personalized medicine.
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Affiliation(s)
- Sanjay Ch
- Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, 500078, India
| | - Priyasha Mishra
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
- Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Sri Ganga Padaga
- Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, 500078, India
| | - Balaram Ghosh
- Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, 500078, India
| | - Sanhita Roy
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Swati Biswas
- Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, 500078, India
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Bisen AC, Bhatta RS. Ocular bioanalysis of moxifloxacin and ketorolac tromethamine in rabbit lacrimal matrix using liquid chromatography-tandem mass spectrometry. Bioanalysis 2024; 16:219-232. [PMID: 38197429 DOI: 10.4155/bio-2023-0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Aim: The fixed-dose combination of moxifloxacin (MOXI) and ketorolac tromethamine (KTR) is widely used for the treatment of bacterial keratitis. Thus, a new LC-MS/MS method was developed to determine MOXI and KTR in lacrimal fluid. Methods: Bioanalysis was performed using a Shimadzu 8050 LC-MS/MS in electrospray ionization-positive mode and the method was validated per US FDA guidelines. Isocratic separation was performed with a Waters Symmetry C18 column using methanol and 0.1% formic acid containing deionized water (85:15, v/v). Results & conclusion: An easy, quick and selective method was established and applied to assess the ocular pharmacokinetic profile of a commercially available formulation containing MOXI and KTR. Based on the pharmacokinetic data, this work describes pharmacokinetics-based dosage regimen calculations and their clinical significance.
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Affiliation(s)
- Amol Chhatrapati Bisen
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, India
- Academy of Scientific & Innovative Research (AcSIR), CSIR-HRDC Campus, Ghaziabad, Uttar Pradesh, 201002, India
| | - Rabi Sankar Bhatta
- Pharmaceutics & Pharmacokinetics Division, CSIR-Central Drug Research Institute, Lucknow, 226031, India
- Academy of Scientific & Innovative Research (AcSIR), CSIR-HRDC Campus, Ghaziabad, Uttar Pradesh, 201002, India
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Hart JN, Lu MC, Tracey BM, Miller KD, Lephart PR, Mian SI, Woodward MA. A Comparison of Culture Results and Visual Acuity in Contact Lens Related Microbial Keratitis. Curr Eye Res 2024; 49:39-45. [PMID: 37815382 PMCID: PMC10842689 DOI: 10.1080/02713683.2023.2269322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Evaluate the effect of corneal and contact lens-related (CLR) culture results on visual acuity (VA) in patients with microbial keratitis (MK). METHODS MK patients with corneal and CLR cultures were identified in the University of Michigan electronic health record from August 2012 to April 2022. Test results were classified as laboratory-positive or laboratory-negative. Linear regression was used to examine trends of VA and associations between changes in VA (differences of VA at 90-day and baseline VA) and corneal and CLR culture results, after adjustment for baseline VA. One-sample t-tests were used to test if the slope estimates were different from zero. RESULTS MK patients (n = 50) were on average 49 years old (standard deviation = 20.9), 56% female, and 90% White. Positive corneal and CLR cultures were reported in 60% and 64% of patients, respectively, and 38% reported both. The agreement rate between corneal and CLR culture results was 30% (n = 15/50). LogMAR VA improved over time in patients with positive corneal and CLR cultures (Estimate=-0.19 per 10-day increase, p = 0.002), and in those with negative corneal and positive CLR cultures (Estimate= -0.17 per 10-day increase, p = 0.004). Compared to patients with negative corneal and CLR cultures, there was a trend toward improvement in VA for patients with positive corneal and CLR cultures (Estimate=-0.68, p = 0.068), and those with negative corneal and positive CLR cultures (Estimate= -0.74, p = 0.059), after adjusting for baseline VA. CONCLUSIONS Positive CLR cultures are associated with significant improvement in VA over time. These additional cultures can provide guidance on appropriate antimicrobial selection, especially when corneal cultures are negative.
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Affiliation(s)
- Jenna N. Hart
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Breanna M. Tracey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith D. Miller
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul R. Lephart
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shahzad I. Mian
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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12
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Carr MA, Marquart ME, Sanchez M, Saleem W, Wellington OI, Lovell KM, McCallister A, Lightfoot V, Ost EB, Wise HZ, Huang B, Sharma AC. Innovative cold atmospheric plasma (iCAP) decreases corneal ulcer formation and bacterial loads and improves anterior chamber health in methicillin resistant Staphylococcus aureus keratitis. Exp Eye Res 2023; 237:109692. [PMID: 37884203 PMCID: PMC10841653 DOI: 10.1016/j.exer.2023.109692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
Bacterial keratitis is a vision-threatening infection of the cornea that is typically treated with antibiotics. However, antibiotics sometimes fail to eradicate the infection and do not prevent or repair the damage caused directly by the bacteria or the host immune response to the infection. Our group previously demonstrated that treatment of Pseudomonas aeruginosa keratitis in rabbits with innovative cold atmospheric plasma (iCAP) resulted in reduced edema, ulcer formation, and bacterial load. In this study, we investigated the efficacy of iCAP treatment in methicillin-resistant Staphylococcus aureus (MRSA). New Zealand white rabbits were infected intrastromally with MRSA then treated with iCAP, moxifloxacin, vancomycin, or combination of iCAP with each antibiotic to assess the safety and efficacy of iCAP treatment compared to untreated controls and antibiotics. iCAP treatment significantly reduced bacterial loads and inflammation, improved anterior chamber clarity, and prevented corneal ulceration compared to untreated controls and antibiotic treatment. Safety assessments of grimace test scores and tear production showed that iCAP was not significantly different from either antibiotic treatment in terms of distress or tear production. Combination iCAP/antibiotic treatment did not appear to provide significant added benefit over iCAP alone. Our findings suggest that the addition of iCAP may be a viable tool in reducing damage to the cornea and anterior chamber of the eye following S. aureus keratitis.
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Affiliation(s)
- Mary A Carr
- Center for Immunology and Microbial Research and the Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Mary E Marquart
- Center for Immunology and Microbial Research and the Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Miguel Sanchez
- Experimental Therapeutics and Diagnostics Group, Lynntech Inc., 2501 Earl Rudder Fwy South, College Station, TX, 77845, USA.
| | - Waqar Saleem
- Experimental Therapeutics and Diagnostics Group, Lynntech Inc., 2501 Earl Rudder Fwy South, College Station, TX, 77845, USA.
| | - Ocean I Wellington
- Center for Immunology and Microbial Research and the Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - K Michael Lovell
- Center for Immunology and Microbial Research and the Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Aaliyah McCallister
- Center for Immunology and Microbial Research and the Department of Cell and Molecular Biology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Victoria Lightfoot
- Experimental Therapeutics and Diagnostics Group, Lynntech Inc., 2501 Earl Rudder Fwy South, College Station, TX, 77845, USA.
| | - Evan B Ost
- Experimental Therapeutics and Diagnostics Group, Lynntech Inc., 2501 Earl Rudder Fwy South, College Station, TX, 77845, USA.
| | - Hua Z Wise
- Experimental Therapeutics and Diagnostics Group, Lynntech Inc., 2501 Earl Rudder Fwy South, College Station, TX, 77845, USA.
| | - Bo Huang
- Department of Ophthalmology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Anjal C Sharma
- Experimental Therapeutics and Diagnostics Group, Lynntech Inc., 2501 Earl Rudder Fwy South, College Station, TX, 77845, USA.
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13
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Soleimani M, Cheraqpour K, Sadeghi R, Pezeshgi S, Koganti R, Djalilian AR. Artificial Intelligence and Infectious Keratitis: Where Are We Now? Life (Basel) 2023; 13:2117. [PMID: 38004257 PMCID: PMC10672455 DOI: 10.3390/life13112117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Infectious keratitis (IK), which is one of the most common and catastrophic ophthalmic emergencies, accounts for the leading cause of corneal blindness worldwide. Different pathogens, including bacteria, viruses, fungi, and parasites, can cause IK. The diagnosis and etiology detection of IK pose specific challenges, and delayed or incorrect diagnosis can significantly worsen the outcome. Currently, this process is mainly performed based on slit-lamp findings, corneal smear and culture, tissue biopsy, PCR, and confocal microscopy. However, these diagnostic methods have their drawbacks, including experience dependency, tissue damage, cost, and time consumption. Diagnosis and etiology detection of IK can be especially challenging in rural areas or in countries with limited resources. In recent years, artificial intelligence (AI) has opened new windows in medical fields such as ophthalmology. An increasing number of studies have utilized AI in the diagnosis of anterior segment diseases such as IK. Several studies have demonstrated that AI algorithms can diagnose and detect the etiology of IK accurately and fast, which can be valuable, especially in remote areas and in countries with limited resources. Herein, we provided a comprehensive update on the utility of AI in IK.
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Affiliation(s)
- Mohammad Soleimani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran; (M.S.); (K.C.); (R.S.)
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran; (M.S.); (K.C.); (R.S.)
| | - Reza Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran; (M.S.); (K.C.); (R.S.)
| | - Saharnaz Pezeshgi
- School of Medicine, Tehran University of Medical Sciences, Tehran 1461884513, Iran;
| | - Raghuram Koganti
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Ali R. Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Cornea Service, Stem Cell Therapy and Corneal Tissue Engineering Laboratory, Illinois Eye and Ear Infirmary, Chicago, IL 60612, USA
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14
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Ding Y, Liu G, Liu S, Li X, Xu K, Liu P, Cai K. A Multifunction Hydrogel-Coating Engineered Implant for Rescuing Biofilm Infection and Boosting Osseointegration by Macrophage-Related Immunomodulation. Adv Healthc Mater 2023; 12:e2300722. [PMID: 37140383 DOI: 10.1002/adhm.202300722] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/03/2023] [Indexed: 05/05/2023]
Abstract
Innovative methodologies combined with scavenging reactive oxygen species (ROS), alleviating oxidative stress damage and promoting macrophage polarization to M2 phenotype may be ideal for remodeling implant-infected bone tissue. Herein, a functionalization strategy for doping Tannic acid-d-tyrosine nanoparticles with photothermal profile into the hydrogel coating composed of konjac gum and gelatin on the surface of titanium (Ti) substrate is accurately constructed. The prepared hydrogel coating exhibits excellent properties of eliminating biofilm and killing planktonic bacteria, which is based on increasing susceptibility to bacteria by the photothermal effect, biofilm-dissipation effect of D-tyrosine, as well as the bactericidal effect of tannic acid. In addition, the modified Ti substrate has effectively alleviated proinflammatory responses by scavenging intracellular excessive ROS and guiding macrophages polarization toward M2. More interesting, conditioned medium from macrophage indicates that paracrine is conducive to osteogenic proliferation and differentiation of mesenchymal stem cells. Results from rat model of femur infection in vivo demonstrate that the modified Ti implant significantly eliminates the residual bacteria, relieves inflammation, mediates macrophage polarization, and accelerates osseointegration. Altogether, this study exhibits a new perspective for the development of advanced functional implant with great application potential in bone tissue regeneration and repair.
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Affiliation(s)
- Yao Ding
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, P. R. China
| | - Genhua Liu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, P. R. China
| | - Shaopeng Liu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, P. R. China
| | - Xuan Li
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, P. R. China
| | - Kun Xu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, P. R. China
| | - Peng Liu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, P. R. China
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, P. R. China
| | - Kaiyong Cai
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, P. R. China
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15
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Morelli MK, Kloosterboer A, Fulton SA, Furin J, Newman N, Omar AF, Rojas LJ, Marshall SH, Yasmin M, Bonomo RA. Investigating and Treating a Corneal Ulcer Due to Extensively Drug-Resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother 2023; 67:e0027723. [PMID: 37166191 PMCID: PMC10358754 DOI: 10.1128/aac.00277-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/10/2023] [Indexed: 05/12/2023] Open
Abstract
Resistant Gram-negative bacteria are a growing concern in the United States, leading to significant morbidity and mortality. We identified a 72-year-old female patient who presented with unilateral vision loss. She was found to have a large corneal ulcer with hypopyon. Culture of corneal scrapings grew extensively drug-resistant Pseudomonas aeruginosa. Treatment involved a combination of systemic and topical antibiotics. Whole genome sequencing revealed the presence of blaVIM-80, blaGES-9, and other resistance determinants. This distinctive organism was linked to an over-the-counter artificial tears product.
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Affiliation(s)
| | - Amy Kloosterboer
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Scott A. Fulton
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jennifer Furin
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nicholas Newman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmed F. Omar
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Assiut University, Assiut, Egypt
| | - Laura J. Rojas
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
| | - Steven H. Marshall
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Mohamad Yasmin
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Robert A. Bonomo
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
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16
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Patil R, Dehari D, Chaudhuri A, Kumar DN, Kumar D, Singh S, Nath G, Agrawal AK. Recent advancements in nanotechnology-based bacteriophage delivery strategies against bacterial ocular infections. Microbiol Res 2023; 273:127413. [PMID: 37216845 DOI: 10.1016/j.micres.2023.127413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
Antibiotic resistance is growing as a critical challenge in a variety of disease conditions including ocular infections leading to disastrous effects on the human eyes. Staphylococcus aureus (S. aureus) mediated ocular infections are very common affecting different parts of the eye viz. vitreous chamber, conjunctiva, cornea, anterior and posterior chambers, tear duct, and eyelids. Blepharitis, dacryocystitis, conjunctivitis, keratitis, endophthalmitis, and orbital cellulitis are some of the commonly known ocular infections caused by S. aureus. Some of these infections are so fatal that they could cause bilateral blindness like panophthalmitis and orbital cellulitis, which is caused by methicillin-resistant S. aureus (MRSA) and vancomycin-resistance S. aureus (VRSA). The treatment of S. aureus infections with known antibiotics is becoming gradually difficult because of the development of resistance against multiple antibiotics. Apart from the different combinations and formulation strategies, bacteriophage therapy is growing as an effective alternative to treat such infections. Although the superiority of bacteriophage therapy is well established, yet physical factors (high temperatures, acidic pH, UV-rays, and ionic strength) and pharmaceutical barriers (poor stability, low in-vivo retention, controlled and targeted delivery, immune system neutralization, etc.) have the greatest influence on the viability of phage virions (also phage proteins). A variety of Nanotechnology based formulations such as polymeric nanoparticles, liposomes, dendrimers, nanoemulsions, and nanofibres have been recently reported to overcome the above-mentioned obstacles. In this review, we have compiled all these recent reports and discussed bacteriophage-based nanoformulations techniques for the successful treatment of ocular infections caused by multidrug-resistant S. aureus and other bacteria.
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Affiliation(s)
- Rohit Patil
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi 221005, U.P., India
| | - Deepa Dehari
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi 221005, U.P., India
| | - Aiswarya Chaudhuri
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi 221005, U.P., India
| | - Dulla Naveen Kumar
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi 221005, U.P., India
| | - Dinesh Kumar
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi 221005, U.P., India
| | - Sanjay Singh
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi 221005, U.P., India; Babasaheb Bhimrao Ambedkar University, Lucknow 226025, U.P., India
| | - Gopal Nath
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, U.P., India
| | - Ashish Kumar Agrawal
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (BHU), Varanasi 221005, U.P., India.
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17
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Huertas-Bello M, Cuéllar-Sáenz JA, Rodriguez CN, Cortés-Vecino JA, Navarrete ML, Avila MY, Koudouna E. A Pilot Study to Evaluate Genipin in Staphylococcus aureus and Pseudomonas aeruginosa Keratitis Models: Modulation of Pro-Inflammatory Cytokines and Matrix Metalloproteinases. Int J Mol Sci 2023; 24:ijms24086904. [PMID: 37108070 PMCID: PMC10138382 DOI: 10.3390/ijms24086904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023] Open
Abstract
Infectious keratitis is a vision-threatening microbial infection. The increasing antimicrobial resistance and the fact that severe cases often evolve into corneal perforation necessitate the development of alternative therapeutics for effective medical management. Genipin, a natural crosslinker, was recently shown to exert antimicrobial effects in an ex vivo model of microbial keratitis, highlighting its potential to serve as a novel treatment for infectious keratitis. This study aimed to evaluate the antimicrobial and anti-inflammatory effects of genipin in an in vivo model of Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa) keratitis. Clinical scores, confocal microscopy, plate count, and histology were carried out to evaluate the severity of keratitis. To assess the effect of genipin on inflammation, the gene expression of pro- and anti-inflammatory factors, including matrix metalloproteinases (MMPs), were evaluated. Genipin treatment alleviated the severity of bacterial keratitis by reducing bacterial load and repressing neutrophil infiltration. The expression of interleukin 1B (IL1B), interleukin 6 (IL6), interleukin 8 (IL8), interleukin 15 (IL15), tumor necrosis factor-α (TNF-α), and interferon γ (IFNγ), as well as MMP2 and MMP9, were significantly reduced in genipin-treated corneas. Genipin promoted corneal proteolysis and host resistance to S. aureus and P. aeruginosa infection by suppressing inflammatory cell infiltration, regulating inflammatory mediators, and downregulating the expression of MMP2 and MMP9.
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Affiliation(s)
- Marcela Huertas-Bello
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Jerson Andrés Cuéllar-Sáenz
- Grupo de Investigación Parasitología Veterinaria, Department of Animal Health, Faculty of Veterinary Medicine and Zootechnics, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Cristian Nicolas Rodriguez
- Department of Microbiology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Jesús Alfredo Cortés-Vecino
- Grupo de Investigación Parasitología Veterinaria, Department of Animal Health, Faculty of Veterinary Medicine and Zootechnics, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Myriam Lucia Navarrete
- Department of Microbiology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Marcel Yecid Avila
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
| | - Elena Koudouna
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogotá 111321, Colombia
- Structural Biophysics Group, School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, UK
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18
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Biomedicine Innovations and Its Nanohydrogel Classifications. Pharmaceutics 2022; 14:pharmaceutics14122839. [PMID: 36559335 PMCID: PMC9787506 DOI: 10.3390/pharmaceutics14122839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
As one of the most cutting-edge and promising polymer crosslinked network nanoparticle systems. Polymer nano-sized hydrogels (nanogels) have been a hot topic in the biomedical field over the last few decades. Due to their unique characteristics, which include their relatively high drug encapsulation efficiency, ease of preparation, high tunability, low toxicity, high stability in serum and responsive behavior to a range of stimuli to facilitate drug release. Nanogels are thought to be the next generation of drug delivery systems that can completely change the way that drug delivery systems have an impact on patients' lives. Nanogels have demonstrated significant potential in a variety of fields, including chemotherapy, diagnosis, organ targeting, and delivery of bioactive molecules of different dimensions. However, the lack of substantial clinical data from nanogels becomes one of the major barriers to translating the nanogel concept into a practical therapeutic application for many disease conditions. In addition, nanogel safety profiles have been the major concern that hinders it advancement to the clinical trial phase. This review aims to emphasize the unique properties of nanogels as delivery systems for a variety of bioactive molecules over other nano-delivery systems. Also, this review attempts to give insight into the recent progress in nanogels as a carrier in the field of nanomedicine to overcome complex biological barriers. Relevant scientific data and clinical rationale for the development and the potential use of nanogel as a carrier for targeted therapeutic interventions are discussed. Finally, the concluding points of this review highlight the importance of understanding the long-term toxicity profile of nanogel within the biological system to fully understand their biocompatibility.
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19
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Chatterjee S, Agrawal D, Gomase SN, Parchand SM, Gangwe AB, Mishra M. Fluoroquinolone resistance in bacterial isolates from ocular infections: Trend in antibiotic susceptibility patterns between 2005-2020. Indian J Ophthalmol 2022; 70:4391-4398. [PMID: 36453351 PMCID: PMC9940527 DOI: 10.4103/ijo.ijo_1033_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To assess the fluoroquinolone resistance pattern and trends among bacterial isolates from ocular infections over a 16-year period and explore alternative antibiotics in fluoroquinolone-resistant strains. Methods In this retrospective, longitudinal study, the microbiology laboratory records of patients with different ocular infections diagnosed at an eye institute in central India from 2005-2020 were reviewed to determine the pattern of fluoroquinolone (ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin) resistance. Antibiotic susceptibility testing was done using the Kirby-Bauer disc diffusion method. Results In 725 Gram-positive bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 55.9% (95% confidence interval [CI]: 52.2 - 59.6), 42.7% (95% CI: 39.0 - 46.4), 47.6% (95% CI: 43.9 - 51.3), and 45.6% (95% CI: 41.7-49.5), respectively. In 266 Gram-negative bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 57.9% (95% CI: 51.9 - 63.9), 56.0% (95% CI: 49.7 - 62.1), 59.9% (95% CI: 53.8 - 66.0), and 74.3% (95% CI: 68.3 - 80.2), respectively. A declining trend in resistance to ciprofloxacin (P < 0.001), ofloxacin (P < 0.001), and moxifloxacin (P < 0.001) was seen in Gram-positive bacteria, whereas a reduction in resistance to only moxifloxacin (P = 0.04) was seen in Gram-negative bacteria. In fluoroquinolone-resistant Gram-positive bacteria, cefuroxime exhibited the highest susceptibility, whereas in fluoroquinolone-resistant Gram-negative bacteria, colistin exhibited the highest susceptibility. Conclusion Fluoroquinolone resistance was high among bacteria from ocular infections in central India, but a declining trend in resistance to some of the fluoroquinolones was observed in recent times. Cefuroxime and colistin emerged as alternatives in fluoroquinolone-resistant Gram-positive and Gram-negative bacterial infections, respectively.
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Affiliation(s)
- Samrat Chatterjee
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India,Correspondence to: Dr. Samrat Chatterjee, MGM Eye Institute, 5th Mile, Vidhan Sabha Road, Raipur - 493 111, Chhattisgarh, India. E-mail:
| | - Deepshikha Agrawal
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Sharad N Gomase
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | | | - Anil B Gangwe
- Vitreo-Retina Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Mihir Mishra
- Oculoplasty and Ocular Oncology Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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20
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Fortingo N, Melnyk S, Sutton SH, Watsky MA, Bollag WB. Innate Immune System Activation, Inflammation and Corneal Wound Healing. Int J Mol Sci 2022; 23:ijms232314933. [PMID: 36499260 PMCID: PMC9740891 DOI: 10.3390/ijms232314933] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Abstract
Corneal wounds resulting from injury, surgeries, or other intrusions not only cause pain, but also can predispose an individual to infection. While some inflammation may be beneficial to protect against microbial infection of wounds, the inflammatory process, if excessive, may delay corneal wound healing. An examination of the literature on the effect of inflammation on corneal wound healing suggests that manipulations that result in reductions in severe or chronic inflammation lead to better outcomes in terms of corneal clarity, thickness, and healing. However, some acute inflammation is necessary to allow efficient bacterial and fungal clearance and prevent corneal infection. This inflammation can be triggered by microbial components that activate the innate immune system through toll-like receptor (TLR) pathways. In particular, TLR2 and TLR4 activation leads to pro-inflammatory nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) activation. Similarly, endogenous molecules released from disrupted cells, known as damage-associated molecular patterns (DAMPs), can also activate TLR2, TLR4 and NFκB, with the resultant inflammation worsening the outcome of corneal wound healing. In sterile keratitis without infection, inflammation can occur though TLRs to impact corneal wound healing and reduce corneal transparency. This review demonstrates the need for acute inflammation to prevent pathogenic infiltration, while supporting the idea that a reduction in chronic and/or excessive inflammation will allow for improved wound healing.
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Affiliation(s)
- Nyemkuna Fortingo
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA 30907, USA
| | - Samuel Melnyk
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA 30907, USA
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30907, USA
| | - Sarah H. Sutton
- Department of Medical Illustration, Augusta University, Augusta, GA 30907, USA
| | - Mitchell A. Watsky
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30907, USA
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30907, USA
| | - Wendy B. Bollag
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, GA 30907, USA
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30907, USA
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30907, USA
- Charlie Norwood VA Medical Center, Augusta, GA 30904, USA
- Correspondence: ; Tel.: +61-(706)-721-0698
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21
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Abd Rashid N, Mohammed SNF, Syed Abd Halim SA, Ghafar NA, Abdul Jalil NA. Therapeutic Potential of Honey and Propolis on Ocular Disease. Pharmaceuticals (Basel) 2022; 15:1419. [PMID: 36422549 PMCID: PMC9696375 DOI: 10.3390/ph15111419] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 09/01/2023] Open
Abstract
Honey and propolis have recently become the key target of attention for treating certain diseases and promoting overall health and well-being. A high content of flavonoids and phenolic acids found in both honey and propolis contributes to the antioxidant properties to scavenge free radicals. Honey and propolis also exhibited antibacterial effects where they act in two ways, namely the production of hydrogen peroxide (H2O2) and gluconic acids following the enzymatic activities of glucose oxidase, which exerts oxidative damage on the bacteria. Additionally, the anti-inflammatory effects of honey and propolis are mainly by reducing proinflammatory factors such as interleukins and tumor necrosis factor alpha (TNF-α). Their effects on pain were discovered through modulation at a peripheral nociceptive neuron or binding to an opioid receptor in the higher center. The aforementioned properties of honey have been reported to possess potential therapeutic topical application on the exterior parts of the eyes, particularly in treating conjunctivitis, keratitis, blepharitis, and corneal injury. In contrast, most of the medicinal values of propolis are beneficial in the internal ocular area, such as the retina, optic nerve, and uvea. This review aims to update the current discoveries of honey and propolis in treating various ocular diseases, including their antioxidant, anti-inflammatory, antibacterial, and anti-nociceptive properties. In conclusion, research has shown that propolis and honey have considerable therapeutic promise for treating various eye illnesses, although the present study designs are primarily animal and in vitro studies. Therefore, there is an urgent need to translate this finding into a clinical setting.
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Affiliation(s)
- Norhashima Abd Rashid
- Department of Biomedical Science, Faculty of Applied Science, Lincoln University College, Petaling Jaya 47301, Malaysia
| | - Siti Nur Farhana Mohammed
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | | | - Norzana Abd Ghafar
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nahdia Afiifah Abdul Jalil
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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22
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Sanap SN, Agrawal S, Biswas A, Verma SK, Kumar M, Chaudhary AD, Rajput R, Bhatta RS. Simultaneous assessment of ciprofloxacin and dexamethasone in ocular tear fluid by LC-MS/MS: Application to a pharmacokinetic study in rabbits. CHINESE JOURNAL OF ANALYTICAL CHEMISTRY 2022. [DOI: 10.1016/j.cjac.2022.100197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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23
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Sanap SN, Bisen AC, Agrawal S, Biswas A, Mishra A, Kumar M, Verma SK, Chaudhary AD, Bhatta RS. Liquid chromatography‐tandem mass spectrometry method for simultaneous assessment of ofloxacin and dexamethasone in ocular biofluids: Application to ocular pharmacokinetic studies. SEPARATION SCIENCE PLUS 2022. [DOI: 10.1002/sscp.202200098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sachin Nashik Sanap
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad India
| | - Amol Chattrapati Bisen
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad India
| | - Sristi Agrawal
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad India
| | - Arpon Biswas
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad India
| | - Anjali Mishra
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad India
| | - Mukesh Kumar
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Jawaharlal Nehru University New Delhi India
| | - Sarvesh Kumar Verma
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Jawaharlal Nehru University New Delhi India
| | - Abhijit Deb Chaudhary
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Jawaharlal Nehru University New Delhi India
| | - Rabi Sankar Bhatta
- Pharmaceutics and Pharmacokinetic Division CSIR‐Central Drug Research Institute Lucknow India
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad India
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24
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Fiqri M, Alhidayah, Nirmayanti, Athiyyah U, Layadi P, Angeleve Fadjar TG, Permana AD. Enhanced localization of cefazoline sodium in the ocular tissue using thermosensitive-mucoadhesive hydrogels: Formulation development, hemocompatibility and in vivo irritation studies. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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All-small-molecule supramolecular hydrogels assembled from guanosine 5'-monophosphate disodium salt and tobramycin for the treatment of bacterial keratitis. Bioact Mater 2022; 16:293-300. [PMID: 35386321 PMCID: PMC8965694 DOI: 10.1016/j.bioactmat.2021.12.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022] Open
Abstract
Bacterial keratitis is the most common corneal infection which may lead to blindness, and seriously threatened the human visual health worldwide. Clinical treatment with antibiotic eye drops formulation usually falls in low bioavailability and poor therapeutic efficiency. Hydrogel has gained much attention as ophthalmic formulation recently due to the prolonged drug retention on ocular surface. In this study, we proposed a type of all-small-molecule supramolecular hydrogel assembled from guanosine-5′-monophosphate disodium salt and tobramycin for the treatment of bacterial keratitis. Guanosine-5′-monophosphate disodium salt assembled into guanosine-quartet nanofibers via hydrogen bonding and π-π stacking, and tobramycin with five primary amine groups further crosslinked the nanofibers bearing multiple phosphate moieties into gel networks via ionic interactions. The supramolecular gel showed shear thinning and thixotropic properties, good biocompatibility, and antibacterial activity. The gel treatment significantly ameliorated P. aeruginosa induced bacterial keratitis, and showed higher therapeutic efficacy compared to tobramycin eye drop. This study provides a facile and efficient antibiotic gel formulation for clinical treatment of bacterial keratitis. A type of all-small-molecule supramolecular hydrogel was assembled from 5′-GMP and tobramycin via ionic interactions. The prepared gel showed good transparency, thixotropic property, biocompatibility, and sustained drug release. The hydrogel showed higher therapeutic efficacy of P. aeruginosa induced bacterial keratitis compared to tobramycin eye drop.
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26
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Gupta K, Unhale R, Garner OB, Deng SX, M Fung SS. Infectious Keratitis Isolates and Susceptibility in Southern California. Cornea 2022; 41:1094-1102. [PMID: 35315617 DOI: 10.1097/ico.0000000000002884] [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: 05/01/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine longitudinal trends in prevalence and resistance profiles for infectious keratitis at referral centers in Southern California. METHODS Cultured infectious keratitis cases from January 1, 2006, through December 31, 2009, and January 1, 2016, through December 31, 2019, at the University of California, Los Angeles, were evaluated. Outcome measures included microbial isolate prevalence and antibiotic/antifungal susceptibility and resistance patterns. RESULTS One hundred thirty-nine and 315 culture-positive isolates were obtained between 2006-2009 and 2016-2019, respectively. Gram-positive organisms accounted for 65% (2006-2009) and 74% (2016-2019) of bacterial isolates ( P = 0.076). Staphylococcus infections, the most common gram-positive and bacterial isolate in both study epochs, demonstrated increased prevalence from 2006-2009 to 2016-2019 (41% vs. 53%, P = 0.019). Although coagulase-negative Staphylococcus (CoNS) increased from 40% to 58% ( P = 0.0012), the prevalence of methicillin-resistant Staphylococcus aureus was unchanged (28% vs. 28%, P = 0.99). Pseudomonas aeruginosa , the most common gram-negative organism, demonstrated decreased prevalence from 18% to 10% ( P = 0.027). Candida species comprised 3.5% of culture-positive isolates in both epochs. All gram-positive isolates were susceptible to vancomycin, and all Staphylococcus isolates were susceptible to linezolid. Pseudomonas aeruginosa remained susceptible to tested fluoroquinolones (>93%) and aminoglycosides (100%) over time. CONCLUSIONS In southern California between 2006 and 2019, there was a shift toward Staphylococcus species, with increased CoNS, decreased methicillin-sensitive Staphylococcus aureus , and decreased prevalence of P. aeruginosa . Empiric therapy of vancomycin and a fluoroquinolone or aminoglycoside provides effective antibacterial coverage for predominant bacterial species when culture sensitivities are pending.
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Affiliation(s)
- Kishan Gupta
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA
- Department of Ophthalmology, Kaiser Permanente Medical Center, Downey, CA
| | - Rutuja Unhale
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA; and
| | - Sophie X Deng
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA
- Molecular Biology Institute, University of California, Los Angeles, CA
| | - Simon S M Fung
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA
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27
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Fan W, Han H, Lu Z, Huang Y, Zhang Y, Chen Y, Zhang X, Ji J, Yao K. ε-poly-L-lysine-modified polydopamine nanoparticles for targeted photothermal therapy of drug-resistant bacterial keratitis. Bioeng Transl Med 2022; 8:e10380. [PMID: 36684079 PMCID: PMC9842021 DOI: 10.1002/btm2.10380] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/30/2022] [Accepted: 07/16/2022] [Indexed: 01/25/2023] Open
Abstract
Bacterial keratitis can lead to intraocular infection and even blindness without prompt and potent treatments. Currently, clinical abuse of antibiotics encouraged the evolution of resistant bacteria. Conventional antibiotic eye drops based keratitis treatment has been heavily restricted due to the lack of bactericidal efficiency and easy induction of bacterial resistance. Hence, developing an effective treatment strategy for bacterial keratitis is of great significance. In this work, we investigated ε-poly-l-lysine (EPL)-modified polydopamine (PDA) nanoparticles (EPL@PDA NPs)-mediated antibacterial photothermal therapy (aPTT), to cope with methicillin-resistant Staphylococcus aureus (MRSA)-induced keratitis. The surface modification of cationic peptide EPL enables EPL@PDA NPs to specifically target negatively charged MRSA and induces local hyperthermia to kill the bacteria under low ambient temperature. Under near-infrared (NIR) irradiation, the sterilization efficiency of EPL@PDA NPs suspension for MRSA in vitro was up to 99.96%. The EPL@PDA-mediated aPTT presented potent antibacterial efficacy in treating MRSA-induced keratitis with little corneal epithelial cytotoxicity and good biocompatibility. In conclusion, the bacterial-targeting aPTT platform in this work provides a prospective method for the management of MRSA-induced refractory bacterial keratitis.
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Affiliation(s)
- Wenjie Fan
- Eye Center, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China,Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China,MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and EngineeringZhejiang UniversityHangzhouPeople's Republic of China
| | - Haijie Han
- Eye Center, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China,Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China
| | - Zhouyu Lu
- Eye Center, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China,Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China
| | - Yue Huang
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and EngineeringZhejiang UniversityHangzhouPeople's Republic of China
| | - Yin Zhang
- Eye Center, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China,Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China
| | - Yaoyao Chen
- Eye Center, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China,Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China
| | - Xiaobo Zhang
- Eye Center, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China,Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education, Department of Polymer Science and EngineeringZhejiang UniversityHangzhouPeople's Republic of China
| | - Ke Yao
- Eye Center, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China,Zhejiang Provincial Key Lab of Ophthalmology, the Second Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople's Republic of China
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28
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Wang Z, Zhang P, Huang C, Guo Y, Dong X, Li X. Conjunctival sac bacterial culture of patients using levofloxacin eye drops before cataract surgery: a real-world, retrospective study. BMC Ophthalmol 2022; 22:328. [PMID: 35907940 PMCID: PMC9338605 DOI: 10.1186/s12886-022-02544-2] [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: 05/24/2021] [Accepted: 07/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background The use of antibiotics preoperatively is effective to decrease the incidence of ocular bacterial infections but may lead to high resistance rate, especially on patients with multi-risk clinical factors. This study systematically analyzed real-world data (RWD) of patients to reveal the association between clinical factors and conjunctival sac bacterial load and offer prophylaxis suggestions. Methods We retrieved RWD of patients using levofloxacin eye drops (5 mL: 24.4 mg, 4 times a day for 3 days) preoperatively. Retrieved data included information on the conjunctival sac bacterial culture, sex, presence of hypertension and diabetes mellitus (DM), and history of hospital-based surgeries. Data was analyzed using SPSS 24.0. Results RWD of 15,415 cases (patients) were retrieved. Among these patients, 5,866 (38.1%) were males and 9,549 (61.9%) females. 5,960 (38.7%) patients had a history of hypertension, and 3,493 (22.7%) patients had a history of DM. 7,555 (49.0%) patients had a history of hospital-based operations. There were 274 (1.8%) positive bacterial cultures. Male patients with hypertension and DM may be at increased risk of having positive bacterial cultures (P < 0.05). Staphylococcus epidermidis (n = 56, 20.4%), Kocuria rosea (n = 37, 13.5%), and Micrococcus luteus (n = 32, 11.7%) were the top 3 isolated strains. Most bacterial strains were resistant to various antibiotics except rifampin, and 82.5% (33 of 40 isolates) of Staphylococcus epidermidis isolates had multidrug antibiotic resistance. Numbers of culture-positive Staphylococcus epidermidis isolates in the male group and non-DM group were greater than those in the female and DM groups, respectively. Micrococcus luteus (n = 11, 8.8%) was found less frequently in non-hypertension group than in hypertension group. Conclusion Sex (Male) and the presence of hypertension and DM are risk factors for greater conjunctival sac bacterial loads. We offer a prophylactic suggestion based on the combined use of levofloxacin and rifampin. However, this approach may aggravate risk of multidrug resistance.
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Affiliation(s)
- Zhenyu Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Pei Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Chen Huang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.,Medical Research Center, Peking University Third Hospital, Beijing, China
| | - Yining Guo
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Xuhe Dong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China. .,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
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29
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Jeang L, Tuli SS. Therapy for contact lens-related ulcers. Curr Opin Ophthalmol 2022; 33:282-289. [PMID: 35779052 DOI: 10.1097/icu.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review covers the current literature and practice patterns of antimicrobial therapy for contact lens-related microbial keratitis (CLMK). Although the majority of corneal ulcers are bacterial, fungus and acanthamoeba are substantial contributors in CLMK and are harder to treat due to the lack of commercially available topical medications and low efficacy of available topical therapy. RECENT FINDINGS Topical antimicrobials remain the mainstay of therapy for corneal ulcers. Fluoroquinolones may be used as monotherapy for small, peripheral bacterial ulcers. Antibiotic resistance is a persistent problem. Fungal ulcers are less responsive to topical medications and adjunct oral or intrastromal antifungal medications may be helpful. Acanthamoeba keratitis continues to remain a therapeutic challenge but newer antifungal and antiparasitic agents may be helpful adjuncts. Other novel and innovative therapies are being studied currently and show promise. SUMMARY Contact lens-associated microbial keratitis is a significant health issue that can cause vision loss. Treatment remains a challenge but many promising diagnostics and procedures are in the pipeline and offer hope.
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Affiliation(s)
- Lauren Jeang
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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30
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Polat HK, Kurt N, Aytekin E, Bozdağ Pehlivan S, Çalış S. Novel Drug Delivery Systems to Improve the Treatment of Keratitis. J Ocul Pharmacol Ther 2022; 38:376-395. [PMID: 35763406 DOI: 10.1089/jop.2021.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Keratitis is a disease characterized by inflammation of the cornea caused by different pathogens. It can cause serious visual morbidity if not treated quickly. Depending on the pathogen causing keratitis, eye drops containing antibacterial, antifungal, or antiviral agents such as besiloxacin, moxifloxacin, ofloxacin, voriconazol, econazole, fluconazole, and acyclovir are used, and these drops need to be applied frequently due to their low bioavailability. Studies are carried out on formulations with extended residence time in the cornea and increased permeability. These formulations include various new drug delivery systems such as inserts, nanoparticles, liposomes, niosomes, cubosomes, microemulsions, in situ gels, contact lenses, nanostructured lipid carriers, carbon quantum dots, and microneedles. Ex vivo and in vivo studies with these formulations have shown that the residence time of the active substances in the cornea is prolonged, and their ocular bioavailability is increased. In addition, in vivo studies have shown that these formulations successfully treat keratitis. However, it has been observed that fluoroquinolones are used in most of the studies; similar drug delivery systems are generally preferred for antifungal drugs, and studies for viral and acanthameba keratitis are limited. There is a need for new studies on different types of keratitis and different drug active substances. At the same time, proving the efficacy of drug delivery systems, which give promising results in in vivo animal models, with clinical studies is of great importance for progress in the treatment of keratitis.
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Affiliation(s)
- Heybet Kerem Polat
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Nihat Kurt
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Eren Aytekin
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sibel Bozdağ Pehlivan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sema Çalış
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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31
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Kang Y, Tian L, Gu X, Chen Y, Ma X, Lin S, Li Z, Lou Y, Zheng M. Characterization of the Ocular Surface Microbiome in Keratitis Patients after Repeated Ophthalmic Antibiotic Exposure. Microbiol Spectr 2022; 10:e0216221. [PMID: 35293804 PMCID: PMC9045205 DOI: 10.1128/spectrum.02162-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/07/2022] [Indexed: 12/31/2022] Open
Abstract
In human medicine, antibiotics have been widely used to treat microbial infections. The extensive use of antibiotics is a leading cause of antibiotic resistance. Currently, the influence of the use of antibiotics on the ocular surface microbiome in the course of keratitis treatment remains to be explored in depth. We performed metagenomic analyses in a cohort of 26 healthy controls (HCs), 28 keratitis patients (KPs) who received antibiotics [KP (abx+) group], and 12 KPs who were antibiotic naive [KP (abx-) group]. We identified that the dissimilarities in microbial community structure (Bray-Curtis and Jaccard analyses) between the KP (abx+) group and the HC group were greater than those between the KP (abx-) group and the HC group. Pseudomonas lactis, P. aeruginosa, Pseudomonas sp. FDAARGOS_380, Pseudomonas sp. J380, Corynebacterium simulans, Streptococcus pyogenes, Finegoldia magna, and Aspergillus oryzae had no statistically significant differences between the KP (abx+) and KP (abx-) groups but did have statistically significant differences between the KP (abx+) and HC groups and between the KP (abx-) and HC groups. Among them, Pseudomonas lactis, P. aeruginosa, Pseudomonas sp. FDAARGOS_380, and Pseudomonas sp. J380 were identified as possible hosts carrying multidrug-resistant genes. The total abundance and number of antibiotic resistance genes (ARGs) were greater in the KP (abx+) group than in the HC and KP (abx-) groups. The functional profile analysis of ocular surface microbiota revealed that pathogenesis-related functional pathways and virulence functions were enriched in KPs. In conclusion, our results show that empirical antibiotic treatment in KPs leads to increases in the antibiotic resistance of ocular surface microbiota. IMPORTANCE Treatment for keratitis is based on appropriate antimicrobial therapy. A direct correlation between antibiotic use and the extent of antibiotic resistance has been reported. Therefore, knowledge of the antibiotic resistance patterns of ocular surface microbial flora in KPs is important for clinical treatment. To the best of our knowledge, this is the first study to use metagenomic approaches to investigate the associations between ophthalmic antibiotic use and the ocular surface microbiome of KPs. Monitoring the microbiota and antibiotic resistome profiles for the ocular surface has huge potential to help ophthalmologists choose the appropriate antibiotics and will thereby improve the efficacy of treatment regimens, which has important implications for reducing the development of antibiotic resistance of the ocular surface to a certain extent.
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Affiliation(s)
- Yutong Kang
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Leihao Tian
- Optometry and Eye Hospital and School of Ophthalmology, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaobin Gu
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiju Chen
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xueli Ma
- Optometry and Eye Hospital and School of Ophthalmology, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shudan Lin
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenjun Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongliang Lou
- Wenzhou Key Laboratory of Sanitary Microbiology, Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meiqin Zheng
- Optometry and Eye Hospital and School of Ophthalmology, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, China
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32
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Sahoo S, Alluri H, Mitra S, Priyadarshini S, Sahu SK, Mohanty A, Das S. Multidrug-resistant keratitis: challenging yet manageable. Br J Ophthalmol 2022; 107:769-773. [DOI: 10.1136/bjophthalmol-2021-320203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/21/2021] [Indexed: 11/03/2022]
Abstract
PurposeTo study the incidence, clinical features and outcomes of multidrug-resistant (MDR) bacterial keratitis.MethodsAll cases of MDR-bacterial keratitis presenting to our institute over a period of 2 years were retrospectively analysed. Details of risk factors, size and depth of infiltrate, treatment, and outcome were noted. Antibiotic susceptibility tests were done on the ocular isolates from the culture of samples obtained from ocular infections, and resistance or sensitivity of the organisms to the commonly used antibiotics was studied.ResultsForty patients were diagnosed with MDR-bacterial keratitis in the study period. The mean age of patients was 50.9±25.4 years. Most common risk factors were vegetative trauma (n=12, 30.0%), followed by corneal transplantation (n=7, 17.5%) and systemic comorbidities (n=7, 17.5%). Infiltrate was small (<6 mm) in 22 (55%) and large (>6 mm) in 18 (45%) patients. It involved the superficial, mid and deep stroma in 11 (27.5%), 9 (22.5%) and 15 (37.5%) cases, respectively. Gram-negative bacilli (n=18, 45%) were the maximum, among which Pseudomonas aeruginosa (15%) was the most common. Resistance to 3 (n=17, 42.5%) and 4 (n=17, 42.5%) classes of antibiotics was the most commonly observed. One (2.5%) patient showed resistance to all seven classes of drugs tested. Complete resolution of infection was seen in 15 (37.5%) MDR patients on medical management alone. Five (12.5%) patients underwent therapeutic penetrating keratoplasty. Size of the infiltrate was found to have a significant correlation with the outcome (p=0.002).ConclusionMDR keratitis, despite being a challenge to treat, can be successfully managed by medical therapy alone, if appropriate therapy is started early in the clinical course.
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Bor’i A, El-Haig WM. Combined Photoactivated Chromophore for Infectious Keratitis-Corneal Collagen Cross-Linking (PACK-CXL) and Therapeutic Penetrating Keratoplasty for Resistant Bacterial Keratitis. Clin Ophthalmol 2022; 16:273-279. [PMID: 35140457 PMCID: PMC8820449 DOI: 10.2147/opth.s348835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/16/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Ashraf Bor’i
- Ophthalmology Department, Zagazig University, Zagazig, Sharkia, Egypt
- Alfat’h Eye Hospital, Zagazig, Sharkia, Egypt
- Correspondence: Ashraf Bor’i, Ophthalmology Department, Zagazig University, PO Box 44286, Zagazig, Sharkia, Egypt, Tel +20 1065338080, Email
| | - Wael M El-Haig
- Ophthalmology Department, Zagazig University, Zagazig, Sharkia, Egypt
- Alfat’h Eye Hospital, Zagazig, Sharkia, Egypt
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de Paiva ADCM, Ferreira MDC, da Fonseca ADS. Photodynamic therapy for treatment of bacterial keratitis. Photodiagnosis Photodyn Ther 2022; 37:102717. [PMID: 35021106 DOI: 10.1016/j.pdpdt.2022.102717] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 12/22/2022]
Abstract
Microbial keratitis is the main cause of corneal opacification and the fourth leading cause of blindness worldwide, with bacteria the major infectious agent. Recently, bacterial keratitis has become a serious threat due to routine use of antibiotics leading to selection of resistant and multidrug-resistant bacteria strains. New approaches for treatment of bacterial keratitis are necessary to outcome the increasing antibiotic resistance. Antimicrobial photodynamic therapy is based on three agents: photosensitizer, oxygen, and light radiation. This therapy has been successful for treatment of infections in different tissues and organs as well as against different type of infectious agents and no resistance development. Also, new photosensitizers are being developed that has increased the spectrum of therapeutic protocols for treatment of a number of infectious diseases. Thus, antimicrobial photodynamic therapy has an extraordinary potential for treatment of those bacterial keratitis cases that actually are not solved by traditional antibiotic therapy.
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Affiliation(s)
- Alexandre de Carvalho Mendes de Paiva
- Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros, 775, Maracanã, Rio de Janeiro 20270002, Brazil
| | - Michelle da Costa Ferreira
- Faculdade de Odontologia, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 157, Vila Isabel, Rio de Janeiro 20551030, Brazil
| | - Adenilson de Souza da Fonseca
- Departamento de Ciências Fisiológicas, Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rua Frei Caneca, 94, Rio de Janeiro 20211040, Brazil; Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 87 fundos, 4º andar, Vila Isabel, Rio de Janeiro 20551030, Brazil; Centro de Ciências da Saúde, Centro Universitário Serra dos Órgãos, Avenida Alberto Torres, 111, Teresópolis, Rio de Janeiro 25964004, Brazil.
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Solulan C24- and Bile Salts-Modified Niosomes for New Ciprofloxacin Mannich Base for Combatting Pseudomonas-Infected Corneal Ulcer in Rabbits. Pharmaceuticals (Basel) 2021; 15:ph15010044. [PMID: 35056101 PMCID: PMC8777637 DOI: 10.3390/ph15010044] [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: 11/30/2021] [Revised: 12/25/2021] [Accepted: 12/26/2021] [Indexed: 11/26/2022] Open
Abstract
Keratitis is a global health issue that claims the eye sight of millions of people every year. Dry eye, contact lens wearing and refractive surgeries are among the most common causes. The resistance rate among fluoroquinolone antibiotics is >30%. This study aims at formulating a newly synthesized ciprofloxacin derivative (2b) niosomes and Solulan C24-, sodium cholate- and deoxycholate-modified niosomes. The prepared niosomal dispersions were characterized macroscopically and microscopically (SEM) and by percentage entrapment efficiency, in vitro release and drug release kinetics. While the inclusion of Solulan C24 produced something discoidal-shaped with a larger diameter, both cholate and deoxycholate were unsuccessful in forming niosomes dispersions. Conventional niosomes and discomes (Solulan C24-modified niosomes) were selected for further investigation. A corneal ulcer model inoculated with colonies of Pseudomonas aeruginosa in rabbits was developed to evaluate the effectiveness of keratitis treatment of the 2b-loaded niosomes and 2b-loaded discomes compared with Ciprocin® (ciprofloxacin) eye drops and control 2b suspension. The histological documentation and assessment of gene expression of the inflammatory markers (IL-6, IL1B, TNFα and NF-κB) indicated that both 2b niosomes and discomes were superior treatments and can be formulated at physiological pH 7.4 compatible with the ocular surface, compared to both 2b suspension and Ciprocin® eye drops.
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Sebbag L, Broadbent VL, Kenne DE, Perrin AL, Mochel JP. Albumin in Tears Modulates Bacterial Susceptibility to Topical Antibiotics in Ophthalmology. Front Med (Lausanne) 2021; 8:663212. [PMID: 34917625 PMCID: PMC8669104 DOI: 10.3389/fmed.2021.663212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/02/2021] [Indexed: 01/12/2023] Open
Abstract
Bacterial keratitis is a serious and vision-threatening condition in veterinary and human patients, one that often requires culture and susceptibility testing to adjust therapy and improve clinical outcomes. The present study challenges the antimicrobial susceptibility testing (AST) paradigm in ophthalmology, enabling more accurate in vitro-to-in vivo translation by incorporating factors normally present during host-pathogen interactions in clinical patients. Thirty bacteria (10 Staphylococcus pseudintermedius, 10 Streptococcus canis, 10 Pseudomonas aeruginosa) were isolated from canine patients with infectious keratitis. For each isolate, commercial plates (Sensititre™ JOEYE2) were used to assess the minimal inhibitory concentration (MIC) of 17 different antibiotics in the absence (0% albumin, control) or presence of canine albumin (0.01–2%). For Staphylococcus pseudintermedius, the experiment was repeated with actual tear fluid collected from canine eyes with ocular surface inflammation. Kruskal-Wallis, Wilcoxon signed rank test and Spearman's correlation tests were used for statistical analysis. Clinical outcomes were unfavorable in selected canine patients with bacterial keratitis (e.g., globe perforation, graft dehiscence) despite standard AST (i.e., 0% albumin in test medium) confirming that most corneal infections (93%) were susceptible to ≥1 topical antibiotics used at the initial visit. Albumin levels ≥0.05% increased MICs in a dose-dependent, bacteria-specific, and antibiotic-specific manner. No significant differences (P = 1.000) were noted in MICs of any antibiotic whether albumin or tear fluid was added to the Mueller-Hinton broth. Percent protein binding inherent to each antibiotic was associated with clinical interpretations (Spearman's rho = −0.53, P = 0.034) but not changes in MICs. Albumin in tears impacted the efficacy of selected ophthalmic antibiotics as only the unbound portion of an antibiotic is microbiologically active. The present findings could improve decision making of clinicians managing bacterial keratitis, reduce development of antimicrobial resistance, influence current guidelines set by the Clinical and Laboratory Standards Institute, and serve as a reference for bacteriological evaluations across medical fields and across species.
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Affiliation(s)
- Lionel Sebbag
- Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel.,Department of Biomedical Sciences, SMART Pharmacology, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Victoria L Broadbent
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Danielle E Kenne
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Ashtyn L Perrin
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Jonathan P Mochel
- Department of Biomedical Sciences, SMART Pharmacology, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
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Xu S, Guo D, Liu X, Jin X, Shi Y, Wang Y, Zhang N, Zhang H. Ocular pathogens and antibiotic resistance in microbial keratitis over three years in Harbin, Northeast China. Acta Ophthalmol 2021; 99:909-915. [PMID: 33565253 PMCID: PMC9542897 DOI: 10.1111/aos.14789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/18/2020] [Accepted: 01/18/2021] [Indexed: 01/06/2023]
Abstract
Purpose Understanding the spectrum of ocular pathogens in a given geographic region is important for devising appropriate practical treatment. Therefore, we examined the pathogen spectrum and antibiotic resistance of microbial keratitis in northeast China. Methods In this retrospective observational study, we reviewed the microbiology laboratory records of patients diagnosed with microbial keratitis in a tertiary eye hospital in Harbin, northeast China, between 2017 and 2019, and analysed the pathogen spectrum and antibiotic susceptibility. Results We collected 462 specimens, of which 282 exhibited positive cultures. Among these cultures, 257 were bacterial and 25 were fungal. Of the 257 bacterial isolates, 214 (83.27%) were gram positive whereas 43 (16.73%) were gram negative. The most prevalent gram‐positive pathogen was coagulase‐negative staphylococcus (CoNS; 58.37%), followed by Staphylococcus aureus (S. aureus; 20.62%) and Streptococcus pneumoniae (2.33%). Of the gram‐negative bacterial isolates, 10 were Pseudomonas aeruginosa (3.89%). The most frequently detected ocular pathogens from fungal isolates were Fusarium species (40%). We also found more culture‐positive cases of bacterial keratitis in summer. Overall, 16.98% S. aureus and 64.00% CoNS isolates were methicillin resistant. These methicillin‐resistant bacteria were also more likely to be resistant to other antibiotics, with multidrug resistance found in 77.78% methicillin‐resistant S. aureus and 90.63% methicillin‐resistant CoNS. However, all gram‐positive isolates were sensitive to vancomycin and linezolid. Conclusion Coagulase‐negative staphylococcus are the most common ocular pathogens in northeast China. We also show the prevalence of methicillin resistance and concurrent multidrug resistance among staphylococcal isolates. Monitoring the patterns of antimicrobial resistance could help in the management selection.
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Affiliation(s)
- Shuo Xu
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Dawen Guo
- Department of Clinical Laboratory The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Xintian Liu
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Xin Jin
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Yan Shi
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Yingbin Wang
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Nan Zhang
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
| | - Hong Zhang
- Department of Ophthalmology The First Affiliated Hospital of Harbin Medical University Harbin Heilongjiang Province People's Republic of China
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Yang X, Sun X, Liu J, Huang Y, Peng Y, Xu Y, Ren L. Photo-crosslinked GelMA/collagen membrane loaded with lysozyme as an antibacterial corneal implant. Int J Biol Macromol 2021; 191:1006-1016. [PMID: 34592226 DOI: 10.1016/j.ijbiomac.2021.09.144] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/07/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
Corneal transplantation is an effective treatment for corneal blindness. However, it brings risk factors for the occurrence of bacterial keratitis, which can affect the repair effect and even lead to transplantation failure. The difficulty in re-epithelialization is also a main problem faced by corneal transplantation. Herein, a collagen-GelMA composite membrane containing lysozyme (CGL) was developed as an antibacterial corneal implant to fill stromal defect and support re-epithelialization. Characterizations of physicochemical properties and in vitro biocompatibility revealed that the composite membranes have proper water content, light transmittance and mechanical strength as well as good biocompatibility. Particularly, the cell adhesion force and adhesion-related genes expression were evaluated and exhibited an improvement after the addition of GelMA. Furthermore, the formed CGL membrane could continuously release lysozyme and exhibited a bactericidal rate of 96% and 64% after 2 h and 72 h, respectively. The results demonstrated that this CGL membrane has promising application in corneal repair.
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Affiliation(s)
- Xiangjing Yang
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, PR China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, PR China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, PR China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, PR China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, PR China
| | - Xiaomin Sun
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, PR China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, PR China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, PR China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, PR China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, PR China
| | - Jia Liu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, PR China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, PR China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, PR China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, PR China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, PR China
| | - Yongrui Huang
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, PR China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, PR China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, PR China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, PR China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, PR China
| | - Yuehai Peng
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, PR China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, PR China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, PR China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, PR China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, PR China
| | - Yingni Xu
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, PR China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, PR China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, PR China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, PR China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, PR China
| | - Li Ren
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510006, PR China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, PR China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou 510006, PR China; Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, PR China; Innovation Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou 510006, PR China; Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou 510005, PR China.
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Siddiqui R, Shah RA, Akbar N, Khamis M, Ibrahim T, Abouleish MY, Khan NA. Antibacterial effects of octadecyl trimethylammonium micelle-clay complex against bacterial eye pathogens: potential as a contact lens disinfectant. Int Ophthalmol 2021; 42:939-944. [PMID: 34611769 DOI: 10.1007/s10792-021-02075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
AIM In this study, we utilized a micelle-clay complex composed of the surfactant octadecyltrimethylammonium bromide and montmorillonite clay and evaluated its antibacterial effects. METHODS Using Pseudomonas aeruginosa, Staphylococcus epidermidis, and Micrococcus luteus, bactericidal assays were performed to determine the effects of ODTMA-clay complex on the viability of bacterial pathogen at various doses and different intervals of time. Cytotoxicity assays were performed to investigate ODTMA-clay complex effects on human cells, as determined by release of intracellular lactate dehydrogenase. RESULTS The results revealed that ODTMA-clay complex abolished bacterial viability at 100 μg/mL within 45 min against P. aeruginosa, S. epidermidis, and M. luteus. Cytotoxicity assays revealed that ODTMA-clay complex exhibited minimal toxicity of the human cells. CONCLUSION Rapid and potent antibacterial effects of ODTMA micelle-clay complex were observed in vitro; however, research is needed to determine precise formulation of contact lens disinfectants comprising ODTMA micelle-clay complex. Additionally, studies should be conducted using in vivo models of keratitis, progressing to pre-clinical and clinical trials. ODTMA micelle-clay complex is an ideal candidate to be incorporated in a novel contact lens disinfectant given the cost-effectiveness and ease of application and can be incorporated as an effective preventative strategy.
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Affiliation(s)
- Ruqaiyyah Siddiqui
- College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Rida Arshad Shah
- College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Noor Akbar
- College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Mustafa Khamis
- College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Taleb Ibrahim
- Department of Chemical Engineering, College of Engineering, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Mohamed Yehia Abouleish
- College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University of Sharjah, PO Box 27272, University City, Sharjah, United Arab Emirates.
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Jadi PK, Sharma P, Bhogapurapu B, Roy S. Alternative Therapeutic Interventions: Antimicrobial Peptides and Small Molecules to Treat Microbial Keratitis. Front Chem 2021; 9:694998. [PMID: 34458234 PMCID: PMC8386189 DOI: 10.3389/fchem.2021.694998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023] Open
Abstract
Microbial keratitis is a leading cause of blindness worldwide and results in unilateral vision loss in an estimated 2 million people per year. Bacteria and fungus are two main etiological agents that cause corneal ulcers. Although antibiotics and antifungals are commonly used to treat corneal infections, a clear trend with increasing resistance to these antimicrobials is emerging at rapid pace. Extensive research has been carried out to determine alternative therapeutic interventions, and antimicrobial peptides (AMPs) are increasingly recognized for their clinical potential in treating infections. Small molecules targeted against virulence factors of the pathogens and natural compounds are also explored to meet the challenges and growing demand for therapeutic agents. Here we review the potential of AMPs, small molecules, and natural compounds as alternative therapeutic interventions for the treatment of corneal infections to combat antimicrobial resistance. Additionally, we have also discussed about the different formats of drug delivery systems for optimal administration of drugs to treat microbial keratitis.
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Affiliation(s)
- Praveen Kumar Jadi
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Prerana Sharma
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
- Department of Animal Sciences, University of Hyderabad, Hyderabad, India
| | - Bharathi Bhogapurapu
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Sanhita Roy
- Prof, Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
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Duan X, Pan Y, Cai Z, Liu Y, Zhang Y, Liu M, Liu Y, Wang K, Zhang L, Yang L. rpoS-mutation variants are selected in Pseudomonas aeruginosa biofilms under imipenem pressure. Cell Biosci 2021; 11:138. [PMID: 34289907 PMCID: PMC8293535 DOI: 10.1186/s13578-021-00655-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background Pseudomonas aeruginosa is a notorious opportunistic pathogen causing various types of biofilm-related infections. Biofilm formation is a unique microbial strategy that allows P. aeruginosa to survive adverse conditions such as antibiotic treatment and human immune clearance. Results In this study, we experimentally evolved P. aeruginosa PAO1 biofilms for cyclic treatment in the presence of high dose of imipenem, and enriched hyperbiofilm mutants within six cycles in two independent lineages. The competition assay showed that the evolved hyperbiofilm mutants can outcompete the ancestral strain within biofilms but not in planktonic cultures. Whole-genome sequencing analysis revealed the hyperbiofilm phenotype is caused by point mutations in rpoS gene in all independently evolved mutants and the same mutation was found in P. aeruginosa clinical isolates. We further showed that mutation in rpoS gene increased the intracellular c-di-GMP level by turning on the expression of the diguanylate cyclases. Mutation in rpoS increased pyocyanin production and virulence in hyperbiofilm variants. Conclusion Here, our study revealed that antibiotic treatment of biofilm-related P. aeruginosa infections might induce a hyperbiofilm phenotype via rpoS mutation, which might partially explain antimicrobial treatment failure of many P. aeruginosa biofilm-related infections. Supplementary Information The online version contains supplementary material available at 10.1186/s13578-021-00655-9.
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Affiliation(s)
- Xiangke Duan
- Guangdong Province Key Laboratory of Microbial Signals and Disease Control, Integrative Microbiology Research Center, South China Agricultural University, Guangzhou, 510642, Guangdong, People's Republic of China.,School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Yanrong Pan
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Zhao Cai
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Yumei Liu
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Yingdan Zhang
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Moxiao Liu
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Yang Liu
- Southern University of Science and Technology Hospital, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Ke Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China
| | - Lianhui Zhang
- Guangdong Province Key Laboratory of Microbial Signals and Disease Control, Integrative Microbiology Research Center, South China Agricultural University, Guangzhou, 510642, Guangdong, People's Republic of China.
| | - Liang Yang
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, People's Republic of China.,Shenzhen Key Laboratory for Gene Regulation and Systems Biology, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, People's Republic of China
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Enzor R, Bowers EM, Perzia B, Perera C, Palazzolo L, Mammen A, Dhaliwal DK, Kowalski RP, Jhanji V. Comparison of Clinical Features and Treatment Outcomes of Pseudomonas aeruginosa Keratitis in Contact Lens and Non-Contact Lens Wearers. Am J Ophthalmol 2021; 227:1-11. [PMID: 33657419 DOI: 10.1016/j.ajo.2021.02.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the outcomes of Pseudomonas aeruginosa keratitis (PAK) in contact lens wearers (CLWs) and non-contact lens wearers (non-CLWs) and identify risk factors for poor visual acuity (VA) outcomes in each group. DESIGN Retrospective cohort study METHODS: Two hundred fourteen consecutive cases of PAK were included between January 2006 and December 2019. Clinical features, microbiologic results, and treatment course were compared between CLW and non-CLW groups. Analyses of clinical features predicting poor final VA were performed. RESULTS This study identified 214 infected eyes in 207 patients with PAK, including 163 eyes (76.2%) in CLWs and 51 eyes (23.8%) in non-CLWs. The average age was 39.2 years in CLWs and 71.9 years in non-CLWs (P < .0001). The average logMAR visual acuity (VA) at presentation was 1.39 in CLWs and 2.17 in non-CLWs (P < .0001); average final VA was 0.76 in CLWs and 1.82 in non-CLWs (P < .0001). Stromal necrosis required a procedural or surgical intervention in 13.5% of CLWs and 49.0% of non-CLWs (P < .0001). A machine learning-based analysis yielded a list of clinical features that most strongly predict a poor VA outcome (worse than 20/40), including worse initial VA, older age, larger size of infiltrate or epithelial defect at presentation, and greater maximal depth of stromal necrosis. CONCLUSIONS Non-CLWs have significantly worse VA outcomes and required a higher rate of surgical intervention, compared with CLWs. Our study elucidates risk factors for poor visual outcomes in non-CLWs with PAK.
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Pattem J, Swift T, Rimmer S, Holmes T, MacNeil S, Shepherd J. Development of a novel micro-bead force spectroscopy approach to measure the ability of a thermo-active polymer to remove bacteria from a corneal model. Sci Rep 2021; 11:13697. [PMID: 34211063 PMCID: PMC8249514 DOI: 10.1038/s41598-021-93172-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023] Open
Abstract
Microbial keratitis occurs from the infection of the cornea by fungi and or bacteria. It remains one of the most common global causes of irreversible blindness accounting for 3.5% (36 million) of blind people as of 2015. This paper looks at the use of a bacteria binding polymer designed to bind Staphylococcus aureus and remove it from the corneal surface. Mechanical unbinding measurements were used to probe the interactions of a thermo-active bacteria-binding polymer, highly-branched poly(N-isopropyl acrylamide), functionalised with modified vancomycin end groups (HB-PNIPAM-Van) to bacteria placed on rabbit corneal surfaces studied ex-vivo. This was conducted during sequential temperature phase transitions of HB-PNIPAM-Van-S. aureus below, above and below the lower critical solution temperature (LCST) in 3 stages, in-vitro, using a novel micro-bead force spectroscopy (MBFS) approach via atomic force microscopy (AFM). The effect of temperature on the functionality of HB-PNIPAM-Van-S. aureus showed that the polymer-bacteria complex reduced the work done in removing bacterial aggregates at T > LCST (p < 0.05), exhibiting reversibility at T < LCST (p < 0.05). At T < LCST, the breaking force, number of unbinding events, percentage fitted segments in the short and long range, and the percentage of unbinding events occurring in the long range (> 2.5 µm) increased (p < 0.05). Furthermore, the LCST phase transition temperature showed 100 × more unbinding events in the long-range z-length (> 2.5 µm) compared to S. aureus aggregates only. Here, we present the first study using AFM to assess the reversible mechanical impact of a thermo-active polymer-binding bacteria on a natural corneal surface.
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Affiliation(s)
- J Pattem
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK. .,National Centre for Molecular Hydrodynamics, and, Soft Matter Biomaterials and Bio-Interfaces, University of Nottingham, The Limes Building, Sutton Bonington Campus, Sutton Bonington, Leicestershire, LE12 5RD, UK.
| | - T Swift
- Polymer and Biomaterials Chemistry Laboratories, School of Chemistry and Biosciences, University of Bradford, Bradford, UK
| | - S Rimmer
- Polymer and Biomaterials Chemistry Laboratories, School of Chemistry and Biosciences, University of Bradford, Bradford, UK
| | - T Holmes
- Department of Oncology and Metabolism, School of Medicine, University of Sheffield, Sheffield, UK
| | - S MacNeil
- Department of Materials Science and Engineering, Faculty of Engineering, University of Sheffield, Sheffield, UK
| | - J Shepherd
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Nasef MH, El Emam SY, Sharaf AF, Allam WA. Adjunctive Green Thermal Laser Photocoagulation for Treatment of Resistant Infectious Keratitis. Clin Ophthalmol 2021; 15:2447-2453. [PMID: 34163128 PMCID: PMC8215689 DOI: 10.2147/opth.s312674] [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: 03/26/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the safety and efficacy of green thermal laser as an adjunctive therapy for the treatment of resistant infectious keratitis (IK) in the Delta region of Egypt. Methods A retrospective case series of 150 patients, within a 4 year duration, with resistant IK, who failed to respond to specific medical treatment alone for 7 days, were included. They all received green thermal laser photocoagulation treatment to the cornea as an adjunctive to medical treatment. Results Forty-eight women and 102 men were included in this study with a mean age of 46.2 ± 7.7 years. Common risk factors associated with IK included trauma by material of plant origin and contact lens wear. The mean duration of healing was 2.87 ± 0.7 weeks. A single session of green thermal laser application was adequate in 138 IK cases (92%), while 12 cases (8%) required an additional session a week later. Supplementary amniotic membrane transplantation (AMT) was required in 26 cases (17.3%). Two patients (1.3%) required tectonic keratoplasty for corneal perforation. The final corrected distance visual acuity (CDVA) was counting fingers (CF) or better in 78 patients (52%). No decrease of CDVA was reported throughout the study. Conclusion Green thermal laser is a safe and effective adjunctive therapy for the treatment of resistant infectious keratitis.
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Affiliation(s)
- Mohamed H Nasef
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sharif Y El Emam
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr F Sharaf
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Waleed A Allam
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Nguyen DD, Lue SJ, Lai JY. Tailoring therapeutic properties of silver nanoparticles for effective bacterial keratitis treatment. Colloids Surf B Biointerfaces 2021; 205:111856. [PMID: 34022702 DOI: 10.1016/j.colsurfb.2021.111856] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/17/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
The formulation of nanoparticles with intrinsically therapeutic properties in a tailorable and appropriate manner is critical in nanomedicine for effective treatments of infectious diseases. Here, we present a biomedical strategy to formulate silver nanoparticles (AgNPs) as intrinsically therapeutic agents for the treatment of Staphylococcus aureus (S. aureus) keratitis. Specifically, AgNPs are controllably obtained as spheres, wrapped with a biopolymer, and varied in sizes. in vitro and in vivo studies indicate that biological interactions between the AgNPs and corneal keratocytes, S. aureus bacteria, and blood vessels are strongly determined by the particle sizes. As the size increased from 3.3 ± 0.7 to 37.2 ± 5.3 nm, the AgNPs exhibit better ocular biocompatibility and stronger antiangiogenic activity, but poorer bactericidal performance. In a rabbit model of S. Aureus-induced keratitis, intrastromal injection of AgNP formulations (single dose) show substantial influences of particle size on the treatment efficacy. As the trade-off, AgNPs with medium size of 15.0 ± 3.6 nm reveal as the best therapeutic agent that could offer ∼5.6 and ∼9.1-fold greater corneal thickness recovery respectively compared to those with smaller and larger sizes at 3 days post-administration. These findings suggest an important advance in structural design for formulating intrinsically therapeutic nano-agents toward the efficient management of infectious diseases.
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Affiliation(s)
- Duc Dung Nguyen
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Shingjiang Jessie Lue
- Department of Chemical and Materials Engineering, Chang Gung University, Taoyuan, 33302, Taiwan; Division of Joint Reconstruction, Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, 33305, Taiwan; Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, 24301, Taiwan
| | - Jui-Yang Lai
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, 33302, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taoyuan, 33305, Taiwan; Department of Materials Engineering, Ming Chi University of Technology, New Taipei City, 24301, Taiwan; Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, 33303, Taiwan.
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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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Tummanapalli SS, Willcox MD. Antimicrobial resistance of ocular microbes and the role of antimicrobial peptides. Clin Exp Optom 2021; 104:295-307. [PMID: 32924208 DOI: 10.1111/cxo.13125] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Isolation of antimicrobial-resistant microbes from ocular infections may be becoming more frequent. Infections caused by these microbes can be difficult to treat and lead to poor outcomes. However, new therapies are being developed which may help improve clinical outcomes. This review examines recent reports on the isolation of antibiotic-resistant microbes from ocular infections. In addition, an overview of the development of some new antibiotic therapies is given. The recent literature regarding antibiotic use and resistance, isolation of antibiotic-resistant microbes from ocular infections and the development of potential new antibiotics that can be used to treat these infections was reviewed. Ocular microbial infections are a global public health issue as they can result in vision loss which compromises quality of life. Approximately 70 per cent of ocular infections are caused by bacteria including Chlamydia trachomatis, Staphylococcus aureus, and Pseudomonas aeruginosa and fungi such as Candida albicans, Aspergillus spp. and Fusarium spp. Resistance to first-line antibiotics such as fluoroquinolones and azoles has increased, with resistance of S. aureus isolates from the USA to fluoroquinolones reaching 32 per cent of isolates and 35 per cent being methicillin-resistant (MRSA). Lower levels of MRSA (seven per cent) were isolated by an Australian study. Antimicrobial peptides, which are broad-spectrum alternatives to antibiotics, have been tested as possible new drugs. Several have shown promise in animal models of keratitis, especially treating P. aeruginosa, S. aureus or C. albicans infections. Reports of increasing resistance of ocular isolates to mainstay antibiotics are a concern, and there is evidence that for ocular surface disease this resistance translates into worse clinical outcomes. New antibiotics are being developed, but not by large pharmaceutical companies and mostly in university research laboratories and smaller biotech companies. Antimicrobial peptides show promise in treating keratitis.
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Affiliation(s)
| | - Mark Dp Willcox
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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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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Ranjith K, Sharma S, Shivaji S. Microbes of the human eye: Microbiome, antimicrobial resistance and biofilm formation. Exp Eye Res 2021; 205:108476. [PMID: 33549582 DOI: 10.1016/j.exer.2021.108476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The review focuses on the bacteria associated with the human eye using the dual approach of detecting cultivable bacteria and the total microbiome using next generation sequencing. The purpose of this review was to highlight the connection between antimicrobial resistance and biofilm formation in ocular bacteria. METHODS Pubmed was used as the source to catalogue culturable bacteria and ocular microbiomes associated with the normal eyes and those with ocular diseases, to ascertain the emergence of anti-microbial resistance with special reference to biofilm formation. RESULTS This review highlights the genetic strategies used by microorganisms to evade the lethal effects of anti-microbial agents by tracing the connections between candidate genes and biofilm formation. CONCLUSION The eye has its own microbiome which needs to be extensively studied under different physiological conditions; data on eye microbiomes of people from different ethnicities, geographical regions etc. are also needed to understand how these microbiomes affect ocular health.
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Affiliation(s)
- Konduri Ranjith
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
| | - Sisinthy Shivaji
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
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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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