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Pirvulescu RA, Vasile VA, Romanitan MO, Zemba M, Ciulei OC, Geamanu A, Anton N, Popa Cherecheanu M. Odontogenic Orbital Cellulitis at the Crossroads of Surgeries: Multidisciplinary Management and Review. Diagnostics (Basel) 2024; 14:1391. [PMID: 39001281 PMCID: PMC11241383 DOI: 10.3390/diagnostics14131391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
This article examines two cases of odontogenic orbital cellulitis, highlighting the complexities and interdisciplinary approaches required for effective management. We present two cases and describe the clinical challenges and treatment strategies employed. We report the diagnosis, treatment, and follow-up of patients who developed orbital cellulitis as a complication of an odontogenic infection. Our objective is to report and discuss the clinical aspects and management of this pathology compared to those observed in the literature. This study underscores the necessity for collaboration among various specialties, including ophthalmology, otolaryngology, oral surgery, radiology, and infectious disease, to address the multifaceted challenges posed by this condition. Effective management of orbital abscesses of odontogenic origin requires a timely and multidisciplinary approach for successful outcomes. This article emphasizes the importance of early diagnosis and coordinated care to prevent serious complications, such as vision loss or intracranial infections.
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Affiliation(s)
- Ruxandra A. Pirvulescu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Victor A. Vasile
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, 050098 Bucharest, Romania
| | - Mihaela O. Romanitan
- Department for Emergency Internal Medicine and Neurology, Stockholm South General Hospital, 11883 Stockholm, Sweden
| | - Mihail Zemba
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Oana C. Ciulei
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, 75013 Paris, France
- Department of Radiology, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Aida Geamanu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Nicoleta Anton
- Department of Ophthalmology, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Matei Popa Cherecheanu
- Cardiovascular Surgery Department, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
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Ahmad Z, Singh S, Lee TJ, Sharma A, Lydic TA, Giri S, Kumar A. Untargeted and temporal analysis of retinal lipidome in bacterial endophthalmitis. Prostaglandins Other Lipid Mediat 2024; 171:106806. [PMID: 38185280 PMCID: PMC10939753 DOI: 10.1016/j.prostaglandins.2023.106806] [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: 06/09/2023] [Revised: 11/22/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
Bacterial endophthalmitis is a blinding infectious disease typically acquired during ocular surgery. We previously reported significant alterations in retinal metabolism during Staphylococcus (S) aureus endophthalmitis. However, the changes in retinal lipid composition during endophthalmitis are unknown. Here, using a mouse model of S. aureus endophthalmitis and an untargeted lipidomic approach, we comprehensively analyzed temporal alterations in total lipids and oxylipin in retina. Our data showed a time-dependent increase in the levels of lipid classes, sphingolipids, glycerolipids, sterols, and non-esterified fatty acids, whereas levels of phospholipids decreased. Among lipid subclasses, phosphatidylcholine decreased over time. The oxylipin analysis revealed increased prostaglandin-E2, hydroxyeicosatetraenoic acids, docosahexaenoic acid, eicosapentaenoic acid, and α-linolenic acid. In-vitro studies using mouse bone marrow-derived macrophages showed increased lipid droplets and lipid-peroxide formation in response to S. aureus infection. Collectively, these findings suggest that S. aureus-infection alters the retinal lipid profile, which may contribute to the pathogenesis of bacterial endophthalmitis.
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Affiliation(s)
- Zeeshan Ahmad
- Department of Ophthalmology, Visual and Anatomical Sciences/ Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Sukhvinder Singh
- Department of Ophthalmology, Visual and Anatomical Sciences/ Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA
| | - Tae Jin Lee
- Augusta University, Augusta, GA, USA. 4 Department of Ophthalmology, Augusta University, Augusta, GA, USA
| | - Ashok Sharma
- Augusta University, Augusta, GA, USA. 4 Department of Ophthalmology, Augusta University, Augusta, GA, USA
| | - Todd A Lydic
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Shailendra Giri
- Department of Neurology, Henry Ford Health System, Detroit, MI, USA
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences/ Kresge Eye Institute, Wayne State University School of Medicine, Detroit, MI, USA; Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA.
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André C, Van Camp AG, Ung L, Gilmore MS, Bispo PJM. Characterization of the resistome and predominant genetic lineages of Gram-positive bacteria causing keratitis. Antimicrob Agents Chemother 2024; 68:e0124723. [PMID: 38289077 PMCID: PMC10916405 DOI: 10.1128/aac.01247-23] [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: 09/27/2023] [Accepted: 12/03/2023] [Indexed: 02/04/2024] Open
Abstract
Bacterial keratitis is a vision-threatening infection mainly caused by Gram-positive bacteria (GPB). Antimicrobial therapy is commonly empirical using broad-spectrum agents with efficacy increasingly compromised by the emergence of antimicrobial resistance. We used a combination of phenotypic tests and genome sequencing to identify the predominant lineages of GPB causing keratitis and to characterize their antimicrobial resistance patterns. A total of 161 isolates, including Staphylococcus aureus (n = 86), coagulase-negative staphylococci (CoNS; n = 34), Streptococcus spp. (n = 34), and Enterococcus faecalis (n = 7), were included. The population of S. aureus isolates consisted mainly of clonal complex 5 (CC5) (30.2%). Similarly, the population of Staphylococcus epidermidis was homogenous with most of them belonging to CC2 (78.3%). Conversely, the genetic population of Streptococcus pneumoniae was highly diverse. Resistance to first-line antibiotics was common among staphylococci, especially among CC5 S. aureus. Methicillin-resistant S. aureus was commonly resistant to fluoroquinolones and azithromycin (78.6%) and tobramycin (57%). One-third of the CoNS were resistant to fluoroquinolones and 53% to azithromycin. Macrolide resistance was commonly caused by erm genes in S. aureus, mphC and msrA in CoNS, and mefA and msr(D) in streptococci. Aminoglycoside resistance in staphylococci was mainly associated with genes commonly found in mobile genetic elements and that encode for nucleotidyltransferases like ant(4')-Ib and ant(9)-Ia. Fluroquinolone-resistant staphylococci carried from 1 to 4 quinolone resistance-determining region mutations, mainly in the gyrA and parC genes. We found that GPB causing keratitis are associated with strains commonly resistant to first-line topical therapies, especially staphylococcal isolates that are frequently multidrug-resistant and associated with major hospital-adapted epidemic lineages.
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Affiliation(s)
- Camille André
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew G. Van Camp
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael S. Gilmore
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Paulo J. M. Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Sreedhar SS, Rajalakshmi AR, Nagarajan S, Easow JM, Rajendran P. Comparison of preoperative prophylaxis with povidone-iodine (5%) and moxifloxacin (0.5%) versus povidone-iodine (5%) alone: a prospective study from India. Int Ophthalmol 2024; 44:48. [PMID: 38337066 DOI: 10.1007/s10792-024-03025-9] [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: 11/24/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To compare the effect of povidone-iodine (PI) 5% and moxifloxacin 0.5% solutions versus PI 5% solution alone on the conjunctival bacterial flora. METHODOLOGY This is a comparative study in which the study population comprised adult patients scheduled for elective small incision cataract surgery. The eye to be operated (control eye) received topical moxifloxacin 0.5% drops 4 times, 1 day before surgery and 2 applications on the day of surgery. As placebo, the contralateral eye (study eye) received saline 0.90% drops as per the same schedule. Before surgery, on table, PI 5% was instilled in the conjunctival sac in both eyes. Conjunctival swabs were taken before initiation of therapy and 3 min after instillation of PI. RESULTS Of the 96 pairs of eyes included in the study, conjunctival cultures before prophylaxis were similar between the two groups (p = 0.31), with 54 samples (56%) of the study group and 49 (51%) of the control group showing growth. With positive cultures reducing to 7 (14%) in the study group and 8 (16%) in the control group, both the prophylaxis methods appeared equally efficacious (p = 0.79). Both the groups showed a significant reduction in positive cultures following prophylaxis (p < 0.0001). CONCLUSIONS PI 5% alone as preoperative prophylaxis was as effective as its combination therapy with moxifloxacin 0.5% in the reduction in conjunctival bacterial colonization.
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Affiliation(s)
- Sanjana S Sreedhar
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - A R Rajalakshmi
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India.
| | - Swathi Nagarajan
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Joshy M Easow
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
| | - Prabha Rajendran
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
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Alsarhani WK, AlOtaibi H, AlEraij S, Bukhari T, Ahmad SK, Al-Mesfer S, Martinez-Osorio H. Trends in antibiotic resistance in ocular samples in a tertiary eye centre in Saudi Arabia in 2003-2019. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e22-e27. [PMID: 36126695 DOI: 10.1016/j.jcjo.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/18/2022] [Accepted: 08/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the antibiotic resistance in ocular samples over a 16-year period. METHODS This was a retrospective cohort study conducted at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia (2003-2019). The study included corneal and conjunctival swabs and aqueous and vitreous samples. RESULTS Coagulase-negative staphylococci exhibited a significant trend of increasing resistance over time to erythromycin (p < 0.001), oxacillin (p < 0.001), fusidic acid (p < 0.001), and moxifloxacin (p = 0.003). Staphylococcus aureus also showed a significant increase in oxacillin (p = 0.001), ofloxacin (p = 0.003), and moxifloxacin (p = 0.001) resistance patterns. Streptococcus pneumoniae demonstrated a significant increase in resistance to erythromycin (p = 0.01) and ofloxacin, which jumped from 0.80% in 2003 to 80% in 2019 (p = 0.015). No statistically significant increase in antibiotic resistance trend was observed for Pseudomonas. CONCLUSIONS An increasing antibiotic resistance pattern was demonstrated, particularly among gram-positive organisms. Such findings warrant revision of the common ocular antibiotic prescribing strategy and consideration of alternative antibiotics.
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Affiliation(s)
- Waleed K Alsarhani
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Humoud AlOtaibi
- Oculoplastics and Orbit Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sheikah AlEraij
- Department of Family Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Thamer Bukhari
- Microbiology Department, Clinical Laboratory, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Syed Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Saleh Al-Mesfer
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Tiwari S, Gidwani B, Vyas A. Quorum Sensing in Gram-Negative Bacteria: Strategies to Overcome Antibiotic Resistance in Ocular Infections. Curr Mol Med 2024; 24:876-888. [PMID: 37497706 DOI: 10.2174/1566524023666230727094635] [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: 05/04/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023]
Abstract
Truly miraculous medications and antibiotics have helped save untold millions of lives. Antibiotic resistance, however, is a significant issue related to health that jeopardizes the effectiveness of antibiotics and could harm everyone's health. Bacteria, not humans or animals, become antibiotic-resistant. Bacteria use quorum-sensing communication routes to manage an assortment of physiological exercises. Quorum sensing is significant for appropriate biofilm development. Antibiotic resistance occurs when bacteria establish a biofilm on a surface, shielding them from the effects of infection-fighting drugs. Acylated homoserine lactones are used as autoinducers by gram-negative microscopic organisms to impart. However, antibiotic resistance among ocular pathogens is increasing worldwide. Bacteria are a significant contributor to ocular infections around the world. Gram-negative microscopic organisms are dangerous to ophthalmic tissues. This review highlights the use of elective drug targets and treatments, for example, combinational treatment, to vanquish antibiotic-resistant bacteria. Also, it briefly portrays anti-biotic resistance brought about by gram-negative bacteria and approaches to overcome resistance with the help of quorum sensing inhibitors and nanotechnology as a promising medication conveyance approach to give insurance of anti-microbials and improve pathways for the administration of inhibitors of quorum sensing with a blend of anti-microbials to explicit target destinations and penetration through biofilms for treatment of ocular infections. It centres on the methodologies to sidestep the confinements of ocular anti-biotic delivery with new visual innovation.
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Affiliation(s)
- Sakshi Tiwari
- University Institute of Pharmacy, Pt. Ravishankar Shukla University, Raipur, C.G., India
| | - Bina Gidwani
- Columbia Institute of Pharmacy, Raipur, C.G., India
| | - Amber Vyas
- University Institute of Pharmacy, Pt. Ravishankar Shukla University, Raipur, C.G., India
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André C, Lebreton F, Van Tyne D, Cadorette J, Boody R, Gilmore MS, Bispo PJM. Microbiology of Eye Infections at the Massachusetts Eye and Ear: An 8-Year Retrospective Review Combined With Genomic Epidemiology. Am J Ophthalmol 2023; 255:43-56. [PMID: 37343741 PMCID: PMC10592486 DOI: 10.1016/j.ajo.2023.06.016] [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: 04/13/2023] [Revised: 05/28/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Ocular bacterial infections are important causes of morbidity and vision loss. Early antimicrobial therapy is necessary to save vision, but their efficacy is increasingly compromised by antimicrobial resistance (AMR). We assessed the etiology of ocular bacterial infections seen at Massachusetts Eye and Ear and investigated the molecular epidemiology and AMR profiles of contemporary isolates. DESIGN Laboratory investigation. METHODS We used a combination of phenotypic tests and genome sequencing to identify the predominant lineages of leading ocular pathogens and their AMR profiles. RESULTS A total of 1601 isolates were collected from 2014 to 2021, with Staphylococcus aureus (n = 621), coagulase-negative staphylococci (CoNS) (n = 234), Pseudomonas aeruginosa (n = 213), Enterobacteriaceae (n = 167), and Streptococcus pneumoniae (n = 95) being the most common. Resistance was high among staphylococci, with methicillin resistance (MR) detected in 28% of S aureus and 39.8% of CoNS isolates. Multidrug resistance (MDR) was frequent among MR staphylococci (MRSA 60%, MRCoNS 76.1%). The population of S aureus isolates consisted mainly of 2 clonal complexes (CCs): CC8 (26.1%) and CC5 (24.1%). CC5 strains carried a variety of AMR markers, resulting in high levels of resistance to first-line therapies. Similarly, the population of ocular Staphylococcus epidermidis was homogenous with most belonging to CC2 (85%), which were commonly MDR (48%). Conversely, ocular S pneumoniae, P aeruginosa, and Enterobacteriaceae were often susceptible to first-line therapies and grouped into highly diverse genetic populations. CONCLUSION Our data showed that ocular bacterial infections in our patient population are disproportionately caused by strains that are resistant to clinically relevant antibiotics and are associated with major epidemic genotypes with both community and hospital associations.
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Affiliation(s)
- Camille André
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary
| | - François Lebreton
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary; Department of Microbiology and Immunology (F.L., D.V., M.S.G.), Harvard Medical School, Boston, Massachusetts, USA
| | - Daria Van Tyne
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary; Department of Microbiology and Immunology (F.L., D.V., M.S.G.), Harvard Medical School, Boston, Massachusetts, USA
| | - James Cadorette
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary
| | - Rick Boody
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary
| | - Michael S Gilmore
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary; Department of Microbiology and Immunology (F.L., D.V., M.S.G.), Harvard Medical School, Boston, Massachusetts, USA
| | - Paulo J M Bispo
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary.
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Shahzad A, Arshad S, Zubair F, Shahzad S, Batool F, Fu Q. Development and Validation of Facile RP-HPLC Method for Simultaneous Determination of Timolol Maleate, Moxifloxacin Hydrochloride, Diclofenac Sodium and Dexamethasone in Plasma, Aqueous Humor and Pharmaceutical Products. J Chromatogr Sci 2023; 61:678-687. [PMID: 35870199 DOI: 10.1093/chromsci/bmac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/02/2022] [Accepted: 06/17/2022] [Indexed: 08/22/2023]
Abstract
The present study aimed to develop a validated RP-HPLC method for the simultaneous determination of timolol maleate (TM), moxifloxacin hydrochloride (MOXI), diclofenac sodium (DS) and dexamethasone (DEXA) in human plasma, bovine aqueous humor and pharmaceutical preparations. The chromatographic separation was studied using the C18 column. The chromatographic conditions, such as composition, pH, the flow rate of mobile phase, the temperature of column, wavelength of absorption and injection volume of the sample, were studied. The method was validated to confirm specificity, linearity and accuracy in accordance with an International Conference on Harmonization guidelines. The optimum conditions for separation included mobile phase 0.05 M monobasic phosphate buffer: acetonitrile (65:35 v/v), pH of buffer adjusted to 6.2 and the flow rate of 1 mL/minute. The optimum temperature of the column was found to be 35°C, absorption wavelength 265 nm and injection volume 50 μL. The baseline separation of all four drugs with good sensitivity, resolution, and a less than 15 min run time was achieved. The retention time of TM, MOXI, DS and DEXA were 4.3,5.7,9.9 and 13.5 minutes respectively. The limit of detection (LOD) values were 6.2, 4.8, 0.8 and 1.2 ng/mL for TM, MOXI, DS and DEXA, respectively, whereas their respective limit of quantification (LOQ) values was: were 42.6, 26.8, 5.6 and 6.2 ng/mL. The coefficient of variation for intra-day and inter-day were in the range of 0.32-1.57 and 1.29-3.07%, respectively. The method was found to be sensitive, precise and accurate in human plasma and bovine aqueous humor and can be applied for the quantification of these compounds in plasma, aqueous humor and pharmaceuticals.
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Affiliation(s)
- Aqeel Shahzad
- Department of Pharmaceutical Analysis, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Sohail Arshad
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Faryal Zubair
- Department of Pharmaceutical Analysis, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Shakeel Shahzad
- Institute of Microbiology, University of Agriculture Faisalabad, Punjab 38040, Pakistan
- Faculty of Medicine and Health, University of New South Wales Sydney, NSW 2052, Australia
| | - Farzana Batool
- Department of Pharmaceutics, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Qiang Fu
- Department of Pharmaceutical Analysis, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China
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Imran M, Ahmed S, Abdullah AZ, Hakami J, Chaudhary AA, Rudayni HA, Khan SUD, Khan A, Basher NS. Nanostructured material-based optical and electrochemical detection of amoxicillin antibiotic. LUMINESCENCE 2023; 38:1064-1086. [PMID: 36378274 DOI: 10.1002/bio.4408] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/19/2022] [Accepted: 11/13/2022] [Indexed: 07/22/2023]
Abstract
The penicillin derivative amoxicillin (AMX) plays an important role in treating various types of infections caused by bacteria. However, excessive use of AMX may have negative health effects. Therefore, it is of utmost importance to detect and quantify the AMX in pharmaceutical drugs, biological fluids, and environmental samples with high sensitivity. Therefore, this review article provides valuable and up-to-date information on nanostructured material-based optical and electrochemical sensors to detect AMX in various biological and chemical samples. The role of using different nanostructured materials on the performance of important optical sensors such as colorimetric sensors, fluorescence sensors, surface-enhanced Raman scattering sensors, chemiluminescence/electroluminescence sensors, optical immunosensors, optical fibre-based sensors, and several important electrochemical sensors based on different electrode types have been discussed. Moreover, nanocomposites, polymer, and MXenes-based electrochemical sensors have also been discussed, in which such materials are being used to further enhance the sensitivity of these sensors. Furthermore, nanocomposite-based photo-electrochemical sensors and the market availability of biosensors including AMX have also been discussed briefly. Finally, the conclusion, challenges, and future perspectives of the above-mentioned sensing techniques for AMX detection are presented.
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Affiliation(s)
- Mohd Imran
- Department of Chemical Engineering, College of Engineering, Jazan University, P.O. Box. 706, Jazan, Saudi Arabia
- School of Chemical Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang, Malaysia
| | - Shahzad Ahmed
- Department of Metallurgical and Materials Engineering, Indian Institute of Technology Jodhpur, Jodhpur, Rajasthan, India
| | - Ahmad Zuhairi Abdullah
- School of Chemical Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang, Malaysia
| | - Jabir Hakami
- Department of Physics, College of Science, Jazan University, P.O. Box. 114, Jazan, Saudi Arabia
| | - Anis Ahmad Chaudhary
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Hassan Ahmad Rudayni
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Salah-Ud-Din Khan
- Department of Biochemistry, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Afzal Khan
- State Key Laboratory of Silicon Materials, School of Materials Science and Engineering, Zhejiang University, Hangzhou, China
| | - Nosiba Suliman Basher
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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Bale BI, Elebesunu EE, Manikavasagar P, Agwuna FO, Ogunkola IO, Sow AU, Lucero-Prisno DE. Antibiotic resistance in ocular bacterial infections: an integrative review of ophthalmic chloramphenicol. Trop Med Health 2023; 51:15. [PMID: 36895063 PMCID: PMC9996861 DOI: 10.1186/s41182-023-00496-x] [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: 08/12/2022] [Accepted: 01/01/2023] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION Chloramphenicol is a broad-spectrum antibiotic widely used for treating ophthalmic infections, but concerns about rising bacterial resistance to chloramphenicol have been observed due to its frequent use as an over-the-counter medication. This review assessed the common ophthalmic bacterial pathogens, their chloramphenicol resistance mechanisms, and rates of drug resistance. METHODS PubMed and Google Scholar databases were searched for relevant publications from the years 2000 to 2022, bordering on ophthalmic bacterial infections, chloramphenicol susceptibility profiles, and drug resistance mechanisms against chloramphenicol. A total of 53 journal publications met the inclusion criteria, with data on the antibiotic susceptibility profiles available in 44 of the reviewed studies, which were extracted and analyzed. RESULTS The mean resistance rates to chloramphenicol from antibiotic susceptibility profiles varied between 0% and 74.1%, with the majority of the studies (86.4%) showing chloramphenicol resistance rates below 50%, and more than half (23 out of 44) of the studies showed resistance rates lower than 20%. The majority of the publications (n = 27; 61.4%) were from developed nations, compared to developing nations (n = 14; 31.8%), while a fraction (n = 3; 6.8%) of the studies were regional cohort studies in Europe, with no country-specific drug resistance rates. No pattern of cumulative increase or decrease in ophthalmic bacterial resistance to chloramphenicol was observed. CONCLUSIONS Chloramphenicol is still active against ophthalmic bacterial infections and is suitable as a topical antibiotic for ophthalmic infections. However, concerns remain about the drug becoming unsuitable in the long run due to some proof of high drug resistance rates.
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Affiliation(s)
| | | | | | | | | | - Alhaji Umar Sow
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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11
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Alzahrani A, Youssef AAA, Nyavanandi D, Tripathi S, Bandari S, Majumdar S, Repka MA. Design and optimization of ciprofloxacin hydrochloride biodegradable 3D printed ocular inserts: Full factorial design and in-vitro and ex-vivo evaluations: Part II. Int J Pharm 2023; 631:122533. [PMID: 36566827 PMCID: PMC9851809 DOI: 10.1016/j.ijpharm.2022.122533] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Coupling hot-melt extrusion (HME) with fused deposition modeling three-dimensional printing (FDM-3DP) can facilitate the fabrication of tailored, patient-centered, and complex-shaped ocular dosage forms. We fabricated ciprofloxacin HCl ocular inserts by coupling high-throughput, solvent-free, and continuous HME with FDM-3DP. Insert fabrication utilized biocompatible, biodegradable, bioadhesive Klucel™ hydroxypropyl cellulose polymer, subjected to distinct FDM-3DP processing parameters, utilizing a design of experiment approach to achieve a tailored release profile. We determined the drug content, thermal properties, drug-excipient compatibility, surface morphology, in vitro release, antibacterial activity, ex-vivo transcorneal permeation, and stability of inserts. An inverse relationship was noted between insert thickness, infill density, and drug release rate. The optimized design demonstrated an amorphous solid dispersion with an extended-release profile over 24 h, no physical or chemical incompatibility, excellent mucoadhesive strength, smooth surface, lack of bacterial growth (Pseudomonas aeruginosa) in all release samples, and prolonged transcorneal drug flux compared with commercial eye drops and immediate-release inserts. The designed inserts were stable at room temperature considering drug content, thermal behavior, and release profile over three months. Overall, the fabricated insert could reduce administration frequency to once-daily dosing, affording a promising topical delivery platform with prolonged antibacterial activity and superior therapeutic outcomes for managing ocular bacterial infections.
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Affiliation(s)
- Abdullah Alzahrani
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, 38677, USA,Department of Pharmacy, East Jeddah Hospital, Ministry of Health, Jeddah 22253, Saudi Arabia
| | - Ahmed Adel Ali Youssef
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, 38677, USA,Department of Pharmaceutical Technology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - Dinesh Nyavanandi
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, 38677, USA
| | - Siddharth Tripathi
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS, USA,Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
| | - Suresh Bandari
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, 38677, USA
| | - Soumyajit Majumdar
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, 38677, USA,Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
| | - Michael A. Repka
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS, 38677, USA,Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA,Pii Center for Pharmaceutical Technology, The University of Mississippi, University, MS 38677, USA,Correspondence: Dr. Michael A. Repka, Chair & Distinguished Professor, Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS 38677, USA. Tel.: +1 (662) 915-1155; fax: +1 (662) 915-1177.
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12
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Alzahrani A, Adel Ali Youssef A, Senapati S, Tripathi S, Bandari S, Majumdar S, Repka MA. Formulation development and in Vitro-Ex vivo characterization of hot-melt extruded ciprofloxacin hydrochloride inserts for ocular applications: Part I. Int J Pharm 2023; 630:122423. [PMID: 36427695 PMCID: PMC9851808 DOI: 10.1016/j.ijpharm.2022.122423] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
This study developed, optimized, characterized, and evaluated bioadhesive, hot-melt extruded (HME), extended-release ocular inserts containing ciprofloxacin hydrochloride (CIP-HCL) to improve the therapeutic outcomes of ocular bacterial infections. The inserts were fabricated with FDA-approved biocompatible, biodegradable, and bioadhesive polymers that were tuned in different ratios to achieve a sustained release profile. The results revealed an inverse relationship between the Klucel™ hydroxypropyl cellulose (HPC, 140,000 Da) concentration and drug release and extended-release profile over 24 h. The CIP-HCL-HME inserts presented stable drug content, thermal behavior, surface pH, and release profiles over three months of room-temperature storage and demonstrated adequate mucoadhesive strength. SEM micrographs revealed a smooth surface. Bacterial growth was not observed on the samples during the in vitro release experiment (0.5-24 h), indicating that a minimum inhibitory concentration (MIC) of 90 against Pseudomonas aeruginosa was achieved. Ex vivo transcorneal permeation studies using excised rabbit corneas revealed that the prepared ocular inserts prolonged the transcorneal flux of the drug compared to commercial eye drops and immediate-release inserts and could reduce the administration frequency to once daily. Therefore, the inserts could increase patient compliance and exhibited prolonged antibacterial activity and thus could provide better therapeutic outcomes against ocular bacterial infections.
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Affiliation(s)
- Abdullah Alzahrani
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS 38677, USA; Department of Pharmacy, East Jeddah Hospital, Ministry of Health, Jeddah 22253, Saudi Arabia
| | - Ahmed Adel Ali Youssef
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS 38677, USA; Department of Pharmaceutical Technology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - Samir Senapati
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS 38677, USA
| | - Siddharth Tripathi
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS, USA; Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
| | - Suresh Bandari
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS 38677, USA
| | - Soumyajit Majumdar
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS 38677, USA; Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
| | - Michael A Repka
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, The University of Mississippi, University, MS 38677, USA; Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA; Pii Center for Pharmaceutical Technology, The University of Mississippi, University, MS 38677, USA.
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13
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D'Oria F, Buonamassa R, Rizzo T, Boscia F, Alessio G, Guerriero S. Bacterial isolates and antimicrobial susceptibility pattern of ocular infection at a tertiary referral hospital in the South of Italy. Eur J Ophthalmol 2023; 33:370-376. [PMID: 35642247 DOI: 10.1177/11206721221106139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE The present study aimed to determine the prevalence of bacterial and fungal infections of the eye and also to assess the antibiotic susceptibility pattern of bacterial isolates at a tertiary referral eye care hospital in Bari, Italy. METHODS Two hundred seventy three samples collected during a 2-year observation period. Culture, Gram's stain, potassium hydroxide mount and occasionally Giemsa staining was done for the clinical specimens. Antibiotic susceptibility testing was performed for bacterial growth. RESULTS Out of 273 samples processed, 236 (86.4%) yielded growth: of them, 183 (77,5%) were bacterial, 26 (11%) fungal, and 23 (9,7%) specimens showed the presence of Acanthamoeba. Among bacterial infections, 99 (54.5%) bacterial isolates were Gram-positives, and 82 (44.8%) were Gram-negatives. Among Gram positives, Tigecycline showed the greatest susceptibility (93.8%), followed by Linezolid (97%) and Daptomycin (95.18%). Gram negative bacteria strains were susceptible to Imipenem (95%), Meropenem (98,5%) and Amikacin (91%) Multidrug in vitro resistance (resistance >3 classes of antibiotics) was found in 45 Gram positive (63%). and 33 Gram negative (44%). CONCLUSION Conjunctival specimens yielded mainly bacterial growth with Staphylococcus species being the predominant isolate followed by Pseudomonas species. Findings from the current analysis evidence a substantial level of in vitro resistance to ≥3 antibiotics.
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Affiliation(s)
- Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Rosa Buonamassa
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Tiziana Rizzo
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Francesco Boscia
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Silvana Guerriero
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
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14
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El-Gendy AO, Obaid Y, Ahmed E, Enwemeka CS, Hassan M, Mohamed T. The Antimicrobial Effect of Gold Quantum Dots and Femtosecond Laser Irradiation on the Growth Kinetics of Common Infectious Eye Pathogens: An In Vitro Study. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:nano12213757. [PMID: 36364531 PMCID: PMC9654226 DOI: 10.3390/nano12213757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 05/29/2023]
Abstract
We studied the antimicrobial effect of gold quantum dots (AuQDs), femtosecond laser irradiation, and the combined effect of laser irradiation and AuQD treatment against common infectious eye pathogens. The INSPIRE HF100 laser system (Spectra Physics) provided a femtosecond laser, which was pumped by a mode-locked femtosecond Ti: sapphire laser MAI TAI HP (Spectra Physics), while a Quanta-Ray nanosecond Nd: YAG laser (Spectra-Physics) was used to precisely synthesize 7.8, 8.7, and 11.6 nm spherical AuQDs. Then, the in vitro growth kinetics and growth rate analysis of E. coli, methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Listeria monocytogenes, and Candida albicans (treated with the AuQDs, femtosecond laser irradiation, or combined laser and AuQDs treatment) was measured. The biocompatibility of the AuQDs with the retinal epithelial cell lines (ARPE-19) and their toxicity to the cells was assayed. The results showed that (1) in vitro irradiation using a 159 J/cm2 energy density obtained from the 400 nm femtosecond laser suppressed the growth of each of the five pathogens. (2) Similarly, treatment with the AuQDs was antimicrobial against the four bacteria. The AuQDs with an average size of 7.8 nm were more highly antimicrobial and biocompatible and were less cytotoxic than the larger AuQD sizes. (3) The combined femtosecond laser irradiation and AuQD treatment was more highly antimicrobial than each treatment alone. (4) The AuQD treatment did not impair the rate of wound closure in vitro. These findings suggest that combined femtosecond laser irradiation and AuQD treatment is significantly antimicrobial against Candida albicans, Gram-positive L. monocytogenes, S. aureus, and E. faecalis, as well as Gram-negative E. coli. The nontoxicity and biocompatibility of the AuQD particles tested suggest that this form of treatment may be clinically viable.
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Affiliation(s)
- Ahmed O. El-Gendy
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Yousif Obaid
- Anbar Health Department, Ministry of Health, Ramadi 31001, Iraq
| | - Esraa Ahmed
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
| | - Chukuka S. Enwemeka
- College of Health and Human Services, San Diego State University, San Diego, CA 92182, USA
- Faculty of Health Sciences, University of Johannesburg, Doornfontein 2028, South Africa
| | - Mansour Hassan
- Department of Ophthalmology, Faculty of Medicine, Beni-Suef University, Beni-Suef 62514, Egypt
| | - Tarek Mohamed
- Laser Institute for Research and Applications LIRA, Beni-Suef University, Beni-Suef 62511, Egypt
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15
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Spectrum of ophthalmic diseases in children hospitalized in a tertiary ophthalmology hospital in China from 2010 to 2019. BMC Ophthalmol 2022; 22:314. [PMID: 35854241 PMCID: PMC9297649 DOI: 10.1186/s12886-022-02533-5] [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: 09/30/2021] [Accepted: 07/07/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Describing the pattern of pediatric eye diseases is necessary for appropriate eye care in children. This study explored the spectrum and characteristics of pediatric ophthalmic diseases in a typical tertiary ophthalmology hospital in China. METHODS A retrospective study was conducted at a tertiary ophthalmology hospital between 2010 and 2019 in Guangzhou, China. This study included 44,552 inpatients who were younger than 18 years old. Demographic and diagnostic data were collected from the electronic medical record system. Multiphase regression analysis was used to estimate trends in the annual percentages of ten common ophthalmic diseases. RESULTS From 2010 to 2019, 44,552 inpatients met the inclusion criteria. The majority were male (61.9%), aged 7 to 12 years (30.3%) and self-paying (56.6%). The top ten conditions were refractive error (41.2%), strabismus (36.1%), cataract (13.6%), trauma (11.8%), congenital ptosis (8.8%), tumor (8.1%), amblyopia (7.1%), glaucoma (7.0%), entropion and trichiasis of eyelid (7.0%), and retinal detachment (6.5%). The annual percentage changes (APCs) for refractive error, strabismus, and retinal detachment were 9.3% (95% CI, 8.1-10.5%), 4.7% (95% CI, 3.8-5.6%) and - 2.8% (95% CI, - 5.1% to - 0.4%) respectively. For trauma, the average APC (AAPC = -9.2%, (95% CI, - 12.1% to - 6.2%) decreased gradually from 2010 to 2015 (APC = -4.2% (95% CI, - 8.8-0.7%)) and decreased rapidly from 2015 to 2019 (APC = -15.1% (95% CI, - 21.0% to - 8.7%)). CONCLUSIONS Pediatric ophthalmic diseases are common in China. Preventive strategies and health education aimed at the prevention of refractive error, strabismus, and entropion and trichiasis of eyelid will be crucial in reducing the burden of pediatric ophthalmic diseases on health care systems and human development.
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Osei Duah Junior I, Tchiakpe MP, Borquaye LS, Amoah K, Amankwah FKD, Kumah DB, Ofori LA, Danso-Appiah A, Prempeh BO, Gbedema SY, Munyaneza J, Danquah CA, Akuffo KO. Clinical characteristics of external bacterial ocular and periocular infections and their antimicrobial treatment patterns among a Ghanaian ophthalmic population. Sci Rep 2022; 12:10264. [PMID: 35715500 PMCID: PMC9206014 DOI: 10.1038/s41598-022-14461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/07/2022] [Indexed: 01/02/2023] Open
Abstract
Empirical antimicrobial therapy is linked to a surge in antimicrobial resistant infections. However, an insight on the bacteria etiology of ocular infections is essential in the appropriation of choice of antimicrobial among clinicians, yet there remains a dearth of data from Ghana. We investigated the bacteria etiology of external ocular and periocular infections and antimicrobial treatment patterns among a Ghanaian ophthalmic population. A multicenter study design with purposive sampling approach was employed. Patients demographics and clinical data were collated using a pretested structure questionnaire. Cornea specimens and conjunctival swabs were obtained for bacterial isolation following standard protocols. About 95% (98/103) of ocular samples were positive for bacteria culture. The proportion of Gram-negative bacteria was 58.2%, and the predominant bacteria species were Pseudomonas aeruginosa 38.8% and Staphylococcus aureus 27.6%. Conjunctivitis 40.0% and keratitis 75.0% were mostly caused by Pseudomonas aeruginosa. The routinely administered antimicrobial therapy were polymyxin B 41.2%, neomycin 35.1% and ciprofloxacin 31.6%. Participants demographic and clinical characteristics were unrelated with positive bacteria culture (p > 0.05). Our results showed a markedly high burden of ocular bacterial infections and variations in etiology. Bacterial infection-control and antimicrobial agent management programs should be urgently institutionalized to prevent the emergence of resistant infections.
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Affiliation(s)
- Isaiah Osei Duah Junior
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michel Pascal Tchiakpe
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lawrence Sheringham Borquaye
- Department of Chemistry, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Central Laboratory, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwadwo Amoah
- The Eye Clinic, Kumasi South Hospital, Atonsu-Agogo, Kumasi, Ghana
| | - Francis Kwaku Dzideh Amankwah
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Ben Kumah
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Linda Aurelia Ofori
- Department of Theoretical and Applied Biology, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
- University of Ghana Centre for Evidence Synthesis and Policy, School of Public Health, University of Ghana, Legon, Ghana
| | - Bright Owusu Prempeh
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- The Anglican Eye Hospital, Jachie, Ghana
| | - Stephen Yao Gbedema
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Justin Munyaneza
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cynthia Amaning Danquah
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Design of Topical Moxifloxacin Mucoadhesive Nanoemulsion for the Management of Ocular Bacterial Infections. Pharmaceutics 2022; 14:pharmaceutics14061246. [PMID: 35745818 PMCID: PMC9228176 DOI: 10.3390/pharmaceutics14061246] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
Ocular bacterial infections can lead to serious visual disability without proper treatment. Moxifloxacin (MOX) has been approved by the US Food and Drug Administration as a monotherapy for ocular bacterial infections and is available commercially as an ophthalmic solution (0.5% w/v). However, precorneal retention, drainage, and low bioavailability remain the foremost challenges associated with current commercial eyedrops. With this study, we aimed to design a MOX-loaded nanoemulsion (NE; MOX-NE) with mucoadhesive agents (MOX-NEM) to sustain MOX release, as well as to overcome the potential drawbacks of the current commercial ophthalmic formulation. MOX-NE and MOX-NEM formulations were prepared by hot homogenization coupled with probe sonication technique and subsequently characterized. The lead formulations were further evaluated for in vitro release, ex vivo transcorneal permeation, sterilization, and antimicrobial efficacy studies. Commercial MOX ophthalmic solution was used as a control. The lead formulations showed the desired physicochemical properties and viscosity. All lead formulations showed sustained release profiles a period of more than 12 h. Filtered and autoclaved lead formulations were stable for one month (the last time point tested) under refrigeration and at room temperature. Ex vivo transcorneal permeation studies revealed a 2.1-fold improvement in MOX permeation of the lead MOX-NE formulation compared with Vigamox® eyedrops. However, MOX-NEM formulations showed similar flux and permeability coefficients to those of Vigamox® eyedrops. The lead formulations showed similar in vitro antibacterial activity as the commercial eyedrops and crude drug solution. Therefore, MOX-NE and MOX-NEM formulations could serve as effective delivery vehicles for MOX and could improve treatment outcomes in different ocular bacterial infections.
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18
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Grandi G, Cavallo R, Zanotto E, Cipriani R, Panico C, Protti R, Scapagnini G, Davinelli S, Costagliola C. In vitro antimicrobial activity of ozonated oil in liposome eyedrop against multidrug-resistant bacteria. Open Med (Wars) 2022; 17:1057-1063. [PMID: 35795001 PMCID: PMC9175013 DOI: 10.1515/med-2022-0495] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Bacteria are the most common causative agents of ocular infections. Treatment with topical broad-spectrum antibiotics is recommended in severe cases. However, antibiotic resistance has become a major concern in recent years, although antibiotics are generally effective in treating ocular infections. Antibacterial compound screening is performed to identify alternative therapeutic options to antibiotics. The aim of this study was to assess the in vitro antimicrobial activity of an ophthalmic solution containing ozonated oil. Strains of bacterial species with a multidrug resistance profile, which are responsible for a large proportion of ocular infections, were isolated and selected from different biological samples. The bacterial isolates were cultured, and ozonated oil was used to evaluate the inhibition zones at different time points. The treatment exhibited antibacterial activity against all the tested species. The effect was lower against the strains of Pseudomonas aeruginosa and more evident against Staphylococcus and Streptococcus spp. Our results suggest that the administration of ozonated oil may be a candidate agent to treat some infections of the ocular surface with a potential role in antimicrobial prophylaxis.
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Affiliation(s)
- Giuseppe Grandi
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, 10126, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, 10126, Italy
| | - Elisa Zanotto
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, 10126, Italy
| | - Raffaella Cipriani
- Microbiology and Virology Unit, Amedeo di Savoia Hospital, Turin, 10149, Italy
| | - Claudio Panico
- Ophthalmology Unit, Humanitas Gradenigo Hospital, Turin, 10153, Italy
| | - Romolo Protti
- Ophthalmic Unit, Hospital San Biagio, Domodossola, 28845, Italy
| | - Giovanni Scapagnini
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Via V. De Sanctis, s.n.c., Campobasso 86100, Italy
| | - Sergio Davinelli
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Via V. De Sanctis, s.n.c., Campobasso 86100, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Via V. De Sanctis, s.n.c., Campobasso 86100, Italy
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Caruso C, Eletto D, Tosco A, Pannetta M, Scarinci F, Troisi M, Porta A. Comparative Evaluation of Antimicrobial, Antiamoebic, and Antiviral Efficacy of Ophthalmic Formulations. Microorganisms 2022; 10:microorganisms10061156. [PMID: 35744674 PMCID: PMC9229167 DOI: 10.3390/microorganisms10061156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 12/10/2022] Open
Abstract
The extensive use of ophthalmic antibiotics is contributing to the appearance of resistant bacterial strains, which require prolonged and massive treatments with consequent detrimental outcomes and adverse effects. In addition to these issues, antibiotics are not effective against parasites and viruses. In this context, antiseptics could be valuable alternatives. They have nonselective mechanisms of action preventing bacterial resistance and a broad spectrum of action and are also effective against parasites and viruses. Here, we compare the in vitro antibacterial, antiameobic, and antiviral activities of six ophthalmic formulations containing antiseptics such as povidone-iodine, chlorhexidine, and thymol against Gram-positive and Gram-negative bacteria, the amoeba Acanthamoeba castellanii, and two respiratory viruses, HAdV-2 and HCoV-OC43. The results suggest that, among all the tested formulations, Dropsept, consisting of Vitamin E TPGS-based (tocopheryl polyethylene glycol succinate) in combination with the antiseptic chlorhexidine, is the one with the highest range of activities, as it works efficiently against bacteria, amoeba, and viruses. On the other hand, the solution containing PVA (polyvinyl alcohol) and thymol showed a promising inhibitory effect on Pseudomonas aeruginosa, which causes severe keratitis. Given its high efficiency, Dropsept might represent a valuable alternative to the widely used antibiotics for the treatment of ocular infections. In addition to this commercial eye drop solution, thymol-based solutions might be enrolled for their natural antimicrobial and antiamoebic effect.
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Affiliation(s)
- Ciro Caruso
- Corneal Transplant Centre, Pellegrini Hospital, 80134 Naples, Italy;
| | - Daniela Eletto
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy; (A.T.); (M.P.)
- Correspondence: (D.E.); (A.P.); Tel.: +39-089-969-421 (D.E.); +39-089-969-455 (A.P.)
| | - Alessandra Tosco
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy; (A.T.); (M.P.)
| | - Martina Pannetta
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy; (A.T.); (M.P.)
| | - Fabio Scarinci
- Department of Ophthalmology, IRCCS Fondazione, Bietti, Via Livenza, 3, 00198 Roma, Italy;
| | - Mario Troisi
- Department of Neurosciences, Reproductive Sciences and Dentistry, Eye Clinic, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Amalia Porta
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy; (A.T.); (M.P.)
- Correspondence: (D.E.); (A.P.); Tel.: +39-089-969-421 (D.E.); +39-089-969-455 (A.P.)
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20
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Roles and Mechanisms of Regulated Necrosis in Corneal Diseases: Progress and Perspectives. J Ophthalmol 2022; 2022:2695212. [PMID: 35655803 PMCID: PMC9152437 DOI: 10.1155/2022/2695212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/24/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Regulated necrosis is defined as cell death characterized by loss of the cell membrane integrity and release of the cytoplasmic content. It contributes to the development and progression of some diseases, including ischemic stroke injury, liver diseases, hypertension, and cancer. Various forms of regulated necrosis, particularly pyroptosis, necroptosis, and ferroptosis, have been implicated in the pathogenesis of corneal disease. Regulated necrosis of corneal cells enhances inflammatory reactions in the adjacent corneal tissues, leading to recurrence and aggravation of corneal disease. In this review, we summarize the molecular mechanisms of pyroptosis, necroptosis, and ferroptosis in corneal diseases and discuss the roles of regulated necrosis in inflammation regulation, tissue repair, and corneal disease outcomes.
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21
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Mahmoud AA, Abd-Rahman MS, Mohamed TA, El-Sebaity DM. Is Corneal Collagen Cross-Linking Beneficial as an Adjunct to the Conventional Treatment of Bacterial Keratitis? Open Ophthalmol J 2022. [DOI: 10.2174/18743641-v16-e2203150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
To evaluate the therapeutic effects of corneal collagen cross-linking CXL as an adjuvant to standard antimicrobial agents in the treatment of bacterial keratitis when compared to treatment with antimicrobial agents alone.
Methods:
This prospective comparative interventional study included 20 eyes of 20 patients with clinical and laboratory evidence of bacterial keratitis who attended the Outpatient Cornea Unit, Ophthalmology Department, Faculty of Medicine in Assiut University Hospital, Assiut, between January 2019 and December 2020.Patients were divided into two groups: group A, treated with CXL using the Dresden Protocol at the EL-Nour Eye Centre, and group B treated with antibiotics alone.
Results:
Group A had ten patients in the age range of 20-80 years (mean age 49.2 years), while that of group B (ten patients) was 19 -70 years (mean age 47.3 years).
The ulcer sizes started to decrease significantly from week 2 in group A to week 3 in group B. The epithelization time was significantly different between the two treatment groups as reepithelization in 60% of group A cases started at week two, while it began at week three in group B. There was no significant difference in the V/A between the two groups after treatment.
Conclusion:
CXL as an adjunct to topical antimicrobial treatment was more effective in treating bacterial keratitis than conventional antimicrobial therapy alone, as it led to shorter recovery times due to more rapid ulcer healing, resolution of infiltration, and faster symptomatic relief in patients. Despite CXL promoted the ulcer to heal quickly, there was no significant change in V/A before and after CXL or between the CXL with antimicrobial or antimicrobial therapy alone .
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22
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Swift T, Pinnock A, Shivshetty N, Pownall D, MacNeil S, Douglas I, Garg P, Rimmer S. GENERATION AND USE OF FUNCTIONALISED HYDROGELS THAT CAN RAPIDLY SAMPLE INFECTED SURFACES. MethodsX 2022; 9:101684. [PMID: 35540105 PMCID: PMC9078998 DOI: 10.1016/j.mex.2022.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
This paper outlined our method for developing polymer-linked contact lens type materials for rapid detection and differentiation of Gram-positive, Gram-negative bacteria and fungi in infected corneas. It can be applied to both model synthetic or ex-vivo corneal models and has been successfully trialed in an initial efficacy tested animal study. First a hydrogel substrate for the swab material is selected, we have demonstrated selective swabs using a glycerol monomethacrylate hydrogel. Alternatively any commercial material with carboxylic acid functional groups is suitable but risks nonspecific adhesion. This is then functionalised via use of N-hydroxysuccinimide reaction with amine groups on the specified highly branched polymer ligand (either individually gram negative, gram positive or fungal binding polymers or a combination of all three can be employed for desired sensing application). The hydrogel is then cut into swabs suitable for sampling, used, and then the presence of gram positive, game negative and fungi are disclosed by the sequential addition of dyes (fluorescent vancomycin, fluorescein isothiocyanate and calcofluor white). In summary this method presents: Method to produce glycerol monomethacrylate hydrogels to minimize nonspecific binding Methods of attaching pathogen binding highly branched polymers to produce selective hydrogel swabs Method for disclosing bound pathogens to this swab using sequential dye addition
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Affiliation(s)
| | | | | | | | | | | | | | - Stephen Rimmer
- University of Bradford, Bradford UK
- Corresponding author.
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23
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Manente R, Santella B, Pagliano P, Santoro E, Casolaro V, Borrelli A, Capunzo M, Galdiero M, Franci G, Boccia G. Prevalence and Antimicrobial Resistance of Causative Agents to Ocular Infections. Antibiotics (Basel) 2022; 11:antibiotics11040463. [PMID: 35453215 PMCID: PMC9032492 DOI: 10.3390/antibiotics11040463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 02/04/2023] Open
Abstract
Bacterial ocular infections are a worldwide health problem and, if untreated, can damage the structure of the eye and contribute to permanent disability. Knowledge of the prevalence and antimicrobial susceptibility patterns of the main causative agents involved in ocular infections is necessary for defining an optimal antibiotic therapy. The aim of this study was to analyse bacterial species involved in ocular infections and the antimicrobial susceptibility patterns. Conjunctival swab samples were collected from patients with bacterial conjunctivitis at the University Hospital San Giovanni di Dio e Ruggi d’Aragona between January 2015 and December 2019. The identification and antibiotic sensitivity tests were performed using the VITEK 2 system. A total of 281 causative agents of ocular infections were isolated, 81.8% of which were Gram-positive bacteria. Coagulase-negative staphylococci (CoNS) were the most commonly isolated species among Gram-positive bacteria, followed by Staphylococcus aureus. In contrast, Pseudomonas spp. and Escherichia coli were the main species isolated among Gram-negative bacteria (18.2%). Overall, linezolid, teicoplanin, tigecycline and vancomycin were the most effective antimicrobials. Analysis of resistance rates over time highlighted increasing resistance for azithromycin, clarithromycin and erythromycin among CoNS, and clindamycin and erythromycin among Staphylococcus aureus. This study has identified the profiles of the major pathogens involved in ocular infection and their susceptibility patterns, which will help improve the treatments and the choice of antibiotics in ocular infections.
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Affiliation(s)
- Roberta Manente
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (R.M.); (B.S.); (M.G.)
| | - Biagio Santella
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (R.M.); (B.S.); (M.G.)
| | - Pasquale Pagliano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
| | - Emanuela Santoro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
| | - Vincenzo Casolaro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
| | - Anna Borrelli
- Azienda Ospedaliero Universitaria San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy;
| | - Mario Capunzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica e Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy
| | - Massimiliano Galdiero
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (R.M.); (B.S.); (M.G.)
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica e Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy
- Correspondence: (G.F.); (G.B.)
| | - Giovanni Boccia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (P.P.); (E.S.); (V.C.); (M.C.)
- Dai Dipartimento Di Igiene Sanitaria e Medicina Valutativa U.O.C. Patologia Clinica e Microbiologica, Azienda Ospedaliero-Universitaria S. Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, Largo Città di Ippocrate, 84131 Salerno, Italy
- Correspondence: (G.F.); (G.B.)
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Woreta AN, Kebede HB, Tilahun Y, Teklegiorgis SG, Abegaz WE. Antibiotic Susceptibility Pattern and Bacterial Spectrum Among Patients with External Eye Infections at Menelik II Referral Hospital in Addis Ababa, Ethiopia. Infect Drug Resist 2022; 15:765-779. [PMID: 35264860 PMCID: PMC8901190 DOI: 10.2147/idr.s352098] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/22/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Asmamaw Nitsuh Woreta
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Microbiology Unit, Department of Laboratory Sciences, Menelik II Referral Hospital, Addis Ababa, Ethiopia
| | - Habtamu Biazin Kebede
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Habtamu Biazin Kebede, Email
| | - Yonas Tilahun
- Department of Ophthalmology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Woldaregay Erku Abegaz
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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25
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Kvopka M, Kingston E, Nguyen DDH, Tong JY, Kirk HL, Whyte CM, Dalgliesh JD, Danks JJ. Multi-resistant Enterobacter cloacae dacryocystitis and preseptal cellulitis: case and review of literature. Orbit 2022:1-4. [PMID: 35075984 DOI: 10.1080/01676830.2022.2026417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A 61-year-old man with no significant past medical history presented to a quaternary ophthalmic referral center with acute right-sided medial canthal pain, periorbital edema, and erythema despite oral antibiotic therapy. CT imaging confirmed the presence of right preseptal cellulitis and lacrimal sac aspiration identified Enterobacter cloacae. A diagnosis of acute right-sided dacryocystitis with preseptal cellulitis was made. He was successfully treated with broadening of antibiotic therapy to intravenous meropenem. Symptomatic resolution was noted on follow-up without evidence of disease recurrence. This unusual case of Enterobacter cloacae dacryocystitis and preseptal cellulitis highlights the increasing prevalence and challenges of treating these uncommon organisms.
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Affiliation(s)
- Michael Kvopka
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - Ezekiel Kingston
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - Daniel D H Nguyen
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - Jessica Y Tong
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - Hayden L Kirk
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - Claudia M Whyte
- Department of Medicine, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - James D Dalgliesh
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
| | - Jennifer J Danks
- Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, Australia
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26
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Josyula A, Omiadze R, Parikh K, Kanvinde P, Appell MB, Patel P, Saeed H, Sutar Y, Anders N, He P, McDonnell PJ, Hanes J, Date AA, Ensign LM. An ion-paired moxifloxacin nanosuspension eye drop provides improved prevention and treatment of ocular infection. Bioeng Transl Med 2021; 6:e10238. [PMID: 34589607 PMCID: PMC8459599 DOI: 10.1002/btm2.10238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/08/2021] [Accepted: 06/13/2021] [Indexed: 12/28/2022] Open
Abstract
There are numerous barriers to achieving effective intraocular drug administration, including the mucus layer protecting the ocular surface. For this reason, antibiotic eye drops must be used multiple times per day to prevent and treat ocular infections. Frequent eye drop use is inconvenient for patients, and lack of adherence to prescribed dosing regimens limits treatment efficacy and contributes to antibiotic resistance. Here, we describe an ion-pairing approach used to create an insoluble moxifloxacin-pamoate (MOX-PAM) complex for formulation into mucus-penetrating nanosuspension eye drops (MOX-PAM NS). The MOX-PAM NS provided a significant increase in ocular drug absorption, as measured by the area under the curve in cornea tissue and aqueous humor, compared to Vigamox in healthy rats. Prophylactic and treatment efficacy were evaluated in a rat model of ocular Staphylococcus aureus infection. A single drop of MOX-PAM NS was more effective than Vigamox, and completely prevented infection. Once a day dosing with MOX-PAM NS was similar, if not more effective, than three times a day dosing with Vigamox for treating S. aureus infection. The MOX-PAM NS provided increased intraocular antibiotic absorption and improved prevention and treatment of ocular keratitis, and the formulation approach is highly translational and clinically relevant.
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Affiliation(s)
- Aditya Josyula
- The Center for Nanomedicine, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Revaz Omiadze
- The Center for Nanomedicine, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kunal Parikh
- The Center for Nanomedicine, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Center for Bioengineering Innovation and DesignJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Pranjali Kanvinde
- The Center for Nanomedicine, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Matthew B. Appell
- The Center for Nanomedicine, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Pharmacology and Molecular SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Pratikkumar Patel
- Department of Pharmaceutical Sciences, The Daniel K. Inouye College of PharmacyUniversity of Hawaii HiloHawaiiUSA
| | - Hiwa Saeed
- Department of Pharmaceutical Sciences, The Daniel K. Inouye College of PharmacyUniversity of Hawaii HiloHawaiiUSA
| | - Yogesh Sutar
- Department of Pharmaceutical Sciences, The Daniel K. Inouye College of PharmacyUniversity of Hawaii HiloHawaiiUSA
| | - Nicole Anders
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Ping He
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Peter J. McDonnell
- Department of Ophthalmology, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Justin Hanes
- The Center for Nanomedicine, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Ophthalmology, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Pharmacology and Molecular SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins UniversityBaltimoreMarylandUSA
- Department of Environmental Health SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Abhijit A. Date
- The Center for Nanomedicine, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Ophthalmology, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Pharmaceutical Sciences, The Daniel K. Inouye College of PharmacyUniversity of Hawaii HiloHawaiiUSA
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of MedicineUniversity of Hawaii ManoaHonoluluHawaiiUSA
| | - Laura M. Ensign
- The Center for Nanomedicine, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Ophthalmology, The Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Pharmacology and Molecular SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins UniversityBaltimoreMarylandUSA
- Department of Gynecology and Obstetrics and Division of Infectious DiseasesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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27
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Koudouna E, Huertas-Bello M, Rodriguez CN, Consuelo Henao S, Navarrete ML, Avila MY. Genipin in an Ex Vivo Corneal Model of Bacterial and Fungal Keratitis. Transl Vis Sci Technol 2021; 10:31. [PMID: 34436544 PMCID: PMC8399543 DOI: 10.1167/tvst.10.9.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/06/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose To determine whether genipin (a natural crosslinker) could reduce the colonization and proliferation of bacteria and fungi in an ex vivo model of corneal infection. Methods This study, using an ex vivo model of bacterial and fungal keratitis, investigated the antimicrobial efficacy of genipin crosslinking. Excised corneoscleral buttons were wounded by scalpel incision and subsequently infected with Staphylococcus aureus, Pseudomonas aeruginosa, or Candida albicans. After inoculation, corneas were treated with genipin for 24 hours at 37°C. Histologic examinations were carried out, and the number of viable colony-forming units (CFU)/cornea was determined. Results Genipin exerts bactericidal action against S. aureus and P. aeruginosa, as well as fungicidal action against C. albicans and significantly reduced the CFU compared to contralateral eyes that received saline treatment (P < 0.05). Conclusions These data identify genipin as a novel ocular antimicrobial agent that has the potential to be incorporated into the therapeutic armamentarium against microbial keratitis. Translational Relevance This study provided evidence for the antimicrobial and antifungal properties of genipin as an alternative crosslinker that could be used in the management of infectious keratitis.
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Affiliation(s)
- Elena Koudouna
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogota Colombia
- Structural Biophysics Group, School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, UK
| | - Marcela Huertas-Bello
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogota Colombia
| | - Cristian Nicolas Rodriguez
- Department of Microbiology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogota Colombia
| | - Sandra Consuelo Henao
- Department of Microbiology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogota Colombia
| | - Myriam Lucia Navarrete
- Department of Microbiology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogota Colombia
| | - Marcel Yecid Avila
- Department of Ophthalmology, Faculty of Medicine, Bogota DC, Universidad Nacional de Colombia, Bogota Colombia
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28
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Liu C, Ding B, Ji J, Wang Z, Chen H, Cao W. Microbial Spectrum and Resistance Patterns in Ocular Infections: A 15-Year Review in East China. Infect Drug Resist 2021; 14:2165-2171. [PMID: 34140784 PMCID: PMC8203601 DOI: 10.2147/idr.s314647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/18/2021] [Indexed: 01/21/2023] Open
Abstract
Purpose To report antibiotic resistance rates and trends of common ocular isolates collected over a 15-year period. Methods We collected 3533 isolates from July 1, 2005 to July 31, 2020. Antibiotic sensitivity was determined according to the guidelines of the Clinical and Laboratory Standards Institute. Chi-squared (χ2) test was used to analyze changes in antibiotic susceptibility over 15 years. Results Among the 3533 isolates, the predominant pathogens were the staphylococcal species. Methicillin resistance was observed in 381 Staphylococcus aureus (S. aureus) isolates (46.4%) and 1888 coagulase-negative staphylococci (CoNS) isolates (61.1%), and methicillin-resistant (MR) isolates had a high probability of concurrent resistance to fluoroquinolones and aminoglycosides. The mean percentage of resistance in staphylococcal isolates did not reach statistical significance across patient age groups (P = 0.87). Methicillin resistance did not increase in the CoNS (P = 0.546) isolates, and resistance to methicillin slightly decreased among S. aureus (P = 0.04) isolates over 15 years. Additional exploratory analysis revealed a small decrease in resistance to tobramycin (P = 0.01) and chloramphenicol (P < 0.001) among the CoNS isolates. All staphylococcal isolates were susceptible to vancomycin. Conclusion Staphylococci were the most common microorganisms responsible for causing ocular infections. Antibiotic resistance was high among staphylococci, with nearly half of these isolates were resistant to methicillin and these had a high probability of concurrent resistance among MR staphylococci to other antibiotics. Overall, ocular resistance did not significantly change during the 15-year study period. We conclude that continued surveillance of antibiotic resistance provides critical data to guide antibiotic selection.
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Affiliation(s)
- Chunhong Liu
- Clinical Laboratory, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Baixing Ding
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian Ji
- Clinical Laboratory, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhujian Wang
- Clinical Laboratory, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Huiwen Chen
- Clinical Laboratory, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenjun Cao
- Clinical Laboratory, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China.,Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
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29
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Feizi S, Karimian F, Esfandiari H. Corneal crosslinking for the treatment of infectious keratitis: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1933440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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30
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Petrillo F, Pignataro D, Di Lella FM, Reibaldi M, Fallico M, Castellino N, Parisi G, Trotta MC, D’Amico M, Santella B, Folliero V, Della Rocca MT, Rinaldi M, Franci G, Avitabile T, Galdiero M, Boccia G. Antimicrobial Susceptibility Patterns and Resistance Trends of Staphylococcus aureus and Coagulase-Negative Staphylococci Strains Isolated from Ocular Infections. Antibiotics (Basel) 2021; 10:antibiotics10050527. [PMID: 34063711 PMCID: PMC8147806 DOI: 10.3390/antibiotics10050527] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 11/16/2022] Open
Abstract
Ocular bacterial infections represent a serious problem that affecting people of all age and genders. These infections can lead to visual impairment and blindness if not properly treated. The current study evaluates the antimicrobial resistance profiles and the resistance trend of both Staphylococcus aureus (S. aureus) and coagulase-negative staphylococci (CoNS), the main pathogens involved in eye infections. A total of 322 isolates of S. aureus and CoNS, were collected from patients with bacterial conjunctivitis and keratitis at the "Luigi Vanvitelli" University Hospital of Campania in Naples, Italy, between 2017 and 2020. The isolated bacteria showed a high percentage of resistance to methicillin and other antibiotics commonly used for the treatment of ocular infections. Trends in antibiotic resistance were not encouraging, recording-especially among CoNS strains-an increase of more than 20% in resistance to methicillin and aminoglycosides during the study period. Instead, the resistance rates to tetracycline had a significant decrease in CoNS isolates while no changes in their susceptibility to fluoroquinolones and macrolides were observed. However, all isolates showed no resistance to trimethoprim/sulfamethoxazole and chloramphenicol. In this scenario, preventive identification of the infection causative agents and the evaluation of the antimicrobial susceptibility patterns are essential to set up an ocular infection effective drug treatment and also prevent antibiotic resistance.
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Affiliation(s)
- Francesco Petrillo
- Section of Ophthalmology, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (F.P.); (M.F.); (N.C.); (T.A.)
| | - Danilo Pignataro
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (D.P.); (F.M.D.L.); (B.S.); (V.F.); (M.T.D.R.)
| | - Federica Maria Di Lella
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (D.P.); (F.M.D.L.); (B.S.); (V.F.); (M.T.D.R.)
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122 Turin, Italy; (M.R.); (G.P.)
| | - Matteo Fallico
- Section of Ophthalmology, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (F.P.); (M.F.); (N.C.); (T.A.)
| | - Niccolò Castellino
- Section of Ophthalmology, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (F.P.); (M.F.); (N.C.); (T.A.)
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, 10122 Turin, Italy; (M.R.); (G.P.)
| | - Maria Consiglia Trotta
- Department of Experimental Medicine, Division of Pharmacology, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (M.D.)
| | - Michele D’Amico
- Department of Experimental Medicine, Division of Pharmacology, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.C.T.); (M.D.)
| | - Biagio Santella
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (D.P.); (F.M.D.L.); (B.S.); (V.F.); (M.T.D.R.)
| | - Veronica Folliero
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (D.P.); (F.M.D.L.); (B.S.); (V.F.); (M.T.D.R.)
| | - Maria Teresa Della Rocca
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (D.P.); (F.M.D.L.); (B.S.); (V.F.); (M.T.D.R.)
| | - Michele Rinaldi
- Department of Ophthalmology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Teresio Avitabile
- Section of Ophthalmology, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy; (F.P.); (M.F.); (N.C.); (T.A.)
| | - Marilena Galdiero
- Section of Microbiology and Virology, University Hospital “Luigi Vanvitelli”, 80138 Naples, Italy; (D.P.); (F.M.D.L.); (B.S.); (V.F.); (M.T.D.R.)
- Correspondence: (M.G.); (G.B.)
| | - Giovanni Boccia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
- Correspondence: (M.G.); (G.B.)
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Youssef AAA, Cai C, Dudhipala N, Majumdar S. Design of Topical Ocular Ciprofloxacin Nanoemulsion for the Management of Bacterial Keratitis. Pharmaceuticals (Basel) 2021; 14:210. [PMID: 33802394 PMCID: PMC7998883 DOI: 10.3390/ph14030210] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Bacterial keratitis (BK) is a critical ocular infection that can lead to serious visual disability. Ciprofloxacin (CIP), moxifloxacin (MOX), and levofloxacin (LFX) have been accepted as monotherapies by the US Food and Drug Administration for BK treatment. CIP is available commercially at 0.3% w/v concentration as an ophthalmic solution and as an ointment for ocular delivery. Because of solubility issues at physiological pH, CIP precipitation can occur at the corneal surface post instillation of the solution dosage form. Consequently, the ocular bioavailability of CIP is reduced. The ointment dosage form is associated with side effects such as blurred vision, itching, redness, eye discomfort, and eye dryness. This study aimed to design a CIP loaded nanoemulsion (NE; CIP-NE) to facilitate drug penetration into the corneal layers for improved therapeutic outcomes as well as to overcome the drawbacks of the current commercial ophthalmic formulations. CIP-NE formulations were prepared by hot homogenization and ultrasonication, using oleic acid (CIP-O-NE) and Labrafac® Lipophile WL 1349 (CIP-L-NE) as the oily phase, and Tween® 80 and Poloxamer 188 as surfactants. Optimized CIP-NE was further evaluated with respect to in vitro release, ex vivo transcorneal permeation, and moist heat sterilization process, using commercial CIP ophthalmic solution as a control. Optimized CIP-O-NE formulation showed a globule size, polydispersity index, and zeta potential of 121.6 ± 1.5 nm, 0.13 ± 0.01, and -35.1 ± 2.1 mV, respectively, with 100.1 ± 2.0% drug content and was spherical in shape. In vitro release and ex vivo transcorneal permeation studies exhibited sustained release and a 2.1-fold permeation enhancement, respectively, compared with commercial CIP ophthalmic solution. Autoclaved CIP-O-NE formulation was found to be stable for one month (last time-point tested) at refrigerated and room temperature. Therefore, CIP-NE formulation could serve as an effective delivery system for CIP and could improve treatment outcomes in BK.
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Affiliation(s)
- Ahmed Adel Ali Youssef
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Chuntian Cai
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Narendar Dudhipala
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
| | - Soumyajit Majumdar
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
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Ayehubizu Z, Mulu W, Biadglegne F. Common bacterial causes of external ocular infections, associated risk factors and antibiotic resistance among patients at ophthalmology unit of Felege Hiwot Referral Hospital, Northwest Ethiopia: a cross-sectional study. J Ophthalmic Inflamm Infect 2021; 11:7. [PMID: 33644821 PMCID: PMC7917034 DOI: 10.1186/s12348-021-00238-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ocular infections are a serious public health problem in Ethiopia with increased incidence of morbidity and blindness. Empirical therapy with topical ophthalmic broad spectrum antibiotic formulations is also a prevailing practice. The aim of this study was to determine the bacterial causes of external ocular infections (EOIs), antimicrobial resistance and its associated risk factors among patients at Felege Hiwot Referral Hospital, Northwest Ethiopia. METHODS A hospital based cross - sectional study was conducted from 1 February to 30 April 2019. Patients with EOIs were consecutively included from 1 February to 30 April, 2019. Data were collected using structured questionnaire by face-to-face interview and complemented with patient card review. Conjunctival, eyelid margin and lacrimal sac swabs were collected aseptically. Bacterial species were identified using standard bacteriological techniques. Antimicrobial susceptibility testing was done using Kirby-Bauer disk diffusion method. Binary logistic regression analysis was calculated to identify the factors associated with EOIs. P.value (p) < < 0.05 was considered as statistically significant. RESULTS A total of 360 patients took part in the study and majority of them were males (64.7%). The median age of study participants was 59.5 years. Overall, 208(57.8%) (95%CI = 52.6- - 62.8%) of patients had culture confirmed bacterial EOIs. The proportion of culture confirmed EOIs was 60.4% among conjunctivitis cases and 55.8% among blepharitis. Ocular trauma (P < < 0.001), ocular disease (P < < 0.001) and having eye allergy (P = 0.027) were significantly associated with EOIs. The most frequent isolates were S. aureus (37%), K. pneumoniae (13.5%), Proteus(7.2%) spp., S. pneumoniae (4.3%), Citrobacter spp. (3.4%) and P. aeruginosa (2.9%). Gram positive isolates were resistant to penicillin in 87% and ampicillin in 86.2%. Gram negative isolates were resistant to ampicillin (87.5%). P.aeruginosa isolates (85.3%) were resistant to piperacillin and 50% were resistant to tobramycin. Overall, 45.2% of the isolates were multi-drug resistant. The percentage of multi-drug resistance was 80% among Enterobacter isolates and 64.3% among K. pneumoniae. CONCLUSIONS Bacterial external ocular infections linked with multi-drug resistance and resistance to penicillin, ampicillin, tetracycline and piperacillin are high. Therefore, empirical treatment of eye infections in the study area needs to be monitored by regular antimicrobial-susceptibility testing of isolates.
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Affiliation(s)
- Zimam Ayehubizu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Fantahun Biadglegne
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Shaeri M, Nazari-Alam A, Fathizadeh H, Moniri R, Akbari H, Mansoori M, Aghajani A. Bacterial Etiology and Antibiotic Susceptibility of Conjunctivitis Patients' Isolates in Kashan, Iran. Adv Biomed Res 2021; 9:49. [PMID: 33457332 PMCID: PMC7792886 DOI: 10.4103/abr.abr_118_20] [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: 05/22/2020] [Revised: 06/09/2020] [Accepted: 07/08/2020] [Indexed: 11/04/2022] Open
Abstract
Background Conjunctivitis is a very common ocular disease, which can be caused by a wide variety of microorganisms. This study was aimed to assess the bacterial etiology and antibiotic susceptibility of conjunctivitis patients' isolates from Central Iran. Materials and Methods This study was performed in 180 patients referred to the Department of Ophthalmology in Kashan University with symptoms of conjunctivitis from July 2017 to December 2017. To detect of different bacteria, Gram staining, morphological characterization, pigment production, biochemical characteristics, coagulase test, optochin and PYR tests, oxidase test, and culture on specific media were used. Antibiotic susceptibility of the bacteria isolated was done using the Kirby-Bauer method. Methicillin resistance in staphylococci isolated from the patients was identified using polymerase chain reaction technique. Results Of the 195 bacteria isolated, about 81.5% were Staphylococcus epidermidis and Staphylococcus aureus and the remaining 19.5% included other species. In the present study, Pseudomonas aeruginosa was most resistant to ampicillin. In the case of S. epidermidis and S. aureus, the highest resistance was observed against erythromycin and the least resistance was against rifampicin and linezolid. Conclusion In this study, S. aureus and S. epidermidis are the most common causes of conjunctivitis in all age groups, however, this condition decreases with age and is also influenced by other factors such as season and weather conditions. The results of this study can be helpful in planning more prudent treatment strategies for patients with conjunctivitis in Kashan.
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Affiliation(s)
- Mahdi Shaeri
- Department of Ophthalmology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Nazari-Alam
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Department of Physiology Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Hadis Fathizadeh
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Rezvan Moniri
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hosein Akbari
- Department of Epidemiology and Biostatistics, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Mansooreh Mansoori
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali Aghajani
- Department of Parasitology and Mycology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Meretoudi A, Banti CN, Siafarika P, Kalampounias AG, Hadjikakou SK. Tetracycline Water Soluble Formulations with Enhanced Antimicrobial Activity. Antibiotics (Basel) 2020; 9:E845. [PMID: 33256054 PMCID: PMC7760183 DOI: 10.3390/antibiotics9120845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
The negligible water solubility of tetracycline (TC), a well-known antibiotic of clinical use, is the major disadvantage for its oral administration. With the aim to improve the water solubility of TC, the micelles of formulae SLS@TC and CTAB@TC (SLS = sodium lauryl sulphate and CTAB = cetrimonium bromide) were synthesized. The micelles SLS@TC and CTAB@TC were characterized by melting point (m.p.), thermogravimetric differential thermal analysis (TG-DTA), differential scanning calorimetry (DTG/DSC), attenuated total reflection spectroscopy (FT-IR-ATR), ultra-violet visible (UV/vis) spectroscopy, proton nucleus magnetic resonance (1H-NMR) spectroscopy, and the ultrasonically-induced biregringence technique. The antimicrobial activity of SLS@TC and CTAB@TC was evaluated, by means of minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and inhibition zone (IZ), against the Gram negative bacterial strains Pseudomonas aeruginosa (P. aeruginosa) and Escherichia coli (E. coli) and the Gram positive ones of the genus of Staphylococcus epidermidis (S. epidermidis) and Staphylococcus aureus (S. aureus). Generally, both micelles show better activity than that of TC against the microbial strains tested. Thus, the MIC value of CTAB@TC is 550-fold higher than that of free TC against S. epidermidis. Despite the stronger activity of CTAB@TC than SLS@TC against both Gram negative and Gram positive microbes, SLS@TC is classified as a bactericidal agent (in that it eliminates 99.9% of the microbes), in contrast to CTAB@TC, which is bacteriostatic one (inhibits, but does not kill the organisms). The toxicity of SLS@TC and CTAB@TC was evaluated against human corneal eukaryotic cells (HCECs). Moreover, SLS@TC and CTAB@TC exhibit low in vivo toxicity against Artemia salina, even at concentrations up to threefold higher than those of their MICmax. Therefore, SLS@TC and CTAB@TC can be candidates for the development of new antibiotics.
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Affiliation(s)
- A. Meretoudi
- Inorganic Chemistry Laboratory, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece;
| | - C. N. Banti
- Inorganic Chemistry Laboratory, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece;
| | - P. Siafarika
- Physical Chemistry Laboratory, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece;
| | - A. G. Kalampounias
- Physical Chemistry Laboratory, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece;
- Institute of Materials Science and Computing, University Research Center of Ioannina (URCI), 45110 Ioannina, Greece
| | - S. K. Hadjikakou
- Inorganic Chemistry Laboratory, Department of Chemistry, University of Ioannina, 45110 Ioannina, Greece;
- Institute of Materials Science and Computing, University Research Center of Ioannina (URCI), 45110 Ioannina, Greece
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Gutiérrez-Abejón E, Herrera-Gómez F, Ayestarán-Martínez IJ, Álvarez FJ. Trend in the use of topical ocular anti-infectives in a region of Spain between 2015 and 2019: a population-based registry study. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:453-458. [PMID: 33103400 PMCID: PMC7712348 DOI: 10.37201/req/096.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study presents the use and trends of use of topical ocular anti-infectives into a European population in the current decade (2015 to 2019) with an analysis of concomitant use with other ocular drugs, considering distribution by age and gender. METHODS A population-based registry study was carried out to assess the ocular anti-infectives use from 2015 to 2019. All dispensations of these medicines at pharmacies in the largest region of Spain, Castile and León, was accessed. The number of packages dispensed, the percentage of the population under treatment, diagnosis, and the concomitant use with other ocular medicines was observed. For all analyses, the population distribution by age and gender was considered. RESULTS An average of 198,000 packages of topical ocular anti-infectives were dispensed annually to 5.38% of the population, and more commonly for women than for men (5.83% vs. 4.91%). Children and the elderly used more these medicines. Tobramycin, alone or in combination, accounted for more than 68% of the total consumption (135,000 packages per year), and was the most widely used anti-infective in almost all identified diagnoses. Conjunctivitis (50.12%), and stye (11.51%) were the most frequent diagnoses. The consumption of ocular anti-infectives increased by 8.23% from 2015 to 2019, and more among men than in women. CONCLUSIONS Our findings show that the most used topical ocular anti-infective was tobramycin, in accordance with the clinical practice guidelines recommendations. However, ocular infections are sometimes treated empirically, especially conjunctivitis.
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Affiliation(s)
- E Gutiérrez-Abejón
- Eduardo Gutiérrez-Abejón, Pharmacological Big Data Laboratory, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
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Mencucci R, Favuzza E, Bottino P, Mazzantini C, Zanotto E, Pellegrini-Giampietro DE, Landucci E. A new ophthalmic formulation containing antiseptics and dexpanthenol: In vitro antimicrobial activity and effects on corneal and conjunctival epithelial cells. Exp Eye Res 2020; 201:108269. [PMID: 32980315 DOI: 10.1016/j.exer.2020.108269] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/01/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
Antibiotic resistance is increasing even in ocular pathogens, therefore the interest towards antiseptics in Ophthalmology is growing. The aim of this study was to analyze the in vitro antimicrobial efficacy and the in vitro effects of an ophthalmic formulation containing hexamidine diisethionate 0.05%, polyhexamethylene biguanide (PHMB) 0.0001% disodium edetate (EDTA) 0.01%, dexpanthenol 5% and polyvinyl alcohol 1.25% (Keratosept, Bruschettini, Genova, Italy) on cultured human corneal and conjunctival cells. The in vitro antimicrobial activity was tested on Staphylococcus aureus, Methicillin-Resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Streptococcus pneumoniae, Streptococcus pyogenes and Streptococcus mitis. For each microbial strain 10 μL of a 0.5 MacFarland standardized bacterial inoculum were incubated at 25 °C with 100 μL of ophthalmic solution for up to 6 h. After different periods of time, samples were inoculated on blood agar with 5% sheep blood. Moreover, a 0.5 MacFarland bacterial inoculum was seeded in triplicate on Mueller-Hinton Agar or on Mueller-Hinton Fastidious Agar; then a cellulose disc soaked with 50 μL of ophthalmic solution was applied on the surface of agar and plates were incubated for 18 h at 37 °C, in order to evaluate the inhibition of bacterial growth around the disc. Human corneal and conjunctival epithelial cells in vitro were incubated for 5, 10 and 15 min with Keratosept or its components. The cytotoxicity was assessed through the release of cytoplasmic enzyme lactate dehydrogenase (LDH) into the medium immediately after exposure to the drugs; the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was performed to evaluate the metabolic cell activity. Our results show that Keratosept ophthalmic solution gave an average logarithmic (log) reduction of bacterial load of 2.14 ± 0.35 within 6 h of exposure (p-value < 0.05 versus control saline solution). On agar plates, all microbial strains, excluding P. Aeruginosa, showed an inhibition zone of growth around the Keratosept-soaked discs. Keratosept and its components after 5 and 10 min did not show any cytotoxic effect on cultured corneal and conjunctival cells, and only after 15 min a significant reduction of cell viability and an increase of cytotoxicity compared to control (vehicle) was seen; dexpanthenol 5% and polyvinyl alcohol accelerated the wounding of corneal cells in vitro. In conclusion, Keratosept showed good antimicrobial activity on the tested strains; the ophthalmic solution and its components were safe and non-toxic for the corneal and conjunctival epithelial cells for 5 and 10 min at the concentrations analyzed, and dexpanthenol 5% and polyvinyl alcohol promoted the wounding of corneal cells.
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Affiliation(s)
- Rita Mencucci
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Eleonora Favuzza
- Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Paolo Bottino
- AOU Città della Salute e della Scienza di Torino, Microbiology and Virology Unit, Turin, Italy.
| | - Costanza Mazzantini
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| | - Elisa Zanotto
- AOU Città della Salute e della Scienza di Torino, Microbiology and Virology Unit, Turin, Italy.
| | - Domenico E Pellegrini-Giampietro
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
| | - Elisa Landucci
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Chalder RH, Knott T, Rushton JO, Nikolic-Pollard D. Changes in antimicrobial resistance patterns of ocular surface bacteria isolated from horses in the UK: An eight-year surveillance study (2012-2019). Vet Ophthalmol 2020; 23:950-956. [PMID: 32961021 DOI: 10.1111/vop.12827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/27/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify temporal changes in antimicrobial resistance of ocular surface bacteria isolated from clinically symptomatic equine eyes in the South West of the UK. STUDY DESIGN Retrospective. METHODS Clinical and laboratory records of horses treated for suspected bacterial ocular surface disease (ulcerative and non-ulcerative) at a single facility between January 2011 and December 2019 were reviewed. Cases were included if they underwent ocular surface sampling, aerobic bacterial culture, and antimicrobial susceptibility testing. Cases were split into two time periods based on when sampling occurred: "early" (2012-2015) and "late" (2016-2019) to enable identification of temporal trends in resistance to chloramphenicol, gentamicin, fusidic acid, neomycin, cloxacillin, ofloxacin, and polymyxin B. RESULTS A total of 125 samples from 110 horses were included in analyses. Culture-positive isolates were identified in 76/110 (60.8%) samples. Principal isolates included Staphylococci spp. (n = 45; 64.3%), Streptococci spp. (n = 14; 20%), and Enterobacter spp. (n = 11; 15.7%). There was a significant increase in resistance to chloramphenicol over time (P = .007) and a decrease in resistance to ofloxacin that approached significance (P = .059). Chloramphenicol (100%) and gentamicin (85.7%) had the highest overall in-vitro efficacy during the early and late periods, respectively. There was no significant difference in the type of bacteria isolated across the two time periods. CONCLUSIONS These results suggest a potential increase in resistance to chloramphenicol among bacteria isolated from the ocular surface of horses in the South West UK, reinforcing the value of surveillance to guide the empirical use of antimicrobials.
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Prevalence and Antibiotic Resistance Patterns of Ocular Bacterial Strains Isolated from Pediatric Patients in University Hospital of Campania “Luigi Vanvitelli,” Naples, Italy. Int J Microbiol 2020. [DOI: 10.1155/2020/8847812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Eye infections caused by bacteria are a serious public health problem among pediatric patients. These diseases, if not properly treated, can cause blindness and impaired vision. The study aimed to evaluate the antimicrobial resistance profiles of the main pathogens involved in eye infections. This study involved pediatric patients enrolled at the “Luigi Vanvitelli” University Hospital of Campania in Naples, Italy, between 2017 and 2019. Of a total of 228 pediatric patients, 73 (32%) tested positive for bacterial infection. In terms of strain distribution, 85% were Gram-positive bacteria, while 15% were Gram-negative bacteria. The most frequently isolated strains were coagulase-negative Staphylococci (60.4%), followed by Staphylococcus aureus (16.4%). The isolated bacteria showed a significant percentage of resistance to multiple antibiotics. Therefore, the identification of the causal bacteria and antimicrobial sensitivity tests are mandatory to select the effective drug for the treatment of eye infections and prevent the development of antibiotic-resistant bacteria.
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Youssef A, Dudhipala N, Majumdar S. Ciprofloxacin Loaded Nanostructured Lipid Carriers Incorporated into In-Situ Gels to Improve Management of Bacterial Endophthalmitis. Pharmaceutics 2020; 12:E572. [PMID: 32575524 PMCID: PMC7356176 DOI: 10.3390/pharmaceutics12060572] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022] Open
Abstract
Bacterial endophthalmitis (BE) is a potentially sight-threatening inflammatory reaction of the intraocular fluids or tissues caused by bacteria. Ciprofloxacin (CIP) eye drops are prescribed as first-line therapy in BE. However, frequent administration is necessary due to precorneal loss and poor ocular bioavailability. The objective of the current research was to prepare CIP containing nanostructured lipid carriers (CIP-NLCs) loaded an in situ gel system (CIP-NLC-IG) for topical ocular administration for enhanced and sustained antibacterial activity in BE treatment. CIP-NLCs were prepared by the hot homogenization method and optimized based on physicochemical characteristics and physical stability. The optimized CIP-NLC formulation was converted into CIP-NLC-IG with the addition of gellan gum as a gelling agent. Furthermore, optimized CIP-NLC and CIP-NLC-IG were evaluated for in vitro release and ex vivo transcorneal permeation studies, using commercial CIP ophthalmic solution (CIP-C) as the control. The optimized CIP-NLC formulation showed particle size, polydispersity index, zeta potential, assay and entrapment efficiency of 193.1 ± 5.1 nm, 0.43 ± 0.01, -32.5 ± 1.5 mV, 99.5 ± 5.5 and 96.3 ± 2.5%, respectively. CIP-NLC-IG with 0.2% w/v gellan gum showed optimal viscoelastic characteristics. The in vitro release studies demonstrated sustained release of CIP from CIP-NLC and CIP-NLC-IG formulations over a 24 h period. Transcorneal flux and permeability increased 4 and 3.5-fold, and 2.2 and 1.9-fold from CIP-NLC and CIP-NLC-IG formulations, respectively, when compared to CIP-C. The results demonstrate that CIP-NLC-IG could be considered as an alternate delivery system to prolong the residence time on the ocular surface after topical administration. Thus, the current CIP ophthalmic formulations may exhibit improved ocular bioavailability and prolonged antibacterial activity, which may improve therapeutic outcomes in the treatment of BE.
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Affiliation(s)
- Ahmed Youssef
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh 33516, Egypt;
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA;
| | - Narendar Dudhipala
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA;
| | - Soumyajit Majumdar
- Department of Pharmaceutics and Drug Delivery, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA;
- Research Institute of Pharmaceutical Sciences, University of Mississippi, Oxford, MS 38677, USA
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Abstract
BACKGROUND Infectious keratitis is an infection of the cornea that can be caused by bacteria, viruses, fungi, protozoa, or parasites. It may be associated with ocular surgery, trauma, contact lens wear, or conditions that cause deficiency or loss of corneal sensation, or suppression of the immune system, such as diabetes, chronic use of topical steroids, or immunomodulatory therapies. Photoactivated chromophore for collagen cross-linking (PACK-CXL) of the cornea is a therapy that has been successful in treating eye conditions such as keratoconus and corneal ectasia. More recently, PACK-CXL has been explored as a treatment option for infectious keratitis. OBJECTIVES To determine the comparative effectiveness and safety of PACK-CXL with standard therapy versus standard therapy alone for the treatment of bacterial keratitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 7); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Science Information database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 8 July 2019. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) of PACK-CXL for bacterial keratitis. We included quasi-RCTs and CCTs as we anticipated that there would not be many RCTs eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors working independently selected studies for inclusion in the review, assessed trials for risk of bias, and extracted data. The primary outcome was proportion of participants with complete healing at four to eight weeks. Secondary outcomes included visual acuity, morphology, adverse events, and treatment failure at four to eight weeks. MAIN RESULTS We included three trials (two RCTs and one quasi-RCT) in this review for a total of 59 participants (59 eyes) with bacterial keratitis. Trials were all single-center and were conducted in Egypt, Iran, and Thailand between 2010 and 2014. It is very uncertain whether PACK-CXL with standard antibiotic therapy is more effective than standard antibiotic therapy alone for re-epithelialization and complete healing (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.88 to 2.66; participants = 15). We judged the certainty of the evidence to be very low due to the small sample size and high risk of selection and performance bias. The high risk of selection bias reflects the overall review. Masking of participants was not possible for the surgical arm. No participant had a best-corrected visual acuity of 20/100 or better at eight weeks (very low certainty evidence). There is also no evidence that use of PACK-CXL with standard therapy results in fewer instances of treatment failure than standard therapy alone (RR 0.50, 95% CI 0.05 to 4.98; participants = 32). We judged the certainty of evidence to be low due to the small sample size and high risk of selection bias. There were no adverse events reported at 14 days (low certainty evidence). Data on other outcomes, such as visual acuity and morphological characteristics, could not be compared because of variable time points and specific metrics. AUTHORS' CONCLUSIONS The current evidence on the effectiveness of PACK-CXL for bacterial keratitis is of low certainty and clinically heterogenous in regard to outcomes. There are five ongoing RCTs enrolling 1136 participants that may provide better answers in the next update of this review. Any future research should include subgroup analyses based on etiology. A core outcomes set would benefit healthcare decision-makers in comparing and understanding study data.
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Affiliation(s)
- Shadi A Davis
- Ophthalmology and Ocuplastics Surgery, Cheyenne VA Hospital, Cheyenne, Wyoming, USA
| | - Renee Bovelle
- Department of Ophthalmology, Howard University, Washington, DC, USA
| | - Genie Han
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John Kwagyan
- General Clinical Research Center, Howard University, Washington, DC, USA
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Mohammed AA, Ali MM, Zenebe MH. Bacterial etiology of ocular and periocular infections, antimicrobial susceptibility profile and associated factors among patients attending eye unit of Shashemene comprehensive specialized hospital, Shashemene, Ethiopia. BMC Ophthalmol 2020; 20:124. [PMID: 32228528 PMCID: PMC7106738 DOI: 10.1186/s12886-020-01398-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Eye infection is a public health problem in developing countries including Ethiopia. Bacteria are major causative agents of eye infections that can lead to loss of vision. The objective of this study was to determine bacterial etiology of ocular and periocular infections, antimicrobial susceptibility profile and associated factors among patients who visited the eye unit of Shashamane Comprehensive Specialized Hospital (SCSH). Method A hospital-based cross-sectional study was conducted at SCSH from September 1, 2018, to March 30, 2019. Specimens from the ocular and periocular areas were collected from a total of 332 patients who visited the eye unit. Specimens were inoculated on blood agar, chocolate agar, MacConkey agar, and mannitol salt agar. Isolated bacteria were identified by a series of biochemical tests using the standard bacteriological method. Antimicrobial susceptibility test was performed according to the Clinical and Laboratory Standard Institute by disk diffusion method. Factors that could be associated with ocular and periocular infection were collected by using structured questionnaire. Data analysis was done using SPSS version 22.0 software package. A P value less than 0.05 was considered statistically significant. Result Out of the total 332 study participants with ocular and periocular infections, 198(60%) were culture positive. The proportion of Gram-positive and Gram-negative bacteria were 135(68.2%) and 63(31.8%) respectively. Among Gram-positive bacteria, Staphylococcus aureus were predominant. Among Gram-negative bacteria, Escherichia coli were predominant. Most S. aureus were resistant to penicillin. Conclusion Majority of ocular and periocular infections in this study were caused by bacteria; Gram-positive bacteria were responsible for most cases.
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Affiliation(s)
| | - Musa Mohammed Ali
- Hawassa University College of Medicine and Health Sciences department of Medical laboratory, Awassa, Ethiopia
| | - Mengistu Hailemariam Zenebe
- Hawassa University College of Medicine and Health Sciences department of Medical laboratory, Awassa, Ethiopia
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In Vitro Biofilm Formation and Antibiotic Susceptibility Patterns of Bacteria from Suspected External Eye Infected Patients Attending Ophthalmology Clinic, Southwest Ethiopia. Int J Microbiol 2020; 2020:8472395. [PMID: 32318110 PMCID: PMC7155758 DOI: 10.1155/2020/8472395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/10/2020] [Accepted: 02/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background Ocular disease with its complications is a major public health problem which has significant impacts on the quality of life particularly in developing countries. An eye infection due to bacterial agents can lead to reduced vision and blindness. This study was aimed to assess the antimicrobial susceptibility pattern and biofilm-forming potential of bacteria isolated from suspected external eye infected patients in Jimma. Method A cross-sectional facility-based study was conducted on 319 suspect patients with external eye infections from March to June 2017 at Jimma University Medical Center (JUMC) Ophthalmology Department in Ethiopia. External ocular specimens were collected and standard operating procedures were followed to handle and culture throughout the study period. Antimicrobial susceptibility was determined by the disk diffusion method according to CLSI guidelines. Microtiter (96 wells) plate method was used to screen biofilm formation by ELISA reader at 570 nm. Results Out of 319 study participants with an external eye infection, the prevalence of bacterial pathogens was 46.1%. The predominant bacterial isolates were coagulase-negative staphylococcus (CoNS) (27.7%) followed by Staphylococcus aureus (19.7%). Among Gram-negative groups, Pseudomonas aeruginosa (6.8%) was the leading isolate. Increased antimicrobial resistance was observed for tetracycline (64%), erythromycin (66.7%), and penicillin (77.1%). Amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin were the most effective drugs for external eye infections due to susceptibility ranging from 70 to 100% among both Gram-negative and Gram-positive groups. Methicillin-resistant S. aureus (MRSA) accounted for 13.8%. Multidrug resistance (MDR) accounted for 68.7%. The overall biofilm formation rate of bacterial ocular pathogens was 66.1%, where P. aeruginosa (40%), CoNS (34.1%), and S. aureus (31%) formed strong biofilm phenotype. Conclusion The prevalence rate of bacterial isolates was high. Almost all bacterial isolates were resistant to at least one or more drugs. MDR pathogens were observed increasingly among biofilm formers or vice versa.
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Badger-Emeka L, Emeka P, Aldossari S, Khalil H. Terfezia claveryi and Terfezia boudieri extracts: An antimicrobial and molecular assay on clinical isolates associated with eye infections. Pharmacogn Mag 2020. [DOI: 10.4103/pm.pm_199_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kłos M, Pomorska-Wesołowska M, Romaniszyn D, Chmielarczyk A, Wójkowska-Mach J. Epidemiology, Drug Resistance, and Virulence of Staphylococcus aureus Isolated from Ocular Infections in Polish Patients. Pol J Microbiol 2019; 68:541-548. [PMID: 31880897 PMCID: PMC7260701 DOI: 10.33073/pjm-2019-056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022] Open
Abstract
Analysis of the epidemiology of Staphylococcus aureus (SA) ocular infections and virulence factors of the isolates with a special emphasis on their drug resistance, and the ability of biofilm formation. In a period from 2009 to 2013, 83 isolates of SA were prospectively collected and preserved in a multicenter laboratory-based study carried out in southern Poland. Epidemiological, phenotypic, and genotypic analyses were performed. The resistance and virulence genes were analyzed. Screening for the biofilm formation was provided. Among the materials derived from ocular infections from 456 patients, SA was found in 18.2% (n = 83) of cases (one SA isolate per one patient). Most infections were identified in the age group of over 65 years (OR 8.4 95%CI; 1.03-68.49). The majority of patients (73.4%) were hospitalized. Among the virulence and resistance genes, the most frequently detected were the lukE (72.2%, n = 60) and ermA (15.6%, n = 13) genes. A positive result of the CRA test (the ability of biofilm formation) was found in 66.2% (n = 55) of isolates. Among the strains under study, 6.0% (n = 5) had the methicillin-resistant Staphylococcus aureus phenotype, and 26.5% (n = 22) had the macrolide-lincosamide-streptogramin B phenotype. In 48 (57.8%) isolates the neomycin resistance was revealed. All isolates under study were sensitive to vancomycin. The population most susceptible to ocular SA infections consists of hospitalized patients aged 65 and more. The SA strains under study showed the increased ability to biofilm formation. In the strains tested, high susceptibility to chloramphenicol and fluoroquinolones was demonstrated. However, the high level of drug resistance to neomycin detected in this study among SA isolates and the blood-ocular barrier makes it difficult to treat ocular infections.
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Affiliation(s)
- Marta Kłos
- Faculty of Health Sciences, Jagiellonian University Medical College , Kraków , Poland
| | | | - Dorota Romaniszyn
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Kraków , Poland
| | - Agnieszka Chmielarczyk
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Kraków , Poland
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Kraków , Poland
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Wang Y, Zhang J, Dong L, Jiang H, Song X. Orbital abscess treated by ultrasound-guided fine needle aspiration and catheter drainage: A case report. Medicine (Baltimore) 2019; 98:e17365. [PMID: 31574884 PMCID: PMC6775400 DOI: 10.1097/md.0000000000017365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Periorbital cellulitis or an orbital abscess caused by acute sinusitis is a serious acute infectious disease. If not treated in time, serious complications may occur. PATIENT CONCERNS A 16-year-old girl with a history of right-sided proptosis, periorbital swelling, chemosis, hypophasis, restricted ocular movement in the upward direction, and diminution of vision was referred to our institution. The clinic, computed tomography (CT) and magnetic resonance imaging (MRI) examination indicate right orbital abscess in the upper quadrant and sinusitis. DIAGNOSES She was diagnosed with orbital abscess, acute sinusitis. INTERVENTIONS She underwent medical management, transnasal endoscopic surgery and then ultrasound-guided fine needle aspiration (FNA) and catheter drainage. OUTCOMES She was completely cured without any complications or sequelae. LESSONS Performance of surgical drainage in a timely manner and administration of effective antibiotic treatment according to bacterial culture can reduce the complications of orbital abscesses. Ultrasound-guided FNA and catheter drainage is a safe, simple, and effective method for the treatment of orbital abscess.
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Affiliation(s)
- Yan Wang
- Department of Otolaryngology–Head and Neck Surgery
| | - Jie Zhang
- Department of Otolaryngology–Head and Neck Surgery
| | - Lei Dong
- Department of Otolaryngology–Head and Neck Surgery
| | - Hong Jiang
- Department of Ultrasound, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Xicheng Song
- Department of Otolaryngology–Head and Neck Surgery
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Lorenzo D. Chloramphenicol Resurrected: A Journey from Antibiotic Resistance in Eye Infections to Biofilm and Ocular Microbiota. Microorganisms 2019; 7:microorganisms7090278. [PMID: 31438629 PMCID: PMC6780676 DOI: 10.3390/microorganisms7090278] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 01/13/2023] Open
Abstract
The advent of multidrug resistance among pathogenic bacteria is devastating the worth of antibiotics and changing the way of their administration, as well as the approach to use new or old drugs. The crisis of antimicrobial resistance is also due to the unavailability of newer drugs, attributable to exigent regulatory requirements and reduced financial inducements. The emerging resistance to antibiotics worldwide has led to renewed interest in old drugs that have fallen into disuse because of toxic side effects. Thus, comprehensive efforts are needed to minimize the pace of resistance by studying emergent microorganisms and optimize the use of old antimicrobial agents able to maintain their profile of susceptibility. Chloramphenicol is experiencing its renaissance because it is widely used in the treatment and prevention of superficial eye infections due to its broad spectrum of activity and other useful antimicrobial peculiarities, such as the antibiofilm properties. Concerns have been raised in the past for the risk of aplastic anemia when chloramphenicol is given intravenously. Chloramphenicol seems suitable to be used as topical eye formulation for the limited rate of resistance compared to fluoroquinolones, for its scarce induction of bacterial resistance and antibiofilm activity, and for the hypothetical low impact on ocular microbiota disturbance. Further in-vitro and in vivo studies on pharmacodynamics properties of ocular formulation of chloramphenicol, as well as its real impact against biofilm and the ocular microbiota, need to be better addressed in the near future.
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Affiliation(s)
- Drago Lorenzo
- Clinical Microbiology, Department of Biomedical Science for Health, University of Milan, 20133 Milan, Italy.
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Gyawali R, Bhayal BK. Practice scope and job confidence of two-year trained optometry technicians in Eritrea. BMC MEDICAL EDUCATION 2019; 19:303. [PMID: 31391042 PMCID: PMC6686253 DOI: 10.1186/s12909-019-1738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 07/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND A two-year optometry technician (OT) training was started in Eritrea in 2009 to fulfill the immediate human resource needs in providing refractive, dispensing and primary eye care services in vision centers. This study aimed to assess the current practice pattern and confidence level among the OTs. METHODS A self-administered questionnaire was developed and administered to all available OTs in January 2017. The OTs were identified through the Ministry of Health's database. The questionnaire included questions on demographics, scope of practice and confidence level in the clinical practice areas. RESULTS A total of 94 OTs had graduated by the end of 2016 and 71 (75.5%) of them were involved in the country's eye care services. All the 70 OTs who completed the survey were working under the Ministry of Health in various regions of the country. The mean age of the OTs was 25.6 ± 4.7 years (range: 20 to 48 years) and 43 (61.4%) of them were male. Four out of six regions in the country lacked the required number of OTs for the recommended ratio of one refractionist to 50,000 population. All the OTs provided refraction services; however, they lacked experience in dispensing (62.9%), clinical examination of patients (35.7%) and low vision care (4.3%). While the OTs expressed confidence in refractive procedures, low levels of confidence were expressed for dispensing and primary eye care services. CONCLUSION OTs contributed to the primary eye care sector in Eritrea. However, high attrition rate, imbalanced distribution, a limited practice in core areas and low clinical confidence were the key challenges for this profession in this country. With better facilities, improved infrastructure and extended education and career opportunities, the two-year trained OTs could potentially serve further in the Eritrean eye care system. Further studies to evaluate the competency, job satisfaction and effectiveness OTs are recommended.
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Affiliation(s)
- Rajendra Gyawali
- Department of Optometry, Asmara College of Health Sciences, Post box no.: 1220, Mai Bela Ave, Asmara, Eritrea
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Bharat Kumar Bhayal
- Department of Optometry, Asmara College of Health Sciences, Post box no.: 1220, Mai Bela Ave, Asmara, Eritrea
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de Paula A, Oliva G, Barraquer RI, de la Paz MF. Prevalence and antibiotic susceptibility of bacteria isolated in patients affected with blepharitis in a tertiary eye centre in Spain. Eur J Ophthalmol 2019; 30:991-997. [PMID: 31232091 DOI: 10.1177/1120672119854985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe which bacteria can be found on lid margins in patients affected with blepharitis, to show their antibiotic susceptibility pattern, and to evaluate the antibiotic resistance trend of coagulase-negative Staphylococcus through time. MATERIALS AND METHODS Consecutive cases of 198 eyes affected with blepharitis between 2012 and 2018 were reviewed. A sample was collected by rubbing a swab against the base of the eyelashes of both the eyes of all patients. The samples were inoculated in blood agar and chocolate agar. The susceptibility of the identified bacteria to common antibiotics was tested. In addition, the antibiotic susceptibility pattern of coagulase-negative Staphylococcus detected from year 2016 to 2018 was compared with that of 4 years before. RESULTS The most common isolated bacterium was coagulase-negative Staphylococcus (89%) and Staphylococcus aureus (28%). Coagulase-negative Staphylococcus showed highest susceptibility to vancomycin (100%), neomycin (94%) and chloramphenicol (91%). Coagulase-negative Staphylococcus and Staphylococcus aureus were the most resistant to penicillin and erythromycin (resistance in 92%, 91% for coagulase-negative Staphylococcus, 86% and 43% of eyes for Staphylococcus aureus). Corynebacterium was resistant to oxacillin and erythromycin. Streptococcus viridans showed resistance to gentamycin and tobramycin. Moraxella was susceptible to most antibiotics. Bacillus was resistant to oxacillin. The antibiotic resistance trend of coagulase-negative Staphylococcus showed that the resistance to rifampicin increased through the years 2012-2018. CONCLUSION Coagulase-negative Staphylococcus and Staphylococcus aureus were the most isolated bacteria in patients affected by blepharitis in our tertiary eye centre. Both bacteria were resistant to erythromycin. Through the years, it seems that coagulase-negative Staphylococcus gained resistance to penicillin, erythromycin, ciprofloxacin and rifampicin.
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Affiliation(s)
- Alessandro de Paula
- Ophthalmology Unit, NESMOS Department St. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Gloria Oliva
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael Ignacio Barraquer
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maria Fideliz de la Paz
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
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Ung L, Bispo PJM, Shanbhag SS, Gilmore MS, Chodosh J. The persistent dilemma of microbial keratitis: Global burden, diagnosis, and antimicrobial resistance. Surv Ophthalmol 2019; 64:255-271. [PMID: 30590103 PMCID: PMC7021355 DOI: 10.1016/j.survophthal.2018.12.003] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 01/16/2023]
Abstract
Microbial keratitis is a potentially blinding condition that must be treated emergently to preserve vision. Although long recognized as a significant cause of corneal blindness, our understanding of its true global scale, associated burden of disease, and etiological patterns remains somewhat limited. Current epidemiological data suggest that microbial keratitis may be epidemic in parts of the world-particularly within South, South-East, and East Asia-and may exceed 2 million cases per year worldwide. Etiological patterns vary between economically developed and developing countries, with bacterial predominance in the former and fungal predominance in the latter. The key to effective management lies in timely diagnosis; however, the current gold standard of stain and culture remains time consuming and often yields no clinically useful results. For this reason, there are attempts to develop highly sensitive and accurate molecular diagnostic tools to provide rapid diagnosis, inform treatment decision making, and minimize the threat of antimicrobial resistance. We provide an overview of these key areas and of avenues for further research toward the goal of more effectively addressing the problem of microbial keratitis on both an individual and public health level.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Paulo J M Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India
| | - Michael S Gilmore
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
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Thomas RK, Melton R, Asbell PA. Antibiotic resistance among ocular pathogens: current trends from the ARMOR surveillance study (2009-2016). CLINICAL OPTOMETRY 2019; 11:15-26. [PMID: 30881168 PMCID: PMC6419597 DOI: 10.2147/opto.s189115] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Antibiotic Resistance Monitoring in Ocular micRoorganisms study is an ongoing surveillance study that tracks antibiotic resistance among bacterial isolates from ocular infections across the United States. We report antibiotic resistance rates and trends from 2009 through 2016. MATERIALS AND METHODS Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae from various ocular infections were obtained from participating United States centers. Isolates were sent to a central laboratory for determination of antibiotic resistance profiles. Minimum inhibitory concentrations were determined by broth microdilution according to the Clinical and Laboratory Standards Institute for drugs from more than ten antibiotic classes, and isolates were classified as susceptible or resistant based on systemic breakpoints, wherever available. Resistance rates were also evaluated based on decade of patient life and longitudinally over the 8-year time period. RESULTS A total of 1,695 S. aureus, 1,475 CoNS, 474 S. pneumoniae, 586 H. influenzae, and 599 P. aeruginosa were collected from 87 sites. Resistance was high among staphylococci and pneumococci, with methicillin resistance detected in 621 (36.6%) S. aureus and 717 (48.6%) CoNS isolates. Multidrug resistance (≥3 drug classes) was observed among staphylococci, particularly in methicillin-resistant (MR) isolates (MR S. aureus [MRSA]: 76.2%; MR CoNS [MRCoNS]: 73.5%). Differences in methicillin resistance among staphylococci were observed based on patient age, with higher rates observed in older patients (P<0.0001). For certain organism-antibiotic combinations, there were significant changes in resistance over time, including a decrease in methicillin resistance among S. aureus (but not CoNS); no notable trends were observed for S. pneumoniae. CONCLUSION Antibiotic resistance was prevalent among gram-positive organisms, and MR staphylococcal isolates were more likely to be multidrug resistant. Although a small decrease in methicillin resistance was observed among S. aureus over time, the continued high prevalence of in vitro methicillin resistance should be considered when treating patients with ocular infections.
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Affiliation(s)
| | - Ron Melton
- Educators in Primary Eye Care, LLC, Concord, NC, USA,
| | - Penny A Asbell
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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