Conjunctival flora in anophthalmic patients: microbiological spectrum and antibiotic sensitivity
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摘要
AIM: To identify the spectrum and susceptibility pattern of isolated microorganisms from conjunctival flora of anophthalmic patients.METHODS: A cross-sectional clinical study including 60 patients with unilateral anophthalmia. Patients with use of antibiotic drops in their socket during the last month were also included. From each patient, three microbiological samples were taken from the lower conjunctival sac(healthy eye, pre-prosthesis, and retro-prosthesis space of socket). The 180 samples obtained were cultured. Isolates were identified and their antibiotic sensitivities were determined.RESULTS: A total of 251 isolates were recovered(62 isolates from healthy eye, 93 from pre-prosthesis, and 96 from retro-prosthesis space). The most common organism was Staphylococcus epidermidis, in both healthy eyes(64.5%) and sockets(45.5%). Altogether, coagulasepositive Staphylococci, Streptococci, and Gram-negative bacteria accounted for less than 15% of isolates in healthy eyes and more than 35% in sockets. Regarding the antibiotic sensitivities, there were no significant differences between isolates from sockets and healthy eyes. Nine patients recognized the use of self-prescribed antibiotic drops in their socket. In the healthy eyes of these subjects, Gram-positive microorganisms showed significantly greater resistance to aminoglycosides and tetracycline.CONCLUSION: Sockets of anophthalmic patients show a greater number of pathogens compared to healthy eyes.The use of antibiotic drops in the socket promotes a resistant flora not only in the socket but also in the healthy eye. Quinolones and macrolides may be better therapeutic options than aminoglycosides for treating conjunctivitis of anophthalmic sockets, since these antibiotics are less active against Staphylococcus epidermidis.
AIM: To identify the spectrum and susceptibility pattern of isolated microorganisms from conjunctival flora of anophthalmic patients.METHODS: A cross-sectional clinical study including 60 patients with unilateral anophthalmia. Patients with use of antibiotic drops in their socket during the last month were also included. From each patient, three microbiological samples were taken from the lower conjunctival sac(healthy eye, pre-prosthesis, and retro-prosthesis space of socket). The 180 samples obtained were cultured. Isolates were identified and their antibiotic sensitivities were determined.RESULTS: A total of 251 isolates were recovered(62 isolates from healthy eye, 93 from pre-prosthesis, and 96 from retro-prosthesis space). The most common organism was Staphylococcus epidermidis, in both healthy eyes(64.5%) and sockets(45.5%). Altogether, coagulasepositive Staphylococci, Streptococci, and Gram-negative bacteria accounted for less than 15% of isolates in healthy eyes and more than 35% in sockets. Regarding the antibiotic sensitivities, there were no significant differences between isolates from sockets and healthy eyes. Nine patients recognized the use of self-prescribed antibiotic drops in their socket. In the healthy eyes of these subjects, Gram-positive microorganisms showed significantly greater resistance to aminoglycosides and tetracycline.CONCLUSION: Sockets of anophthalmic patients show a greater number of pathogens compared to healthy eyes.The use of antibiotic drops in the socket promotes a resistant flora not only in the socket but also in the healthy eye. Quinolones and macrolides may be better therapeutic options than aminoglycosides for treating conjunctivitis of anophthalmic sockets, since these antibiotics are less active against Staphylococcus epidermidis.
AIM: To identify the spectrum and susceptibility pattern of isolated microorganisms from conjunctival flora of anophthalmic patients.METHODS: A cross-sectional clinical study including 60 patients with unilateral anophthalmia. Patients with use of antibiotic drops in their socket during the last month were also included. From each patient, three microbiological samples were taken from the lower conjunctival sac(healthy eye, pre-prosthesis, and retro-prosthesis space of socket). The 180 samples obtained were cultured. Isolates were identified and their antibiotic sensitivities were determined.RESULTS: A total of 251 isolates were recovered(62 isolates from healthy eye, 93 from pre-prosthesis, and 96 from retro-prosthesis space). The most common organism was Staphylococcus epidermidis, in both healthy eyes(64.5%) and sockets(45.5%). Altogether, coagulasepositive Staphylococci, Streptococci, and Gram-negative bacteria accounted for less than 15% of isolates in healthy eyes and more than 35% in sockets. Regarding the antibiotic sensitivities, there were no significant differences between isolates from sockets and healthy eyes. Nine patients recognized the use of self-prescribed antibiotic drops in their socket. In the healthy eyes of these subjects, Gram-positive microorganisms showed significantly greater resistance to aminoglycosides and tetracycline.CONCLUSION: Sockets of anophthalmic patients show a greater number of pathogens compared to healthy eyes.The use of antibiotic drops in the socket promotes a resistant flora not only in the socket but also in the healthy eye. Quinolones and macrolides may be better therapeutic options than aminoglycosides for treating conjunctivitis of anophthalmic sockets, since these antibiotics are less active against Staphylococcus epidermidis.
引文
1 Pine K,Sloan B,Stewart J,Jacobs RJ.Concerns of anophthalmic patients wearing artificial eyes.Clin Exp Ophthalmol 2011;39(1):47-52.
2 Dave SB,Toma HS,Kim SJ.Changes in ocular flora in eyes exposed to ophthalmic antibiotics.Ophthalmology 2013;120(5):937-941.
3 Christensen JN,Fahmy JA.The bacterial flora of the conjunctival anophthalmic socket in glass prosthesis-carriers.Acta Ophthalmol(Copenh)1974;52(6):801-809.
4 Miller SD,Smith RE,Dippe DW,Lacey DR,Abel M.Bacteriology of the socket in patients with prostheses.Can J Ophthalmol 1976;11(2):126-129.
5 Patillon JC,Rousse C,Gauthier C,Guyot J,Barbier A,Royer J,MichelBriand Y.Bacterial flora of the conjunctiva in enucleated subjects.Bull Soc Ophtalmol Fr 1978;78(11):781-787.
6 Vasquez RJ,Linberg JV.The anophthalmic socket and the prosthetic eye.A clinical and bacteriologic study.Ophthalmic Plast Reconstr Surg1989;5(4):277-280.
7 Campos MS,Campos e Silva Lde Q,Rehder JR,Lee MB,O’Brien T,McDonnell PJ.Anaerobic flora of the conjunctival sac in patients with AIDS and with anophthalmia compared with normal eyes.Acta Ophthalmol(Copenh)1994;72(2):241-245.
8 López-Sánchez E,Espa?a Grégori E,Roda Marzal V,Bueno I,Francés Mu?oz E,Menezo JL.Conjunctival microbiological study in corneo-schleral prosthesis users.Arch Soc Esp Oftalmol 2001;76(11):669-672.
9 Toribio A,Marrodán T,Fernández-Natal I,Martínez-Blanco H,Rodríguez-Aparicio L,Ferrero Má.Study of conjunctival flora in anophthalmic patients:influence on the comfort of the socket.Graefes Arch Clin Exp Ophthalmol 2017;255(8):1669-1679.
10 Morris R,Camesasca FI,Byrne J,John G.Postoperative endophthalmitis resulting from prosthesis contamination in a monocular patient.Am JOphthalmol 1993;116(3):346-349.
11 Kim SJ,Toma HS,Midha NK,Cherney EF,Recchia FM,Doherty TJ.Antibiotic resistance of conjunctiva and nasopharynx evaluation study:a prospective study of patients undergoing intravitreal injections.Ophthalmology 2010;117(12):2372-2378.
12 Suwantarat N,Weik C,Romagnoli M,Ellis BC,Kwiatkowski N,Carroll KC.Practical utility and accuracy of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of corynebacterium species and other medically relevant coryneform-like bacteria.Am J Clin Pathol 2016;145(1):22-28.
13 Gentile RC,Shukla S,Shah M,Ritterband DC,Engelbert M,Davis A,Hu DN.Microbiological spectrum and antibiotic sensitivity in endophthalmitis:a 25-year review.Ophthalmology 2014;121(8):1634-1642.
14 Tao H,Wang J,Li L,Zhang HZ,Chen MP,Li L.Incidence and antimicrobial sensitivity profiles of normal conjunctiva bacterial flora in the central area of China:a hospital-based study.Front Physiol 2017;8:363.
15 Hsu HY,Lind JT,Miller D,Tseng L.Assessment of risk factors for oxacillin-resistant ocular flora in eyes having cataract surgery.J Cataract Refract Surg 2015;41(2):387-392.
16 Grzybowski A,Brona P,Kim SJ.Microbial flora and resistance in ophthalmology:a review.Graefes Arch Clin Exp Ophthalmol2017;255(5):851-862.
17 Pine KR,Sloan B,Jacobs RJ.Deposit buildup on prosthetic eyes and implications for conjunctival inflammation and mucoid discharge.Clin Ophthalmol 2012;6:1755-1762.
18 Barría von-B F,Chabouty H,Moreno R,Ortiz F,Barría MF.Microbial flora isolated from patient’s conjunctiva previous to cataract surgery.Rev Chilena Infectol 2015;32(2):150-157.
19 Kodym A,Paw?owska M,Rumiński JK,Bartosińska A,Kieliba A.Stability of cefepime in aqueous eye drops.Pharmazie2011;66(1):17-23.
20 Papa V,Blanco AR,Santocono M.Ocular flora and their antibiotic susceptibility in patients having cataract surgery in Italy.J Cataract Refract Surg 2016;42(9):1312-1317.
21 Asbell PA,DeCory HH.Antibiotic resistance among bacterial conjunctival pathogens collected in the Antibiotic Resistance Monitoring in Ocular Microorganisms(ARMOR)surveillance study.PLoS One2018;13(10):e0205814.
22 Lin YH,Kang YC,Hou CH,Huang YC,Chen CJ,Shu JC,Hsieh PH,Hsiao CH.Antibiotic susceptibility profiles of ocular and nasal flora in patients undergoing cataract surgery in Taiwan:an observational and cross-sectional study.BMJ Open 2017;7(8):e017352.
23 Milder E,Vander J,Shah C,Garg S.Changes in antibiotic resistance patterns of conjunctival flora due to repeated use of topical antibiotics after intravitreal injection.Ophthalmology 2012;119(7):1420-1424.
24 Suto C,Morinaga M,Yagi T,Tsuji C,Toshida H.Conjunctival sac bacterial flora isolated prior to cataract surgery.Infect Drug Resist2012;5:37-41.
25 Eshraghi B,Alemzadeh SA,Abedinifar Z.Conjunctival bacterial flora in fellow eyes of patients with unilateral nasolacrimal duct obstruction and its changes after successful dacryocystorhinostomy surgery.J Curr Ophthalmol 2017;29(1):59-62.
2 Dave SB,Toma HS,Kim SJ.Changes in ocular flora in eyes exposed to ophthalmic antibiotics.Ophthalmology 2013;120(5):937-941.
3 Christensen JN,Fahmy JA.The bacterial flora of the conjunctival anophthalmic socket in glass prosthesis-carriers.Acta Ophthalmol(Copenh)1974;52(6):801-809.
4 Miller SD,Smith RE,Dippe DW,Lacey DR,Abel M.Bacteriology of the socket in patients with prostheses.Can J Ophthalmol 1976;11(2):126-129.
5 Patillon JC,Rousse C,Gauthier C,Guyot J,Barbier A,Royer J,MichelBriand Y.Bacterial flora of the conjunctiva in enucleated subjects.Bull Soc Ophtalmol Fr 1978;78(11):781-787.
6 Vasquez RJ,Linberg JV.The anophthalmic socket and the prosthetic eye.A clinical and bacteriologic study.Ophthalmic Plast Reconstr Surg1989;5(4):277-280.
7 Campos MS,Campos e Silva Lde Q,Rehder JR,Lee MB,O’Brien T,McDonnell PJ.Anaerobic flora of the conjunctival sac in patients with AIDS and with anophthalmia compared with normal eyes.Acta Ophthalmol(Copenh)1994;72(2):241-245.
8 López-Sánchez E,Espa?a Grégori E,Roda Marzal V,Bueno I,Francés Mu?oz E,Menezo JL.Conjunctival microbiological study in corneo-schleral prosthesis users.Arch Soc Esp Oftalmol 2001;76(11):669-672.
9 Toribio A,Marrodán T,Fernández-Natal I,Martínez-Blanco H,Rodríguez-Aparicio L,Ferrero Má.Study of conjunctival flora in anophthalmic patients:influence on the comfort of the socket.Graefes Arch Clin Exp Ophthalmol 2017;255(8):1669-1679.
10 Morris R,Camesasca FI,Byrne J,John G.Postoperative endophthalmitis resulting from prosthesis contamination in a monocular patient.Am JOphthalmol 1993;116(3):346-349.
11 Kim SJ,Toma HS,Midha NK,Cherney EF,Recchia FM,Doherty TJ.Antibiotic resistance of conjunctiva and nasopharynx evaluation study:a prospective study of patients undergoing intravitreal injections.Ophthalmology 2010;117(12):2372-2378.
12 Suwantarat N,Weik C,Romagnoli M,Ellis BC,Kwiatkowski N,Carroll KC.Practical utility and accuracy of matrix-assisted laser desorption ionization-time of flight mass spectrometry for identification of corynebacterium species and other medically relevant coryneform-like bacteria.Am J Clin Pathol 2016;145(1):22-28.
13 Gentile RC,Shukla S,Shah M,Ritterband DC,Engelbert M,Davis A,Hu DN.Microbiological spectrum and antibiotic sensitivity in endophthalmitis:a 25-year review.Ophthalmology 2014;121(8):1634-1642.
14 Tao H,Wang J,Li L,Zhang HZ,Chen MP,Li L.Incidence and antimicrobial sensitivity profiles of normal conjunctiva bacterial flora in the central area of China:a hospital-based study.Front Physiol 2017;8:363.
15 Hsu HY,Lind JT,Miller D,Tseng L.Assessment of risk factors for oxacillin-resistant ocular flora in eyes having cataract surgery.J Cataract Refract Surg 2015;41(2):387-392.
16 Grzybowski A,Brona P,Kim SJ.Microbial flora and resistance in ophthalmology:a review.Graefes Arch Clin Exp Ophthalmol2017;255(5):851-862.
17 Pine KR,Sloan B,Jacobs RJ.Deposit buildup on prosthetic eyes and implications for conjunctival inflammation and mucoid discharge.Clin Ophthalmol 2012;6:1755-1762.
18 Barría von-B F,Chabouty H,Moreno R,Ortiz F,Barría MF.Microbial flora isolated from patient’s conjunctiva previous to cataract surgery.Rev Chilena Infectol 2015;32(2):150-157.
19 Kodym A,Paw?owska M,Rumiński JK,Bartosińska A,Kieliba A.Stability of cefepime in aqueous eye drops.Pharmazie2011;66(1):17-23.
20 Papa V,Blanco AR,Santocono M.Ocular flora and their antibiotic susceptibility in patients having cataract surgery in Italy.J Cataract Refract Surg 2016;42(9):1312-1317.
21 Asbell PA,DeCory HH.Antibiotic resistance among bacterial conjunctival pathogens collected in the Antibiotic Resistance Monitoring in Ocular Microorganisms(ARMOR)surveillance study.PLoS One2018;13(10):e0205814.
22 Lin YH,Kang YC,Hou CH,Huang YC,Chen CJ,Shu JC,Hsieh PH,Hsiao CH.Antibiotic susceptibility profiles of ocular and nasal flora in patients undergoing cataract surgery in Taiwan:an observational and cross-sectional study.BMJ Open 2017;7(8):e017352.
23 Milder E,Vander J,Shah C,Garg S.Changes in antibiotic resistance patterns of conjunctival flora due to repeated use of topical antibiotics after intravitreal injection.Ophthalmology 2012;119(7):1420-1424.
24 Suto C,Morinaga M,Yagi T,Tsuji C,Toshida H.Conjunctival sac bacterial flora isolated prior to cataract surgery.Infect Drug Resist2012;5:37-41.
25 Eshraghi B,Alemzadeh SA,Abedinifar Z.Conjunctival bacterial flora in fellow eyes of patients with unilateral nasolacrimal duct obstruction and its changes after successful dacryocystorhinostomy surgery.J Curr Ophthalmol 2017;29(1):59-62.