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.
GopinathanUSharmaSGargP,et al.Review of epidemiological features, microbiological diagnosis and treatment outcome of microbial keratitis: experience of over a decade. Indian J Ophthalmol2009; 57: 273–279.
2.
BertinoJS. Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics. Clin Ophthalmol2009; 3: 507–521.
3.
D’OriaFGaleoneAPastoreV,et al.Multi-drug resistant Enterococcus faecium in late-onset keratitis after deep anterior lamellar keratoplasty: a case report and review of the literature. Medicine (Baltimore)2019; 98: e17140.
4.
ShimizuYToshidaHHondaR,et al.Prevalence of drug resistance and culture-positive rate among microorganisms isolated from patients with ocular infections over a 4-year period. Clin Ophthalmol2013; 7: 695–702.
5.
HemavathiSarmahPShenoyP. Profile of microbial isolates in ophthalmic infections and antibiotic susceptibility of the bacterial isolates: a study in an eye care hospital, bangalore. J Clin Diagn Res2014; 8: 23–25.
6.
WeldemedhinMGebreyesusHAtsbahaAH,et al.Bacterial profile of ocular infections: a systematic review. BMC Ophthalmol2017; 17: 212.
7.
AbdelghanyAAD’OriaFAlio Del BarrioJ,et al.The value of anterior segment optical coherence tomography in different types of corneal infections: an update. J Clin Med2021; 10: 2841.
8.
FukudaMOhashiHMatsumotoC,et al.Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus ocular surface infection efficacy of chloramphenicol eye drops. Cornea2002; 21: S86–S89.
9.
SummaiyaMNeetaKSangitaR. Ocular infections: rational approach to antibiotic therapy. Natl J Med Res2012; 2: 22–24.
10.
OrlansHOHornbySJBowlerICJW. In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: a 10-year review. Eye2011; 25: 489–493.
11.
LongCLiuBXuC,et al.Causative organisms of post- traumatic endophthalmitis: a 20-year retrospective study. BMC Ophthalmol2014; 14: 34.
12.
MuluyeDWondimenehYMogesF,et al.Types and drug susceptibility patterns of bacterial isolates from eye discharge samples at gondar university hospital, northwest Ethiopia. BMC Res Notes2014; 7: 292.
13.
KhosraviADMehdinejadMHeidariM. Bacteriological findings in patients with ocular infection and antibiotic susceptibility pattern of isolated pathogens. Singapore Med J2007; 48: 741–743.
14.
de PaulaAOlivaGBarraquerRI,et al.Prevalence and antibiotic susceptibility of bacteria isolated in patients affected with blepharitis in a tertiary eye centre in Spain. Eur J Ophthalmol2020 Sep; 30: 991–997.
15.
AlmizelAAlsuhaibaniFAAlkaffAM,et al.Bacterial profile and antibiotic susceptibility pattern of bacterial keratitis at a tertiary hospital in Riyadh. Clin Ophthalmol2019 Dec 20; 13: 2547–2552. PMID: 31908410; PMCID: PMC6929922.
16.
UbaniUA. Common bacterial isolates from infected eye. J Niger Optom Assoc2009; 15: 40–47.
CHSMITH. Bacteriology of the healthy conjunctiva. Br J Ophthalmol1954 Dec; 38: 719–726. PMID: 132.
19.
PerkinsREKundsinRBPrattMV,et al.Bacteriology of normal and infected conjunctiva. J Clin Microbiol1975 Feb; 1: 147–149. PMID: 1176598; PMCID: PMC274990.
20.
EguchiHNishidaKHottaF,et al.In Vitro antimicrobial activity of quinolones against Major bacterial isolates from the ocular surface bacterial Flora of tertiary hospital patients in Japan. J Ocul Pharmacol Ther2021 Mar; 37: 84–89. Epub 2021 Jan 4. PMID: 33395563.
21.
SutoCMorinagaMYagiT,et al.Conjunctival sac bacterial flora isolated prior to cataract surgery. Infect Drug Resist2012; 5: 37–41. Epub 2012 Jan 24. PMID: 22294861; PMCID: PMC3269131.
22.
MshangilaBPaddyMKajumbulaH, et al.External ocular surface bacterial isolates and their antimicrobial susceptibility patterns among pre-operative cataract patients at mulago national hospital in Kampala, Uganda. BMC Ophthalmol2013; 13: 71
23.
RubioE. Climatic influence on conjunctival bacteria of patients undergoing cataract surgery. Eye2004; 18: 778–784.
24.
PinnaAZanettiSSotgiuM,et al.Identification and antibiotic susceptibility of coagulase negative staphylococci isolated in corneal/external infections. Br J Ophthalmol1999; 83: 771–773.
25.
LeibowitzHM. Antibacterial effectiveness of ciprofloxacin 0.3% ophthalmic solution in the treatment of bacterial conjunctivitis. Am J Ophthalmol1991; 112: 29S–33S.
26.
IwalokunAOluwadunAAkinsindeAN,et al.Bacteriologic and plasmid analysis of etiologic agents of conjunctivitis in lagos, Nigeria. J Ophthal Inflamm Infect2011; 1: 95–103.
27.
LyNCPhamNBadenochR,et al.Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluoroquinolones and gentamicin plus cephalothin. Clin Exp Ophthalmol2006; 34: 44–50.
28.
SyASrinivasanMMascarenhasJ, et al.Acharya; Pseudomonas aeruginosa keratitis: outcomes and response to corticosteroid treatment. Invest Ophthalmol. Vis. Sci2012; 53: 267–272doi.
de Kaspar HMKossMJHeL,et al.Antibiotic susceptibility of preoperative normal conjunctival bacteria. Am J Ophthalmol2005 Apr; 139: 730–733. PMID: 15808182.
31.
ArantesTECavalcantiRFDiniz MdeF,et al.Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery. Arq Bras Oftalmol2006 Jan-Feb; 69: 33–36. Epub 2006 Feb 10. PMID: 16491231.
32.
TaCNChangRTSinghK, et al.Antibiotic resistance patterns of ocular bacterial flora: a prospective study of patients undergoing anterior segment surgery. Ophthalmology2003 Oct; 110: 1946–1951. PMID: 14522770.
33.
AsbellPASanfilippoCMPillarCM,et al.Antibiotic resistance among ocular pathogens in the United States: five-year results from the antibiotic resistance monitoring in ocular microorganisms (ARMOR) surveillance study. JAMA Ophthalmol2015 Dec; 133: 1445–1454.
34.
DegenerJEHeckMEOCvan LeeuwenWJ, et al.Nosocomial infection by Staphylococcus haemolyticus and typing methods for epidemiological study. J Clin Microbiol1994; 32: 2260–2265.
35.
AsbellPAColbyKADengS, et al.Ocular TRUST: nationwide antimicrobial susceptibility patterns in ocular isolates. Am J Ophthalmol2008; 145: 951–958.
36.
GaynorBDChidambaramJDCevallosV, et al.Topical ocular antibiotics induce bacterial resistance at extra-ocular sites. Br J Ophthalmol2005; 89: 1097–1099.
