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Zhou R, Wang Q, Yuan L, Zhou H, Xue J. Safety and efficacy of fortified antibiotics and fluoroquinolones for the treatment of bacterial keratitis: A meta-analysis. J Fr Ophtalmol 2024; 47:103940. [PMID: 37741755 DOI: 10.1016/j.jfo.2023.01.046] [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: 12/01/2022] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE To compare the safety and efficacy of fortified antibiotics and fluoroquinolones in the treatment of bacterial keratitis. METHODS PubMed, EMBASE, Cochrane Library, CNKI, Wanfang database and VIP database were systematically searched for randomized controlled trials (RCT) of treatment of bacterial keratitis with fortified antibiotics and fluoroquinolones. Rev Man 5.3 software was used to analyze outcome index cure rate, time to cure, and adverse events in a meta-analysis. RESULTS After literature search and screening, 9 randomized controlled trials were included in this study. Compared with traditional fortified antibiotic therapy, fluoroquinolones show consistency in terms of cure rate and incidence of adverse events: cure rates (OR=0.99, 95% CI: 0.75, 1.30) and incidence of adverse events (OR=0.75, 95% CI: 0.48, 1.17). However, the time to cure for fluoroquinolones was shorter than that of fortified antibiotics (MD=0.96, 95% CI: 0.50, 1.41). CONCLUSION The cure rate and safety of fluoroquinolones are equivalent to those of fortified antibiotics, so it seems reasonable to use fluoroquinolones as the preferred treatment for bacterial keratitis.
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Affiliation(s)
- R Zhou
- Department of Ophthalmology, Jingdezhen traditional Chinese medicine hospital, Jingdezhen, China
| | - Q Wang
- Department of Ophthalmology, Jingdezhen traditional Chinese medicine hospital, Jingdezhen, China
| | - L Yuan
- Department of Ophthalmology, Affiliated Hospital of Jiangxi University of traditional Chinese Medicine, No. 445, Bayi Avenue, Nanchang, Jiangxi, 330006, China
| | - H Zhou
- Department of Ophthalmology, Jingdezhen traditional Chinese medicine hospital, Jingdezhen, China
| | - J Xue
- Department of Ophthalmology, Affiliated Hospital of Jiangxi University of traditional Chinese Medicine, No. 445, Bayi Avenue, Nanchang, Jiangxi, 330006, China.
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2
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Arun K, Georgoudis P. Pseudomonas Keratitis: From Diagnosis to Successful Deep Anterior Lamellar Keratoplasty. Cureus 2024; 16:e56154. [PMID: 38495968 PMCID: PMC10940118 DOI: 10.7759/cureus.56154] [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] [Accepted: 03/14/2024] [Indexed: 03/19/2024] Open
Abstract
Pseudomonas keratitis is an aggressive form of bacterial keratitis that can have devastating consequences, such as corneal perforation, if not promptly identified and appropriately managed. The aim of this case report is to highlight key clinical features of Pseudomonas keratitis and evaluate the initial and long-term management options for this condition. We report a case of a 32-year-old female who presented with a large corneal abscess and hypopyon following contact lens wear. Corneal cultures confirmed Pseudomonas as the causative organism and she was treated with topical levofloxacin and gentamycin. Following sterilisation of the corneal ulcer, the patient was left with deep stromal scarring, peripheral corneal thinning as well as four-quadrant deep corneal vascularisation. She was listed for deep anterior lamellar keratoplasty surgery to clear her visual axis. We highlight some of the challenges that were faced both intra-operatively and post-operatively and how they were managed.
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3
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Margolis TP, Galor A. Controllable Errors in the Management of Infectious Keratitis. Cornea 2024; 43:137-140. [PMID: 38155400 DOI: 10.1097/ico.0000000000003417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Affiliation(s)
- Todd P Margolis
- John F. Hardesty Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, MO
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL; and
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
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4
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Astley RA, Mursalin MH, Coburn PS, Livingston ET, Nightengale JW, Bagaruka E, Hunt JJ, Callegan MC. Ocular Bacterial Infections: A Ten-Year Survey and Review of Causative Organisms Based on the Oklahoma Experience. Microorganisms 2023; 11:1802. [PMID: 37512974 PMCID: PMC10386592 DOI: 10.3390/microorganisms11071802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Ocular infections can be medical emergencies that result in permanent visual impairment or blindness and loss of quality of life. Bacteria are a major cause of ocular infections. Effective treatment of ocular infections requires knowledge of which bacteria are the likely cause of the infection. This survey of ocular bacterial isolates and review of ocular pathogens is based on a survey of a collection of isolates banked over a ten-year span at the Dean McGee Eye Institute in Oklahoma. These findings illustrate the diversity of bacteria isolated from the eye, ranging from common species to rare and unique species. At all sampled sites, staphylococci were the predominant bacteria isolated. Pseudomonads were the most common Gram-negative bacterial isolate, except in vitreous, where Serratia was the most common Gram-negative bacterial isolate. Here, we discuss the range of ocular infections that these species have been documented to cause and treatment options for these infections. Although a highly diverse spectrum of species has been isolated from the eye, the majority of infections are caused by Gram-positive species, and in most infections, empiric treatments are effective.
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Affiliation(s)
- Roger A Astley
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Md Huzzatul Mursalin
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Phillip S Coburn
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Erin T Livingston
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - James W Nightengale
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Eddy Bagaruka
- Department of Biology, Oklahoma Christian University, Edmond, OK 73013, USA
| | - Jonathan J Hunt
- Department of Biology, Oklahoma Christian University, Edmond, OK 73013, USA
| | - Michelle C Callegan
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- Dean McGee Eye Institute, Oklahoma City, OK 73104, USA
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5
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Ung L, Chodosh J. Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis. Ocul Surf 2023; 28:378-400. [PMID: 34461290 PMCID: PMC10721114 DOI: 10.1016/j.jtos.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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6
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Pearce JG, Naunton M, Maddess T. A Literature-Based Review and Analysis of the Pharmacodynamics of the Dose Frequency of Topical 0.3% Ciprofloxacin and 0.3% Ofloxacin in the Day-1 Treatment of Bacterial Keratitis. J Ocul Pharmacol Ther 2023; 39:17-26. [PMID: 36454630 DOI: 10.1089/jop.2022.0110] [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: 12/03/2022] Open
Abstract
Purpose: To determine the appropriate dose frequency for the second-generation fluoroquinolones (2FQs), ciprofloxacin 0.3% and ofloxacin 0.3%, in the day-1 treatment of bacterial keratitis (BK) based on the corneal concentrations achievable and required Minimum Inhibitory Concentration90 (MIC90) of common BK isolates. Methods: Literature-based ocular MIC90 required to treat bacterial isolates of BK patients were determined for each fluoroquinolone. Published corneal concentrations for each 2FQ, and the drop regimens used to reach these concentrations, were then analyzed to determine the relationship between the corneal 2FQ concentration and the amount of drug applied per hour and the total amount applied. Results: Significant relationships were found to exist for corneal concentrations of both ciprofloxacin and ofloxacin and the amount of drug applied per hour (both P = 0.005), and the total amount of drug applied (P = 0.003 and P = 0.0004, respectively). Derived ciprofloxacin drops/hour corneal concentrations agreed well with both a literature-based regimen and the manufacturers' day-1 drop regimen for various MIC90. Derived ofloxacin drops per hour indicated a higher rate than that suggested by the manufacturer. Conclusions: Both a literature-based and the manufacturers' drop regimens for the day-1 treatment of BK using 0.3% ciprofloxacin have a pharmacodynamic basis, which is related to the required MIC90 of commonly encountered isolates in BK. Dose frequency for 0.3% ofloxacin should be in line with the manufacturers' maximum suggested drop regimen. Commonly suggested drop regimens below these recommendations for either FQ may need to be revised in view of these findings.
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Affiliation(s)
- John Graham Pearce
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Mark Naunton
- Discipline of Pharmacy, School of Health Sciences, University of Canberra, Canberra, Australia
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
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7
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Pearce JG, Essex RW, Maddess T. The clinical treatment of bacterial keratitis: A review of drop instillation regimes. Cont Lens Anterior Eye 2022; 45:101725. [PMID: 35725684 DOI: 10.1016/j.clae.2022.101725] [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: 12/30/2021] [Revised: 04/20/2022] [Accepted: 06/12/2022] [Indexed: 11/26/2022]
Abstract
Bacterial keratitis (BK) presentations are often treated using the commercially available second-generation fluoroquinolones ciprofloxacin 0.3% and ofloxacin 0.3% as monotherapy. The guidelines available for instillation regimes are often not supported by data from clinical studies. This review examines the peer-reviewed clinical studies and compared treatment failure rates for ciprofloxacin 0.3% and ofloxacin 0.3% for BK in relation to Day-1 drop-regimes. From the statistical analysis, this review derived evidence-based clinically applicable minimum drop-regimes for the treatment of BK on Day-1. Lower numbers of drops of ciprofloxacin on Day-1 were significantly associated with increased treatment failure rates (p < 0.002). The derived minimum number of drops on Day for ciprofloxacin on Day-1 was 47 drops, and for ofloxacin 24 drops. The mean number of drops used in the clinical studies was significantly lower than the manufacturers' recommended Day-1 regimes for both ciprofloxacin (p = 0.0006) and ofloxacin (p = 0.048). From Day-3 to -6 of treatment the drop rates for ciprofloxacin relative to recommended rates were higher, and for ofloxacin lower (p = 0.014). The findings of this review were then compared with a representative sample of published guidelines and case studies to determine the validity of applying those drop-regimes in clinical practice. Although the manufacturers' suggested minimum drop-regimes on Day-1 were significantly different (120 drops ciprofloxacin, 34 drops ofloxacin, p < 0.0001), many of the published guidelines suggested the same drop-regime for both fluoroquinolones. The suggested drop numbers on Day-1 for ciprofloxacin in these guidelines and case studies were significantly less than those used in the clinical studies (p = 0.043). Increased treatment failure rates for ciprofloxacin are associated with lower drop numbers on Day-1. The Day-1 dosing rates for ciprofloxacin and ofloxacin should be considered separately, and the regimes suggested in published guidelines and case studies may need be re-considered in light of the findings of this review.
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Affiliation(s)
- John G Pearce
- John Curtin School of Medical Research, Australian National University (ANU), 131 Garran Rd, Acton, ACT 2601, Australia.
| | - Rohan W Essex
- Academic Unit of Ophthalmology, ANU Medical School, Building 4, The Canberra Hospital, Garran, Canberra, ACT 2065, Australia; Department of Ophthalmology, Canberra Hospital, 15 Hospital Road, Garran, Canberra, ACT 2065, Australia; Royal Victorian Eye and Ear Hospital, 32 Gisbourne Street, East Melbourne, Melbourne, VIC 3002, Australia
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University (ANU), 131 Garran Rd, Acton, ACT 2601, Australia
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8
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Hazlett LD, McClellan S, Somayajulu M, Bessert D. Targeting Inflammation Driven by HMGB1 in Bacterial Keratitis-A Review. Pathogens 2021; 10:pathogens10101235. [PMID: 34684184 PMCID: PMC8538492 DOI: 10.3390/pathogens10101235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/30/2021] [Accepted: 09/24/2021] [Indexed: 12/29/2022] Open
Abstract
Pseudomonas (P.) aeruginosa is a Gram-negative bacteria that causes human infectionsinfections. It can cause keratitis, a severe eye infection, that develops quickly and is a major cause of ulceration of the cornea and ocular complications globally. Contact lens wear is the greatest causative reason in developed countries, but in other countries, trauma and predominates. Use of non-human models of the disease are critical and may provide promising alternative argets for therapy to bolster a lack of new antibiotics and increasing antibiotic resistance. In this regard, we have shown promising data after inhibiting high mobility group box 1 (HMGB1), using small interfering RNA (siRNA). Success has also been obtained after other means to inhinit HMGB1 and include: use of HMGB1 Box A (one of three HMGB1 domains), anti-HMGB1 antibody blockage of HMGB1 and/or its receptors, Toll like receptor (TLR) 4, treatment with thrombomodulin (TM) or vasoactive intestinal peptide (VIP) and glycyrrhizin (GLY, a triterpenoid saponin) that directly binds to HMGB1. ReducingHMGB1 levels in P. aeruginosa keratitis appears a viable treatment alternative.
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9
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Tsvetanova A, Powell RM, Tsvetanov KA, Smith KM, Gould DJ. Melting corneal ulcers (keratomalacia) in dogs: A 5-year clinical and microbiological study (2014-2018). Vet Ophthalmol 2021; 24:265-278. [PMID: 33794048 DOI: 10.1111/vop.12885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To identify bacterial microorganisms associated with canine keratomalacia, review their antimicrobial sensitivity, and evaluate clinical outcomes compared to results of microbial culture. METHODS Retrospective analysis of clinical records of dogs diagnosed with a melting corneal ulcer presented to a referral hospital in Hertfordshire, UK between 2014 and 2018. RESULTS One hundred and ten melting corneal ulcers were sampled in 106 dogs. The most common pure bacterial isolate was Pseudomonas aeruginosa (n = 26) followed by β-hemolytic Streptococcus (n = 12). Melting corneal ulcers that cultured coagulase-positive Staphylococcus, coliform bacteria, Pasteurella multocida, Enterococcus, and Streptococcus viridans presented in smaller numbers and were analyzed together (n = 16). Multiple cultures were identified in nine cases (n = 9). Forty-seven cultures yielded no bacterial growth (n = 47). The susceptibility to fluoroquinolones remained high with the exception of β-hemolytic Streptococci. There was no significant difference in the ulcer severity at presentation in regard to the cultured bacteria. Overall, 63 eyes (57%) received surgical grafting in addition to medical treatment. In 14 cases (13%), the progression of corneal melting despite medical ± surgical treatment resulted in enucleation. Fifty-seven percent (8/14) of the enucleated eyes cultured pure Pseudomonas aeruginosa isolates. In contrast, all β-hemolytic Streptococcus-associated ulcers healed. CONCLUSIONS The most common bacterial species associated with canine keratomalacia were Pseudomonas aeruginosa and β-hemolytic Streptococcus. Because of the variation in antibacterial sensitivity between these two species, bacterial culture and sensitivity testing should be performed in all dogs presenting with keratomalacia. Melting corneal ulcers associated with pure Pseudomonas infection were significantly more likely to result in globe loss than melting corneal ulcers associated with other cultures.
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Affiliation(s)
- Agata Tsvetanova
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
| | | | - Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Kerry M Smith
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
| | - David J Gould
- Davies Veterinary Specialists, Manor Farm Business Park, Hertfordshire, UK
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10
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Webber AL, Sharwood P. Practical use and prescription of ocular medications in children and infants. Clin Exp Optom 2021; 104:385-395. [PMID: 33689620 DOI: 10.1080/08164622.2021.1877533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Optometrists in Australia employ ophthalmic medicines in their paediatric practice to assist clinical diagnosis and to treat ocular conditions. Prior to employing ocular medicines or initiating treatment, it is important to consider the risks versus benefits of ophthalmic medicines and determine the minimum dose required to safely achieve a diagnostic or therapeutic benefit. Instilling drops in infants and young children may require techniques that do not depend on full cooperation, particularly to maintain appropriate dosing and limit the rate of elimination from the eye. Diagnostic cycloplegic agents are highly recommended for the accurate determination of refractive error in infants and young children. Topical atropine is commonly prescribed in paediatric optometry practice in highly variable concentrations. 1% atropine eye drops are used for pharmacological penalisation in management of amblyopia, and, increasingly, low concentration (< 0.1%) atropine is used to manage the progression of childhood myopia. Doses of topical ocular medicines to treat inflammation, infection or glaucoma are generally identical to those use in adults; however, there is potential for increased ocular and systemic side effects with certain medications. It is, therefore, timely to present, summarise and comment on the use of ophthalmic diagnostic and therapeutic agents in children and reference where practitioners can look for more detailed information. The perspective is set in the Australian context of a collaborative approach between paediatric optometry and ophthalmology eye care practitioners for delivery of best practice care in infants and young children. Inclusion of the more complex spectrum of paediatric eye disease in a tertiary ophthalmological setting is provided to build practitioner knowledge of treatment regimens their patients may be using, even though management of these conditions lies outside their scope of practice.
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Affiliation(s)
- Ann L Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia.,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Phillipa Sharwood
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
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11
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Menda SA, Das M, Panigrahi A, Prajna NV, Acharya NR, Lietman TM, McLeod SD, Keenan JD. Association of Postfungal Keratitis Corneal Scar Features With Visual Acuity. JAMA Ophthalmol 2020; 138:113-118. [PMID: 31804657 DOI: 10.1001/jamaophthalmol.2019.4852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Corneal opacity is a leading cause of visual impairment worldwide; however, the specific features of corneal scars, which decrease visual acuity, have not been well characterized. Objective To investigate which features of a postfungal keratitis corneal scar contribute to decreased visual acuity after an episode of infectious keratitis and evaluate whether any corneal features may be used as outcomes for clinical trials. Design, Setting, and Participants In this ancillary, prospective cross-sectional study, a subset of study participants treated for fungal keratitis (n = 71) as part of the Mycotic Ulcer Treatment Trial I (MUTT I) underwent best spectacle-corrected visual acuity (BSCVA) and best contact lens-corrected visual acuity examination, Scheimpflug imaging, and anterior segment optical coherence tomography at a referral hospital in India approximately 2 years after enrollment. Data were collected from December 3, 2012, to December 19, 2012, and analyses were performed from December 2, 2013, to October 2, 2019. Main Outcomes and Measures Linear regression models were used to evaluate the importance of various corneal features for BSCVA and to assess whether these features could be used to differentiate the 2 treatment arms of the MUTT I trial. Results Seventy-one patients (42 men [59.1%]; median age, 48 [range, 39-60] years) were examined at a median (IQR) time of 1.8 (1.4-2.2) years after enrollment. The mean (SD) logMAR BSCVA was 0.17 (0.19) (Snellen equivalent, 20/32). In multivariable linear regression models, BSCVA was most associated with irregular astigmatism (1.0 line of worse BSCVA per 1-line difference between BSCVA and contact lens visual acuity; 95% CI, 0.6-1.4) and corneal scar density (1.5 lines of worse vision per 10-unit increase in the mean central corneal density; 95% CI, 0.8-2.3). The thinnest point of the cornea was the metric that best discriminated between the natamycin- and voriconazole-treated ulcers in MUTT I, with 29.3 μm (95% CI, 7.1-51.6 μm) less thinning in natamycin-treated eyes. Conclusions and Relevance Both irregular astigmatism and corneal scar density may be important risk factors for BSCVA in a population with relatively mild, healed fungal corneal ulcers. The thinnest point of the corneal scar may be a cornea-specific outcome that could be used to evaluate treatments for corneal ulcers.
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Affiliation(s)
- Shivali A Menda
- Department of Ophthalmology, University of Washington, Seattle
| | - Manoranjan Das
- Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India
| | - Arun Panigrahi
- Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India
| | - N Venkatesh Prajna
- Department of Cornea and Refractive Surgery, Aravind Eye Care System, Madurai, India
| | - Nisha R Acharya
- Department of Ophthalmology, University of California, San Francisco, San Francisco.,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Thomas M Lietman
- Department of Ophthalmology, University of California, San Francisco, San Francisco.,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco.,Institute for Global Health, University of California, San Francisco, San Francisco
| | - Stephen D McLeod
- Department of Ophthalmology, University of California, San Francisco, San Francisco.,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco
| | - Jeremy D Keenan
- Department of Ophthalmology, University of California, San Francisco, San Francisco.,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco
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12
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Seven-Year Analysis of Microbial Keratitis Tendency at an Ophthalmology Department in Poland: A Single-Center Study. J Ophthalmol 2020; 2020:8851570. [PMID: 33489345 PMCID: PMC7803137 DOI: 10.1155/2020/8851570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 12/05/2022] Open
Abstract
This study aimed to analyze the frequency, drug susceptibility, and drug resistance of pathogens causing microbial keratitis (a corneal inflammation) in the Clinical Department of Ophthalmology, Medical University of Silesia, Katowice. Despite intensive treatment, severe inflammation causes irreversible blindness in ∼7% of cases and eye loss (evisceration or enucleation of the eyeball) in ∼1% of cases at our hospital. The choice of a targeted drug depends on the culture result and drug resistance of the microorganism. This was a retrospective observation study. Conjunctival swabs and corneal scrapes were collected between January 1, 2013, and December 31, 2019, in the tertiary reference center for keratitis. The collected data included the type of material received, culture result, and antimicrobial susceptibilities. Of the 2482 samples analyzed, 679 were positive and 1803 were negative. Of the total pathogens isolated, 69.9% were Gram-positive bacteria, 20.8% were Gram-negative bacteria, and 7.1% were fungi. A significant increase in the number of Gram-positive methicillin-resistant Staphylococcus aureus and a partial increase in the number of Gram-negative beta-lactams-resistant bacteria were observed. All fungal species were sensitive to amphotericin B, 82.81% were sensitive to voriconazole, and 56.25% were sensitive to fluconazole. Dual drug therapy (levofloxacin and tobramycin) was the first-line treatment. Drug susceptibility testing of the cultured microorganisms is necessary to initiate targeted treatment. Increased drug resistance was observed in this study. In the present study, most bacteria were sensitive to fluoroquinolones. Ciprofloxacin therapy remains the recommended empirical treatment in microbial keratitis. According to our study, voriconazole remains a first-line antifungal drug, when a fungal infection is suspected.
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13
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Carruthers NJ, McClellan SA, Somayajulu M, Pitchaikannu A, Bessert D, Peng X, Huitsing K, Stemmer PM, Hazlett LD. Effects of Glycyrrhizin on Multi-Drug Resistant Pseudomonas aeruginosa. Pathogens 2020; 9:pathogens9090766. [PMID: 32962036 PMCID: PMC7557769 DOI: 10.3390/pathogens9090766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023] Open
Abstract
The effects of glycyrrhizin (GLY) on multi-drug resistant (MDR) systemic (MDR9) vs. ocular (B1045) Pseudomonas aeruginosa clinical isolates were determined. Proteomes of each isolate with/without GLY treatment were profiled using liquid chromatography mass spectrometry (LC-MS/MS). The effect of GLY on adherence of MDR isolates to immortalized human (HCET) and mouse (MCEC) corneal epithelial cells, and biofilm and dispersal was tested. Both isolates were treated with GLY (0.25 minimum inhibitory concentration (MIC), 10 mg/mL for MDR9 and 3.75 mg/mL for B1045) and subjected to proteomic analysis. MDR9 had a greater response to GLY (51% of identified proteins affected vs. <1% in B1045). In MDR9 vs. controls, GLY decreased the abundance of proteins for: antibiotic resistance, biofilm formation, and type III secretion. Further, antibiotic resistance and type III secretion proteins had higher control abundances in MDR9 vs. B1045. GLY (5 and 10 mg/mL) significantly reduced binding of both isolates to MCEC, and B1045 to HCET. MDR9 binding to HCET was only reduced at 10 mg/mL GLY. GLY (5 and 10 mg/mL) enhanced dispersal for both isolates, at early (6.5 h) but not later times (24–72 h). This study provides evidence that GLY has a greater effect on the proteome of MDR9 vs. B1045, yet it was equally effective at disrupting adherence and early biofilm dispersal.
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Affiliation(s)
- Nicholas J. Carruthers
- Institute of Environmental Health Sciences, Wayne State University School of Medicine, 540 E. Canfield Avenue, Detroit, MI 48201, USA; (N.J.C.); (P.M.S.)
| | - Sharon A. McClellan
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, School of Medicine, Detroit, MI 48201, USA; (S.A.M.); (M.S.); (A.P.); (D.B.); (K.H.)
| | - Mallika Somayajulu
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, School of Medicine, Detroit, MI 48201, USA; (S.A.M.); (M.S.); (A.P.); (D.B.); (K.H.)
| | - Ahalya Pitchaikannu
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, School of Medicine, Detroit, MI 48201, USA; (S.A.M.); (M.S.); (A.P.); (D.B.); (K.H.)
| | - Denise Bessert
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, School of Medicine, Detroit, MI 48201, USA; (S.A.M.); (M.S.); (A.P.); (D.B.); (K.H.)
| | - Xudong Peng
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao 266071, China;
| | - Kylie Huitsing
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, School of Medicine, Detroit, MI 48201, USA; (S.A.M.); (M.S.); (A.P.); (D.B.); (K.H.)
| | - Paul M. Stemmer
- Institute of Environmental Health Sciences, Wayne State University School of Medicine, 540 E. Canfield Avenue, Detroit, MI 48201, USA; (N.J.C.); (P.M.S.)
| | - Linda D. Hazlett
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, School of Medicine, Detroit, MI 48201, USA; (S.A.M.); (M.S.); (A.P.); (D.B.); (K.H.)
- Correspondence: ; Tel.: +1-313-577-1079; Fax: +1-313-577-3125
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Treatment of Severe Infectious Keratitis With Scleral Contact Lenses as a Reservoir of Moxifloxacin 0.5. Cornea 2020; 40:831-836. [PMID: 32833847 DOI: 10.1097/ico.0000000000002482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the outcomes of using scleral contact lenses as antibiotic reservoirs as a therapeutic approach in a case series of severe infectious keratitis and to discuss the clinical potential. METHODS This was a prospective consecutive case series study of 12 eyes treated for infectious keratitis at the "Conde de Valenciana" Institute of Ophthalmology. A scleral lens (SL) filled with 0.5% moxifloxacin was used as a reservoir and replaced every 24 hours until epithelization was complete or the culture report and/or antibiogram demonstrated either a microorganism not susceptible to or resistant to moxifloxacin. RESULTS The study included 12 eyes of 12 patients (7 women; 58.33%; average age of 63 ± 20.11 years). All patients completed at least 1 month of follow-up. Patients had a diagnosis of infectious keratitis, and the SL was fitted on initial consultation. Of the 12 eyes, 7 had culture-positive bacterial infection, 2 eyes were mycotic, and 3 eyes had no culture growth. In 3 eyes, SL was discontinued because of the lack of response (one eye) and to the presence of mycotic infection (2 eyes). All infections resolved favorably at the final follow-up. CONCLUSIONS The use of SLs could be an alternative for antibiotic impregnation and treatment of infectious keratitis. No complications or side effects were observed related to the use of the scleral contact lens as a reservoir for the antibiotic. This treatment modality could offer a comfortable treatment for the patient, ensuring good impregnation and maintenance of antibiotic concentrations during the 24-hour wear periods.
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Abstract
Background:In microbial keratitis, infection of the cornea can threaten vision through permanent corneal scarring and even perforation resulting in the loss of the eye. A literature review was conducted by Karsten, Watson and Foster (2012) to determine the spectrum of microbial keratitis. Since this publication, there have been over 2600 articles published investigating the causative pathogens of microbial keratitis.Objective:To determine the current spectrum of possible pathogens implicated in microbial keratitis relative to the 2012 study.Methods:An exhaustive literature review was conducted of all the peer-reviewed articles reporting on microbial pathogens implicated in keratitis. Databases including MEDLINE, EMBASE, Scopus and Web of Science were searched utilising their entire year limits (1950-2019).Results:Six-hundred and eighty-eight species representing 271 genera from 145 families were implicated in microbial keratitis. Fungal pathogens, though less frequent than bacteria, demonstrated the greatest diversity with 393 species from 169 genera that were found to cause microbial keratitis. There were 254 species of bacteria from 82 genera, 27 species of amoeba from 11 genera, and 14 species of virus from 9 genera, which were also identified as pathogens of microbial keratitis.Conclusion:The spectrum of pathogens implicated in microbial keratitis is extremely diverse. Bacteria were most commonly encountered and in comparison, to the review published in 2012, further 456 pathogens have been identified as causative pathogens of microbial keratitis. Therefore, the current review provides an important update on the potential spectrum of microbes, to assist clinicians in the diagnosis and treatment of microbial keratitis.
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Hazlett LD, Ekanayaka SA, McClellan SA, Francis R. Glycyrrhizin Use for Multi-Drug Resistant Pseudomonas aeruginosa: In Vitro and In Vivo Studies. Invest Ophthalmol Vis Sci 2019; 60:2978-2989. [PMID: 31311033 PMCID: PMC6944246 DOI: 10.1167/iovs.19-27200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose Our purpose was to test glycyrrhizin (GLY) effects and ciprofloxacin interactions on multidrug resistant (MDR) isolates of Pseudomonas aeruginosa in vitro and in vivo in a mouse model of keratitis. Methods A Hardy-disk tested antibiotic sensitivity of isolates MDR9 (nonocular) and B1045 (ocular). GLY MIC (both isolates) and ciprofloxacin was determined spectrophotometrically. A live/dead assay using confocal microscopy and plate count, tested GLY effects on bacterial permeabilization/viability. Proteomics profiled bacterial efflux pumps (MDR9 vs. PAO1); RT-PCR comparatively tested GLY effects on their mRNA expression levels. The activity of efflux pumps was tested using ethidium bromide (EB); and scanning electron microscopy (SEM) visualized the effects of GLY treatment of bacteria. A combination of GLY and ciprofloxacin was tested in C57BL/6 mice (begun 18 hours after infection) and disease scored, photographed and MPO and plate counts done. Results MDR9 was resistant to 6/12 and B1045 to 7/12 antibiotics (both to ciprofloxacin). MIC GLY for MDR9 was 40 mg/mL and 15 mg/mL for B1045. Ciprofloxacin MIC (32 μg/mL) was reduced 2-fold to 16 μg/mL when ciprofloxacin and GLY were combined. GLY altered bacterial membrane permeability and reduced viability. Proteomics revealed increased efflux pumps in MDR9 versus PAO1; GLY reduced their mRNA expression levels and EB suggested decreased activity. In C57BL/6 mice, treatment with GLY and ciprofloxacin versus ciprofloxacin, significantly reduced clinical scores, plate count, and MPO. Conclusions GLY decreases MDR by: altering bacterial parameters, including viability and efflux pump activity. In vivo, it increases the effectiveness of ciprofloxacin, reducing ocular disease, plate count, and MPO activity.
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Affiliation(s)
- Linda D Hazlett
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Sandamali A Ekanayaka
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Sharon A McClellan
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Rebecca Francis
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States
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Tavassoli S, Nayar G, Darcy K, Grzeda M, Luck J, Williams OM, Tole D. An 11-year analysis of microbial keratitis in the South West of England using brain-heart infusion broth. Eye (Lond) 2019; 33:1619-1625. [PMID: 31073162 DOI: 10.1038/s41433-019-0463-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aims of this study were to identify the organisms responsible for microbial keratitis, as identified by corneal scrape using brain-heart infusion broth, trends over time and antimicrobial sensitivities, over an 11-year period at two eye units in the South West of England; Bristol Eye Hospital and Royal United Hospital, Bath. METHODS All corneal scrapes performed and sent for microbiological analysis between 4th April 2006 and 31st October 2017 at the two eye units were retrospectively reviewed. First-line treatment was monotherapy with levofloxacin 0.5% and second-line treatment was a combination of cefuroxime 5% and gentamicin 1.5%. Both direct and enrichment cultures were used. RESULTS In total, 2614 corneal scrapes from 2116 patients (1082 female, mean age 47.7 ± 21.2 years) were identified. 38.1% (n = 996) were culture positive and 1195 organisms were cultured. In all, 91.6% were bacteria (69.4% were gram-positive, 30.6% gram-negative). Coagulase-negative Staphylococci (CoNS) were the most commonly cultured organism (n = 430). Pseudomonas aeruginosa was the most commonly identified gram-negative organism (n = 189). In total, 6.9% (n = 83) of organisms cultured were fungi. In all, 1.4% (n = 17) were acanthamoeba. There was no statistically significant trend in the organisms observed over the study period. Sensitivity testing confirmed reasonable sensitivity to the empiric antibiotics used in clinical practice. CONCLUSIONS This is the first report on microbial keratitis trends in the South West of England. Virulent organisms were likely to be detected on direct culture, whereas low virulent organisms such as CoNS were more likely to be detected on enrichment alone. Antibiotic sensitivity testing confirmed fluoroquinolone monotherapy as appropriate first-line treatment.
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Affiliation(s)
- Shokufeh Tavassoli
- Bristol Eye Hospital, Cornea and Refractive Surgery, Bristol, United Kingdom.
| | - Gayathri Nayar
- University Hospitals Bristol and Public Health England Microbiology Laboratory Services Bristol, Bristol, United Kingdom
| | - Kieren Darcy
- Bristol Eye Hospital, Cornea and Refractive Surgery, Bristol, United Kingdom
| | - Mariusz Grzeda
- Bristol Eye Hospital, Cornea and Refractive Surgery, Bristol, United Kingdom
| | - Jon Luck
- Royal United Hospital Bath, Bristol, United Kingdom
| | - O Martin Williams
- University Hospitals Bristol and Public Health England Microbiology Laboratory Services Bristol, Bristol, United Kingdom
| | - Derek Tole
- Bristol Eye Hospital, Cornea and Refractive Surgery, Bristol, United Kingdom
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18
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Das M, Menda SA, Panigrahi AK, Venkatesh Prajna N, Yen M, Tsang B, Kumar A, Rose-Nussbaumer J, Acharya NR, McCulloch CE, Lietman TM, McLeod SD, Keenan JD. Repeatability and Reproducibility of Slit Lamp, Optical Coherence Tomography, and Scheimpflug Measurements of Corneal Scars. Ophthalmic Epidemiol 2019; 26:251-256. [PMID: 31018742 DOI: 10.1080/09286586.2019.1600199] [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: 10/27/2022]
Abstract
Purpose: To determine the repeatability and reproducibility of anterior segment optical coherence tomography (AS-OCT) and Scheimpflug photography for several measurements of corneal scars, including scar size, scar depth, and corneal thickness. Methods: A series of patients treated for fungal keratitis at a tertiary eye care center in South India were recalled two years after successful treatment. Eyes with corneal scars had a slit lamp examination performed by two ophthalmologists masked to the other's examination. For AS-OCT and Scheimpflug photography, each eye had two scans taken by one technician and a third scan taken by a separate technician. Scar measurements were subsequently assessed from AS-OCT images by three graders masked to each other's results. Repeatability and reproducibility were assessed by calculating the intra-class correlation coefficient (ICC) from mixed effects linear regression models. Results: Fifty eyes had all measurements taken. The corneal scar size, measured as the geometric mean of the two longest perpendicular meridians, ranged from 0.8 to 5.4 (mean 2.8 mm, 95%CI 2.6 to 3.1). Scar size measurements taken by two separate individuals were most reproducible when the border of the scar was traced from the OCT (ICC 0.90, 95%CI 0.86 to 0.94), and least repeatable when assessed from slit lamp examination (ICC 0.80, 95%CI 0.70 to 0.90). Conclusions: AS-OCT and Scheimpflug imaging of corneal scars produced measurements with acceptable reproducibility that could be useful as cornea-specific outcomes for clinical trials.
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Affiliation(s)
- Manoranjan Das
- a Department of Cornea and External Disease , Aravind Eye Care System , Madurai , India
| | - Shivali A Menda
- b Department of Ophthalmology , University of California , San Francisco , USA
| | - Arun K Panigrahi
- a Department of Cornea and External Disease , Aravind Eye Care System , Madurai , India
| | - N Venkatesh Prajna
- a Department of Cornea and External Disease , Aravind Eye Care System , Madurai , India
| | - Michael Yen
- c Francis I. Proctor Foundation, University of California , San Francisco , USA
| | - Betty Tsang
- c Francis I. Proctor Foundation, University of California , San Francisco , USA
| | - Alisha Kumar
- c Francis I. Proctor Foundation, University of California , San Francisco , USA
| | - Jennifer Rose-Nussbaumer
- b Department of Ophthalmology , University of California , San Francisco , USA.,c Francis I. Proctor Foundation, University of California , San Francisco , USA
| | - Nisha R Acharya
- b Department of Ophthalmology , University of California , San Francisco , USA.,c Francis I. Proctor Foundation, University of California , San Francisco , USA
| | - Charles E McCulloch
- d Department of Epidemiology & Biostatistics, University of California , San Francisco , USA
| | - Thomas M Lietman
- b Department of Ophthalmology , University of California , San Francisco , USA.,c Francis I. Proctor Foundation, University of California , San Francisco , USA.,d Department of Epidemiology & Biostatistics, University of California , San Francisco , USA.,e Institute for Global Health , University of California , San Francisco , USA
| | - Stephen D McLeod
- b Department of Ophthalmology , University of California , San Francisco , USA.,c Francis I. Proctor Foundation, University of California , San Francisco , USA
| | - Jeremy D Keenan
- b Department of Ophthalmology , University of California , San Francisco , USA.,c Francis I. Proctor Foundation, University of California , San Francisco , USA
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Kugadas A, Geddes-McAlister J, Guy E, DiGiandomenico A, Sykes DB, Mansour MK, Mirchev R, Gadjeva M. Frontline Science: Employing enzymatic treatment options for management of ocular biofilm-based infections. J Leukoc Biol 2019; 105:1099-1110. [PMID: 30690787 PMCID: PMC6618031 DOI: 10.1002/jlb.4hi0918-364rr] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 12/22/2022] Open
Abstract
Pseudomonas aeruginosa-induced corneal keratitis is a sight-threatening disease. The rise of antibiotic resistance among P. aeruginosa keratitis isolates makes treatment of this disease challenging, emphasizing the need for alternative therapeutic modalities. By comparing the responses to P. aeruginosa infection between an outbred mouse strain (Swiss Webster, SW) and a susceptible mouse strain (C57BL6/N), we found that the inherent neutrophil-killing abilities of these strains correlated with their susceptibility to infection. Namely, SW-derived neutrophils were significantly more efficient at killing P. aeruginosa in vitro than C57BL6/N-derived neutrophils. To interrogate whether the distinct neutrophil killing capacities were dependent on endogenous or exogenous factors, neutrophil progenitor cell lines were generated. The in vitro differentiated neutrophils from either SW or C57BL6/N progenitors retained the differential killing abilities, illustrating that endogenous factors conferred resistance. Consistently, quantitative LC-MS/MS analysis revealed strain-specific and infection-induced alterations of neutrophil proteomes. Among the distinctly elevated proteins in the SW-derived proteomes were α-mannosidases, potentially associated with protection. Inhibition of α-mannosidases reduced neutrophil bactericidal functions in vitro. Conversely, topical application of α-mannosidases reduced bacterial biofilms and burden of infected corneas. Cumulatively, these data suggest novel therapeutic approaches to control bacterial biofilm assembly and improve bacterial clearance via enzymatic treatments.
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Affiliation(s)
- Abirami Kugadas
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Geddes-McAlister
- Proteomics and Signal Transduction Department, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Emilia Guy
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - David B Sykes
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael K Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rossen Mirchev
- Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mihaela Gadjeva
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Leibovitch I, Lai T, Senarath L, Hsuan J, Selva D. Infectious Keratitis in South Australia: Emerging Resistance to Cephazolin. Eur J Ophthalmol 2018. [DOI: 10.1177/112067210501500104] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- I. Leibovitch
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide - Australia
| | - T.F. Lai
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide - Australia
| | - L. Senarath
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide - Australia
| | - J. Hsuan
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide - Australia
| | - D. Selva
- Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide - Australia
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Burgalassi S, Cappello B, Chetoni P, Iervolino M, Monti D, Saettone MF. Rufloxacin Eyedrops: Effect of Different Formulations on Ocular Pharmacokinetics in Rabbits. Eur J Ophthalmol 2018; 16:311-7. [PMID: 16703552 DOI: 10.1177/112067210601600219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the aqueous humor pharmacokinetics of rufloxacin in rabbits after topical administration of different formulations, and to individuate the ones showing the best pharmacokinetic profile. METHODS Six formulations were instilled in rabbit eyes: two pH 7.2 suspensions of non-salified rufloxacin base, or zwitterion (RUF), one of which was viscosized with tamarind seed polysaccharide (TSP); two pH 7.2 solutions of RUF obtained using hydroxypropyl-beta-cyclodextrin (CD), one of which was viscosized with TSP; and two pH 5.0 solutions of rufloxacin hydrochloride (RUF-HCl ), one of which was viscosized with TSP. At different times after administration, samples of aqueous humor were withdrawn and analyzed by high-pressure liquid chromatography. The main pharmacokinetic parameters of RUF in the aqueous humor produced by the different formulations were calculated and statistical differences were assessed. RESULTS The best results, in terms of aqueous humor bioavailability, were observed with two TSP-viscosized formulations: a solution of the hydrochloride (TSP/RUF-HCl) and a suspension of the base (TSP/RUF), followed by the non-viscosized solution of RUF-HCl. The formulations containing CD-solubilized RUF were much less effective. CONCLUSIONS The present data confirm the significant availability-enhancing properties of tamarind seed polysaccharide, and indicate that solubilization of RUF with hydroxypropyl-beta-cyclodextrin (CD/RUF) results in decreased drug availability with respect to standard formulations. Two of the TSP-viscosized formulations (RUF suspension and RUF-HCl solution) produced aqueous humor RUF concentrations in the range of activity against Enterobacteriaceae and Pseudomonas aeruginosa, thus warranting further studies on applications of rufloxacin in ocular therapy.
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Affiliation(s)
- S Burgalassi
- Department of Bioorganic Chemistry and Biopharmaceutics, University of Pisa, Pisa, Italy.
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22
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Austin A, Lietman T, Rose-Nussbaumer J. Update on the Management of Infectious Keratitis. Ophthalmology 2017; 124:1678-1689. [PMID: 28942073 PMCID: PMC5710829 DOI: 10.1016/j.ophtha.2017.05.012] [Citation(s) in RCA: 300] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022] Open
Abstract
Infectious keratitis is a major global cause of visual impairment and blindness, often affecting marginalized populations. Proper diagnosis of the causative organism is critical, and although culture remains the prevailing diagnostic tool, newer techniques such as in vivo confocal microscopy are helpful for diagnosing fungus and Acanthamoeba. Next-generation sequencing holds the potential for early and accurate diagnosis even for organisms that are difficult to culture by conventional methods. Topical antibiotics remain the best treatment for bacterial keratitis, and a recent review found all commonly prescribed topical antibiotics to be equally effective. However, outcomes remain poor secondary to corneal melting, scarring, and perforation. Adjuvant therapies aimed at reducing the immune response associated with keratitis include topical corticosteroids. The large, randomized, controlled Steroids for Corneal Ulcers Trial found that although steroids provided no significant improvement overall, they did seem beneficial for ulcers that were central, deep or large, non-Nocardia, or classically invasive Pseudomonas aeruginosa; for patients with low baseline vision; and when started early after the initiation of antibiotics. Fungal ulcers often have worse clinical outcomes than bacterial ulcers, with no new treatments since the 1960s when topical natamycin was introduced. The randomized controlled Mycotic Ulcer Treatment Trial (MUTT) I showed a benefit of topical natamycin over topical voriconazole for fungal ulcers, particularly among those caused by Fusarium. MUTT II showed that oral voriconazole did not improve outcomes overall, although there may have been some effect among Fusarium ulcers. Given an increase in nonserious adverse events, the authors concluded that they could not recommend oral voriconazole. Viral keratitis differs from bacterial and fungal cases in that it is often recurrent and is common in developed countries. The Herpetic Eye Disease Study (HEDS) I showed a significant benefit of topical corticosteroids and oral acyclovir for stromal keratitis. HEDS II showed that oral acyclovir decreased the recurrence of any type of herpes simplex virus keratitis by approximately half. Future strategies to reduce the morbidity associated with infectious keratitis are likely to be multidimensional, with adjuvant therapies aimed at modifying the immune response to infection holding the greatest potential to improve clinical outcomes.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antifungal Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Corneal Ulcer/diagnosis
- Corneal Ulcer/drug therapy
- Corneal Ulcer/microbiology
- Diagnostic Techniques, Ophthalmological
- Eye Infections, Bacterial/diagnosis
- Eye Infections, Bacterial/drug therapy
- Eye Infections, Bacterial/microbiology
- Eye Infections, Fungal/diagnosis
- Eye Infections, Fungal/drug therapy
- Eye Infections, Fungal/microbiology
- Female
- Glucocorticoids/therapeutic use
- Humans
- Keratitis, Herpetic/diagnosis
- Keratitis, Herpetic/drug therapy
- Keratitis, Herpetic/virology
- Male
- Randomized Controlled Trials as Topic
- Visual Acuity/physiology
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Affiliation(s)
- Ariana Austin
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Tom Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California.
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Austin A, Schallhorn J, Geske M, Mannis M, Lietman T, Rose-Nussbaumer J. Empirical treatment of bacterial keratitis: an international survey of corneal specialists. BMJ Open Ophthalmol 2017; 2. [PMID: 29226254 PMCID: PMC5718621 DOI: 10.1136/bmjophth-2016-000047] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background/aims New antibiotic agents and changing susceptibility patterns may have changed the empirical treatment of bacterial keratitis. Our objective in this study was to survey cornea specialists’ practice patterns in the initial treatment of bacterial ulcers. Methods This study consisted of a short online survey emailed to members of the Cornea Society listserv for an international sample of cornea specialists. Data collection began July 2014 and ended October 2014. Results A total of 1009 surveys were emailed, and we received 140 (14%) responses. The majority of US clinicians surveyed (n=83, 80%) chose fortified antibiotics empirically, with 55% (n=57) selecting fortified vancomycin and 16% (n=17) using fluoroquinolone alone. International respondents were twice as likely to use fluoroquinolone monotherapy (31%, n=11, p=0.07) and less likely to use fortified vancomycin (33%, n=12, p=0.03). Forty-five per cent (n=46) of US respondents reported that their initial antibiotic choice covered methicillin-resistant Staphylococcus aureus, compared with 22% (n=8) of international respondents (p<0.01). Overall, respondents who were concerned about availability of antibiotics and toxicity were 20.86 (p<0.001) and 7.48 (p<0.001) times more likely to choose fluoroquinolone monotherapy, respectively. If respondents’ primary considerations were broad spectrum coverage or antibiotic resistance they had 7.10 (p<0.001) and 12.51 (p<0.001) times the odds of using fortified vancomycin, respectively. Conclusion Practice patterns for the initial treatment of bacterial keratitis vary with clinicians in the USA being more likely to use fortified antibiotics versus fluoroquinolone monotherapy and more concerned with resistant organisms than their international peers.
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Affiliation(s)
- Ariana Austin
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Julie Schallhorn
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Mike Geske
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Mark Mannis
- Department of Ophthalmology & Vision Science, University of California, Davis, Davis, California, USA
| | - Tom Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jennifer Rose-Nussbaumer
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
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Twelve-year analysis of microbial keratitis trends at a UK tertiary hospital. Eye (Lond) 2017; 31:1229-1236. [PMID: 28452995 DOI: 10.1038/eye.2017.55] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/12/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeTo investigate the frequencies, trends, and in vitro drug susceptibilities of the causative pathogens in microbial keratitis in Manchester Royal Eye Hospital.Patients and methodsCorneal scrape results recorded by the microbiology service between 2004 and 2015 were extracted from an established database. A total of 4229 corneal scrape specimens were identified from an established database. First-line antibiotic treatment in our centre during the study period was ofloxacin and second line was cefuroxime and gentamicin.ResultsMean age was 45.9±21.0. A total of 1379 samples (32.6%) were culture positive. One hundred forty-eight (10.7%) specimens cultured multiple organisms. Of the 1539 organisms identified, 63.3% were Gram-positive bacteria, 27.3% Gram-negative bacteria, 7.1% fungi, and 2.3% Acanthamoebae. A decreasing trend in Gram-positive isolates was found together with a stable trend in Gram negatives and an increasing trend in Acanthamoeba and fungi. There appeared to be a significant increasing trend of Moraxella infection (P=0.001). In all, 83.1 and 90.8% of Gram-positive and -negative isolates tested were susceptible to ofloxacin, respectively. Cefuroxime covered 86.6% of Gram-positive and 61.4% of Gram-negative isolates, whereas gentamicin covered 88.8 and 96.5% of Gram-positive and -negative isolates, respectively.ConclusionWe found a change in the type of Gram-negative organisms isolated over time, with the Moraxella species on the rise. Reassuringly, no significant increase in resistance was observed in vitro for any of the commonly used antibiotics. Ofloxacin remains a good first-line antibiotic treatment but duo-therapy does have broader coverage and should be considered in non-responsive cases.
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Kasetsuwan N, Tanthuvanit P, Reinprayoon U. The efficacy and safety of 0.5% Levofloxacin versus fortified Cefazolin and Amikacin ophthalmic solution for the treatment of suspected and culture-proven cases of infectious bacterial keratitis: a comparative study. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0501.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Bacterial keratitis is a major devastating ocular condition that quickly deteriorates the patient’s vision. Vigorous and prompt treatment of bacterial keratitis with broad-spectrum antibiotic eye-drops is preferred.
Objective: Evaluate the efficacy and safety of 0.5% Levofloxacin for the treatment of suspected and cultureproven cases of infectious bacterial keratitis in comparison to fortified Cefazolin and Amikacin ophthalmic solution.
Materials and methods: Seventy-one eyes from 69 patients suspected of having infectious bacterial keratitis were enrolled in the study. The patients were randomized into two arms, 0.5% Levofloxacin eye drops (34 eyes) or fortified Cefazolin and Amikacin (37 eyes). Sixty-eight eyes were included in the efficacy analysis. During treatment, on days 2, 7, 14, and 21, the patient’s symptoms and signs were scored from grade 0-3 (absent to severe).
Results: At the end of the treatment, 61 out of 71 eyes completely healed. The resolution of the keratitis was not significantly different between both groups. There were no significant differences in the mean time-duration for the ulcer to heal or for the symptoms and clinical signs to disappear between the two groups. No serious adverse events or side effects from the disease were found. The patients compliance was 80% based on the self-reported diaries.
Conclusion: The efficacy and safety of 0.5% topical Levofloxacin was comparable to fortified Cefazolin and Amikacin for the treatment of mild-to-moderate bacterial keratitis. Topical Levofloxacin is far superior because of its availability and patient compliance when used as monotherapy for the treatment of infectious bacterial keratitis.
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Affiliation(s)
- Ngamjit Kasetsuwan
- MD, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand
| | - Pinnita Tanthuvanit
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Usanee Reinprayoon
- Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
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Odorcic S, Sabeti S, Haas W, Durand ML, Dohlman CH. Fungal Infections in Boston Keratoprosthesis Patients: Lessons Learned and Novel Developments on the Horizon. Semin Ophthalmol 2016; 31:71-84. [DOI: 10.3109/08820538.2015.1114871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gatifloxacin 0.3% Versus Fortified Tobramycin–Cefazolin in Treating Nonperforated Bacterial Corneal Ulcers. Cornea 2016; 35:56-61. [DOI: 10.1097/ico.0000000000000664] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yuan Q, Wu Y, Wang Y, Chen L, Qu M, Duan K, Zhao G. Protective efficacy of a peptide derived from a potential adhesin of Pseudomonas aeruginosa against corneal infection. Exp Eye Res 2015; 143:39-48. [PMID: 26500187 DOI: 10.1016/j.exer.2015.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/09/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
Dissecting the interactions between Pseudomonas aeruginosa and corneal cells is important to identify a novel target for prevention and treatment of Pseudomonas keratitis. The current study began with a peptide identified by phage display, and was to investigate the protective efficacy against P. aeruginosa infection in cornea. The original peptide Pc-E, with high homology to a hypothetical membrane protein (HmpA) in P. aeruginosa, and the derived peptide Pc-EP, with the same sequence as a region in HmpA, were synthesized. Peptide Pc-EP could directly bind to HCEC, stronger than Pc-E, and specifically activate toll-like receptor 5, and thereby significantly induce the production of pro-inflammatory factors, such as IL-1β, IL-6, IFN-γ and IL-17. Moreover, Pc-EP could act as an antagonist to inhibit the adhesion of wild-type P. aeruginosa to HCEC and mouse corneas. No inhibitory effect was observed on the adhesion of the strain loss of HmpA. When compared to the wild-type strain, the adhesion of the hmpA mutant to corneal cells was significantly decreased. Treatment of infected mouse corneas with Pc-EP before infection significantly decreased the bacterial load in the cornea and attenuated the corneal pathology. These results indicate that Pc-EP can be a useful prophylactic agent for P. aeruginosa keratitis.
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Affiliation(s)
- Qing Yuan
- Shandong Provincial Key Laboratory of Ophthalmology, Shandong Provincial Excellent Innovation Team Program, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, China
| | - Yuting Wu
- Key Laboratory of Resources Biology and Biotechnology in Western China, Ministry of Education, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Yiqiang Wang
- Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Lin Chen
- Key Laboratory of Resources Biology and Biotechnology in Western China, Ministry of Education, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Mingli Qu
- Shandong Provincial Key Laboratory of Ophthalmology, Shandong Provincial Excellent Innovation Team Program, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, China
| | - Kangmin Duan
- Key Laboratory of Resources Biology and Biotechnology in Western China, Ministry of Education, College of Life Sciences, Northwest University, Xi'an 710069, China
| | - Ge Zhao
- Shandong Provincial Key Laboratory of Ophthalmology, Shandong Provincial Excellent Innovation Team Program, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, China; China Animal Health and Epidemiology Center, Qingdao, 266114, China.
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Samarawickrama C, Chan E, Daniell M. Rising fluoroquinolone resistance rates in corneal isolates: implications for the wider use of antibiotics within the community. ACTA ACUST UNITED AC 2015. [DOI: 10.1071/hi15014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schechter BA, Parekh JG, Trattler W. Besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial keratitis: a retrospective safety surveillance study. J Ocul Pharmacol Ther 2014; 31:114-21. [PMID: 25409447 DOI: 10.1089/jop.2014.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The objective of this study was to collect and evaluate retrospective safety information about the use of besifloxacin ophthalmic suspension 0.6% for the treatment of bacterial keratitis. METHODS This was a retrospective, postmarketing surveillance study conducted at 10 clinical centers in the United States. The study population included 142 patients treated with besifloxacin ophthalmic suspension 0.6% for bacterial keratitis in one or both eyes. For perspective, data on 85 patients treated at these centers with moxifloxacin ophthalmic solution 0.5% for bacterial keratitis were also included. The analysis was designed to measure the types and rates of adverse events (AEs) reported during the treatment of bacterial keratitis with besifloxacin ophthalmic suspension 0.6%. Other treatment outcomes of interest included the development of corneal scarring and corneal neovascularization, measured or presumed bacterial eradication, ending visual acuity, and duration of pain before and after treatment. RESULTS There was one reported AE of mild superficial punctate keratitis in a patient using besifloxacin ophthalmic suspension 0.6%. The difference in AE frequencies between groups was not significant (P>0.999). Additional treatment outcomes were similar for both groups. Limitations of this report include the retrospective nature of the study. CONCLUSIONS These retrospective data suggest that besifloxacin ophthalmic suspension 0.6% was well tolerated when included in the treatment of bacterial keratitis; no serious AEs were reported. A prospective clinical trial is needed to better isolate the contribution of besifloxacin to the therapeutic outcome and to confirm these observations.
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Abstract
BACKGROUND Bacterial keratitis is a serious ocular infectious disease that can lead to severe visual disability. Risk factors for bacterial corneal infection include contact lens wear, ocular surface disease, corneal trauma, and previous ocular or eyelid surgery. Topical antibiotics constitute the mainstay of treatment in cases of bacterial keratitis, whereas the use of topical corticosteroids as an adjunctive therapy to antibiotics remains controversial. Topical corticosteroids are usually used to control inflammation using the smallest amount of the drug. Their use requires optimal timing, concomitant antibiotics, and careful follow-up. OBJECTIVES The objective of the review was to assess the effectiveness and safety of corticosteroids as adjunctive therapy for bacterial keratitis. Secondary objectives included evaluation of health economic outcomes and quality of life outcomes. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2014), EMBASE (January 1980 to July 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to July 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 14 July 2014. We also searched the Science Citation Index to identify additional studies that had cited the only trial included in the original version of this review, reference lists of included trials, earlier reviews, and the American Academy of Ophthalmology guidelines. We also contacted experts to identify any unpublished and ongoing randomized trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) that had evaluated adjunctive therapy with topical corticosteroids in people with bacterial keratitis who were being treated with antibiotics. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We found four RCTs that met the inclusion criteria of this review. The total number of included participants was 611 (612 eyes), ranging from 30 to 500 participants per trial. One trial was included in the previous version of the review, and we identified three additional trials through the updated searches in July 2014. One of the three smaller trials was a pilot study of the largest study: the Steroids for Corneal Ulcers Trial (SCUT). All trials compared the treatment of bacterial keratitis with topical corticosteroid and without topical corticosteroid and had follow-up periods ranging from two months to one year. These trials were conducted in the USA, Canada, India, and South Africa.All trials reported data on visual acuity ranging from three weeks to one year, and none of them found any important difference between the corticosteroid group and the control group. The pilot study of the SCUT reported that time to re-epithelialization in the steroid group was 53% slower than the placebo group after adjusting for baseline epithelial defect size (hazard ratio (HR) 0.47; 95% confidence interval (CI) 0.23 to 0.94). However, the SCUT did not find any important difference in time to re-epithelialization (HR 0.92; 95% CI 0.76 to 1.11). For adverse events, none of the three small trials found any important difference between the two treatment groups. The investigators of the largest trial reported that more patients in the control group developed intraocular pressure (IOP) elevation (risk ratio (RR) 0.20; 95% CI 0.04 to 0.90). One trial reported quality of life and concluded that there was no difference between the two groups (data not available). We did not find any reports regarding economic outcomes.Although the four trials were generally of good methodological design, all trials had considerable losses to follow-up (10% or more) in the final analyses. Further, three of the four trials were underpowered to detect treatment effect differences between groups and inconsistency in outcome measurements precluded meta-analyses for most outcomes relevant to this review. AUTHORS' CONCLUSIONS There is inadequate evidence as to the effectiveness and safety of adjunctive topical corticosteroids compared with no topical corticosteroids in improving visual acuity, infiltrate/scar size, or adverse events among participants with bacterial keratitis. Current evidence does not support a strong effect of corticosteroid, but may be due to insufficient power to detect a treatment effect.
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Affiliation(s)
- Samantha Herretes
- Department of Ophthalmology, Bascom Palmer Eye Institute, University
of Miami School of Medicine, Miami, Florida, USA
| | - Xue Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, Maryland, USA
| | - Johann MG Reyes
- Department of Ophthalmology, The Medical City, Pasig City,
Philippines
- Department of Ophthalmology and Visual Sciences, University of the
Philippines, Philippine General Hospital, Manila, Philippines
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Spectrum of bacterial keratitis at a tertiary eye care centre in India. BIOMED RESEARCH INTERNATIONAL 2013; 2013:181564. [PMID: 24066286 PMCID: PMC3770006 DOI: 10.1155/2013/181564] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 07/27/2013] [Indexed: 12/05/2022]
Abstract
Aim. To report the aetiological spectrum and susceptibility patterns of bacteria isolated from patients with corneal ulceration. Method. The microbiological data of all patients with suspected infectious corneal ulceration who presented to the ocular microbiology service at this centre between 2005 and 2012 were reviewed retrospectively. Result. Microorganisms were recovered from 1665 (77%) of the 2170 ulcers. Bacterial isolates accounted for 1205 of the organisms isolated. The most common bacterial pathogens isolated were various species of Staphylococcus, representing 777 (64.5%), followed by Staphylococcus spp. (148; 12.3%) and Pseudomonas aeruginosa (117; 9.7%). High percentages of Gram-positive bacteria were susceptible to gatifloxacin (>94%), followed by ofloxacin and moxifloxacin. Almost 90% of Pseudomonas aeruginosa isolates were susceptible to ciprofloxacin and moxifloxacin. Sixty-two (44%) of 140 isolates of Streptococcus pneumoniae, 79 (14.8%) of 534 isolates of Staphylococcus epidermidis, and 33 (14%) of 234 isolates of Staphylococcus aureus were resistant to three or more antibiotics. Conclusion. Staphylococcus spp. were the most common bacterial pathogens isolated from patients with keratitis in this setting. High percentages of Gram-positive and Gram-negative bacteria were susceptible to gatifloxacin and moxifloxacin, respectively. Interestingly, a high percentage of Streptococcus pneumoniae isolates were found to be resistant to three or more antibiotics.
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Suryawanshi A, Cao Z, Thitiprasert T, Zaidi TS, Panjwani N. Galectin-1-mediated suppression of Pseudomonas aeruginosa-induced corneal immunopathology. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2013; 190:6397-409. [PMID: 23686486 PMCID: PMC3689592 DOI: 10.4049/jimmunol.1203501] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Corneal infection with Pseudomonas aeruginosa leads to a severe immunoinflammatory lesion, often causing vision impairment and blindness. Although past studies have indicated a critical role for CD4(+) T cells, particularly Th1 cells, in corneal immunopathology, the relative contribution of recently discovered Th17 and regulatory T cells is undefined. In this study, we demonstrate that after corneal P. aeruginosa infection, both Th1 and Th17 cells infiltrate the cornea with increased representation of Th17 cells. In addition to Th1 and Th17 cells, regulatory T cells also migrate into the cornea during early as well as late stages of corneal pathology. Moreover, using galectin-1 (Gal-1), an immunomodulatory carbohydrate-binding molecule, we investigated whether shifting the balance among various CD4(+) T cell subsets can modulate P. aeruginosa-induced corneal immunopathology. We demonstrate in this study that local recombinant Gal-1 (rGal-1) treatment by subconjunctival injections significantly diminishes P. aeruginosa-mediated corneal inflammation through multiple mechanisms. Specifically, in our study, rGal-1 treatment significantly diminished corneal infiltration of total CD45(+) T cells, neutrophils, and CD4(+) T cells. Furthermore, rGal-1 treatment significantly reduced proinflammatory Th17 cell response in the cornea as well as local draining lymph nodes. Also, rGal-1 therapy promoted anti-inflammatory Th2 and IL-10 response in secondary lymphoid organs. Collectively, our results indicate that corneal P. aeruginosa infection induces a strong Th17-mediated corneal pathology, and treatment with endogenously derived protein such as Gal-1 may be of therapeutic value for the management of bacterial keratitis, a prevalent cause of vision loss and blindness in humans worldwide.
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Affiliation(s)
- Amol Suryawanshi
- New England Eye Center and Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111
| | - Zhiyi Cao
- New England Eye Center and Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111
| | - Thananya Thitiprasert
- New England Eye Center and Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111
| | - Tanveer S. Zaidi
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115
| | - Noorjahan Panjwani
- New England Eye Center and Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111
- Department of Biochemistry, Tufts University School of Medicine, Boston, MA 02111
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Sharma N, Goel M, Bansal S, Agarwal P, Titiyal JS, Upadhyaya AD, Vajpayee RB. Evaluation of Moxifloxacin 0.5% in Treatment of Nonperforated Bacterial Corneal Ulcers. Ophthalmology 2013; 120:1173-8. [DOI: 10.1016/j.ophtha.2012.11.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 10/14/2012] [Accepted: 11/08/2012] [Indexed: 11/24/2022] Open
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Microbiota Evaluation of Patients With a Boston Type I Keratoprosthesis Treated With Topical 0.5% Moxifloxacin and 5% Povidone–Iodine. Cornea 2013; 32:407-11. [DOI: 10.1097/ico.0b013e31824a8b9b] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Papadopoulos TA, Vrouva G, Bafa M, Paterakis N, Chounta M. Chronic ocular hypertension after treated multifocal bacterial keratitis. Case Rep Ophthalmol 2013; 4:23-6. [PMID: 23525505 PMCID: PMC3604868 DOI: 10.1159/000348291] [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] [Indexed: 11/19/2022] Open
Abstract
Purpose To report an unusual case of multifocal bacterial keratitis that despite success-ful treatment caused chronic ocular hypertension. Methods A 67-year-old woman with unilateral multifocal keratitis and no previous ocular pathology was admitted to our hospital. Corneal scrapings and conjunctival samples were obtained for culture and the patient received intensive therapy with fortified vancomycin and tobramycin eye drops. Results The cultures demonstrated two strains of Staphylococcus epidermidis, one resistant to ciprofloxacin and both sensitive to vancomycin. Treatment was effective and gradually discontinued after total cessation of the inflammatory activity. During the follow-up period, the patient developed late and persistent ocular hypertension of unknown etiology, in absence of any detectable inflammation or complication, and received permanent antiglaucoma therapy. Conclusion Differential diagnosis between fungal and bacterial infection is critical in cases of multifocal keratitis. Patients with multifocal bacterial keratitis may need intraocular pressure monitoring, even after complete infection healing.
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Abstract
INTRODUCTION Cornea ulceration and infectious keratitis are leading causes of corneal morbidity and blindness. Infectious causes are among the most frequent and most severe. Management strategies for bacterial corneal ulcers have changed significantly over the last decades, however with a more limited progress in the treatment and management of nonbacterial, infectious ulcers. AREAS COVERED This paper provides an overview of the current principles, strategies and treatment choices for infectious corneal ulcers in adults. EXPERT OPINION Topical application with a broad-spectrum antimicrobial remains the preferred method for the pharmacological management of infectious corneal ulcers. Increasing reports of clinical failures and in vitro resistance to antibiotics to treat the most common infectious (bacterial) corneal ulcers are increasing concerns. New approaches for improvement in the pharmacological management of corneal ulcers should focus on strategies for a more rational and evidence-based use of current antimicrobials and development of products to modulate the host immune response and to neutralize microbial toxins and other immune modulators.
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Affiliation(s)
- Darlene Miller
- University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Anne Bates Leach Eye Hospital, Miami, Florida 33136, USA.
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Fluoroquinolones or fortified antibiotics for treating bacterial keratitis: systematic review and meta-analysis of comparative studies. Can J Ophthalmol 2012; 47:493-9. [DOI: 10.1016/j.jcjo.2012.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 08/07/2012] [Accepted: 09/04/2012] [Indexed: 11/17/2022]
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Abstract
Pubmed and Medline were searched for articles referring to Pseudomonas keratitis between the years 2007 and 2012 to obtain an overview of the current state of this disease. Keyword searches used the terms "Pseudomonas" + "Keratitis" limit to "2007-2012", and ["Ulcerative" or "Microbial"] + "Keratitis" + "Contact lenses" limit to "2007-2012". These articles were then reviewed for information on the percentage of microbial keratitis cases associated with contact lens wear, the frequency of Pseudomonas sp. as a causative agent of microbial keratitis around the world, the most common therapies to treat Pseudomonas keratitis, and the sensitivity of isolates of Pseudomonas to commonly prescribed antibiotics. The percentage of microbial keratitis associated with contact lens wear ranged from 0% in a study from Nepal to 54.5% from Japan. These differences may be due in part to different frequencies of contact lens wear. The frequency of Pseudomonas sp. as a causative agent of keratitis ranged from 1% in Japan to over 50% in studies from India, Malaysia, and Thailand. The most commonly reported agents used to treat Pseudomonas keratitis were either aminoglycoside (usually gentamicin) fortified with a cephalosporin, or monotherapy with a fluoroquinolone (usually ciprofloxacin). In most geographical areas, most strains of Pseudomonas sp. (≥95%) were sensitive to ciprofloxacin, but reports from India, Nigeria, and Thailand reported sensitivity to this antibiotic and similar fluoroquinolones of between 76% and 90%.
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Affiliation(s)
- Mark Dp Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Al-Otaibi AG. Non-viral microbial keratitis in children. Saudi J Ophthalmol 2012; 26:191-7. [PMID: 23960991 PMCID: PMC3729792 DOI: 10.1016/j.sjopt.2011.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 09/18/2011] [Accepted: 10/06/2011] [Indexed: 10/16/2022] Open
Abstract
Microbial (non-viral) keratitis is a serious vision-threatening condition. The management of microbial keratitis in children is particularly complicated by the children's inability to cooperate during examinations and the lack of information prior to presentation. Predisposing factors vary according to geographical location and age. Corneal trauma is the leading cause for microbial keratitis in children, followed by systemic and ocular disease. Etiologic agents are most frequently Gram-positive and Gram-negative bacteria commonly found in contact lens-related microbial keratitis. Mycotic keratitis is a major risk factor in tropical weather conditions, particularly when associated with agricultural trauma. Early diagnosis, intensive drug treatment, and timely planned surgical intervention may effectively improve the outcome of pediatric microbial keratitis.
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Affiliation(s)
- Abdullah G. Al-Otaibi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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In vitro comparison of the cytotoxic effects of clinically available ophthalmic solutions of fluoroquinolones on human keratocytes. Can J Ophthalmol 2011; 46:513-20. [DOI: 10.1016/j.jcjo.2011.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 06/20/2011] [Accepted: 07/20/2011] [Indexed: 11/23/2022]
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Management of Corneal Perforation. Surv Ophthalmol 2011; 56:522-38. [PMID: 22117886 DOI: 10.1016/j.survophthal.2011.06.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 05/26/2011] [Accepted: 06/07/2011] [Indexed: 12/20/2022]
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Reply. Cornea 2011. [DOI: 10.1097/ico.0b013e318207f152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shalchi Z, Gurbaxani A, Baker M, Nash J. Antibiotic resistance in microbial keratitis: ten-year experience of corneal scrapes in the United Kingdom. Ophthalmology 2011; 118:2161-5. [PMID: 21764458 DOI: 10.1016/j.ophtha.2011.04.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 04/21/2011] [Accepted: 04/26/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To determine the scale of antibiotic resistance in microbial keratitis in East Kent, United Kingdom. DESIGN Retrospective, observational case series. PARTICIPANTS Corneal scrapes over a 10-year period to December 2008 were identified using the local microbiology database, which provided culture results and antibiotic sensitivity-resistance profiles. TESTING Isolate sensitivity to chloramphenicol, cefuroxime, gentamicin, and ciprofloxacin was determined by microdilution using the Microscan System (Siemens Diagnostics, Dearfield, IL). MAIN OUTCOME MEASURES Isolates were graded as sensitive, intermediate, or resistant to the tested antibiotics, with minimal inhibitory concentrations interpreted against breakpoints from the Clinical and Laboratory Standards Institute. RESULTS There were 476 scrapes from 440 patients (female, 57.6%; mean age, 53.5 years). All samples were cultured. Culture was positive in 163 samples (34.2%), growing 172 organisms. Bacterial keratitis accounted for 162 isolates (94.2%), of which 99 (61.1%) were gram-negative. There was a general increase in the number of gram-negative isolates with time (P=0.003). In vitro testing showed widespread gram-negative resistance to chloramphenicol (74.1%), with reducing sensitivity over the study period (P=0.004). There was 97.3% sensitivity to combination gentamicin and cefuroxime, and 94.4% sensitivity to ciprofloxacin. Ciprofloxacin resistance was found in 8 (17.0%) of 47 gram-positive isolates tested, with no trend toward increasing resistance. CONCLUSIONS This study has documented the highest levels of gram-negative keratitis in any open retrospective survey to date and highlights a trend of increasing gram-negative infection. We have demonstrated reducing chloramphenicol sensitivity, with high sensitivity to combination gentamicin and cefuroxime, as well as ciprofloxacin. Gram-positive fluoroquinolone resistance was higher than previously reported in the United Kingdom, but showed no evidence of increasing resistance. Second-generation fluoroquinolone monotherapy remains the recommended empirical treatment in microbial keratitis in the United Kingdom, and a change to fourth-generation compounds is not advised. Continued testing is essential to monitor for increasing resistance. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Zaid Shalchi
- Department of Microbiology, William Harvey Hospital, East Kent Hospitals University NHS Trust, Ashford, Kent, UK.
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Post-traumatic Infectious Endophthalmitis. Surv Ophthalmol 2011; 56:214-51. [DOI: 10.1016/j.survophthal.2010.09.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 09/15/2010] [Accepted: 09/21/2010] [Indexed: 12/25/2022]
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Abstract
Bacterial conjunctivitis is a common ocular infection that is generally treated empirically with a broad-spectrum antibiotic. The more common pathogens causing bacterial conjunctivitis include Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus epidermidis, and Moraxella species. Several antibiotics traditionally used to treat bacterial conjunctivitis are no longer widely prescribed because of increased bacterial resistance and/or safety concerns. The introduction of the fluoroquinolone class of anti-infectives offered effective and better tolerated treatment options. Nonetheless, successful therapy for bacterial conjunctivitis continues to be limited by several factors. A primary concern is the development of bacterial resistance that may be impacted not only by widespread antibiotic use but also by antibacterial pharmacokinetics, such as maintenance of insufficient bactericidal concentrations at the site of infection. In addition, poor adherence to prescribed regimens that require frequent administration, along with undesirable adverse events, affects the development of bacterial resistance and the success of treatment regimens. This article reviews current antibacterial agents used to treat bacterial conjunctivitis, factors that limit their successful use in treatment, and options for future development of more effective topical ophthalmic anti-infective agents.
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Orlans HO, Hornby SJ, Bowler ICJW. In vitro antibiotic susceptibility patterns of bacterial keratitis isolates in Oxford, UK: a 10-year review. Eye (Lond) 2011; 25:489-93. [PMID: 21252952 DOI: 10.1038/eye.2010.231] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyse the spectrum of bacterial keratitis isolates and their in vitro antibiotic susceptibilities over a 10-year period in Oxford, UK; and to compare the in vitro efficacy of ciprofloxacin with that of the combination of gentamicin and cefuroxime over the same period. METHODS All culture-positive corneal scrapes received from the Oxford Eye Hospital between July 1999 and June 2009 were identified retrospectively using a local microbiology database. For analysis of trends over time, the data was split into two equal 5-year periods. Statistical analysis was done using the χ² and Fisher exact tests. RESULTS Over the 10-year study period, 467 corneal scrapes were performed of which 252 (54.0%) had positive bacterial cultures, growing a total of 267 organisms. The most commonly isolated bacteria were Staphylococci(40.1%) followed by Pseudomonasspecies (28.5%), other Gram-negative species (17.2%), Streptococci(7.1%), and Corynebacteria(6.0%). Between the first and second time periods there was an increase in the number of coagulase-negative Staphylococciand an increased resistance of the non-Pseudomonas Gram-negative group to chloramphenicol. Of the 189 isolates tested for sensitivity to both empirical antibiotic regimens, 176 (93.2%) were susceptible to ciprofloxacin whereas 188 (99.5%) were susceptible to either gentamicin or cefuroxime (P=0.0015). CONCLUSIONS The spectrum of bacterial keratitis isolates and their in vitro antibiotic sensitivity patterns have generally remained stable over time. The combination of gentamicin and cefuroxime provides a broader spectrum of antimicrobial cover than ciprofloxacin monotherapy in Oxford, although both regimens continue to be appropriate choices for the initial management of this condition.
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Affiliation(s)
- H O Orlans
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.
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