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Elibol ES, Habip Z, Elbay A, Cırık AA, Oğuz H. Conjunctival and nasal microflora in patients on topical cyclosporine for dry eye. Int J Immunopathol Pharmacol 2024; 38:3946320241227103. [PMID: 38323796 PMCID: PMC10851765 DOI: 10.1177/03946320241227103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction: Dry eye is a common ocular condition causing discomfort and visual disturbances. Anti-inflammatory agents like Cyclosporine A (CsA) are often used in its treatment. However, the impact of CsA on ocular flora remains understudied. This research aimed to evaluate changes in conjunctival and nasal microflora in patients receiving topical cyclosporine for dry eye. Methods: In this cross-sectional study, conjunctival and nasal samples were collected from two groups of dry eye patients. Group 1 consisted of 38 patients using CsA eye drops, while Group 2 included 34 patients using preservative-free artificial tear drops. Bacterial cultures were grown from the samples, and the identified organisms underwent antibiotic susceptibility testing. Additionally, alpha diversity metrics were employed to assess the diversity of bacterial species in the samples. Results: Bacterial growth was observed in 75% of conjunctival samples and 97.22% of nasal samples. Staphylococcus epidermidis was the predominant organism in both groups. Alpha diversity analysis showed no significant differences in Shannon diversity and OTU richness between the groups for most bacterial species. Antibiotic susceptibility tests revealed no substantial variations in resistance patterns between the groups. Conclusion: This study provides valuable insights into the impact of CsA eye drops on conjunctival and nasal flora in dry eye patients. The findings suggest that CsA does not significantly influence the composition, diversity, or antibiotic resistance patterns of ocular flora. Long-term topical cyclosporine treatment for dry eye does not significantly impact conjunctival microflora or lead to antibiotic resistance. These results have important implications for the safe use of CsA in patients undergoing ocular treatments, particularly those at risk of intraocular infections.
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Affiliation(s)
- Emine S Elibol
- Department Of Ophtalmology, Bahçeşehir University, Göztepe Medikalpark Hospital, İstanbul, Turkey
| | - Zafer Habip
- Medeniyet University, Göztepe Training and Research Hospital, Medical Microbiology Department, İstanbul, Turkey
- Department Of Ophtalmology, Göztepe Training and Research Hospital, Medeniyet University, İstanbul, Turkey
| | - Ahmet Elbay
- Department Of Ophtalmology, Bezmialem University, İstanbul, Turkey
| | - Ahmet Adnan Cırık
- Department Of Otorhinolaringology, Ümraniye Training and Research Hospital, Sağlık Bilimleri University, İstanbul, Turkey
| | - Halit Oğuz
- Medeniyet University, Göztepe Training and Research Hospital, Medical Microbiology Department, İstanbul, Turkey
- Department Of Ophtalmology, Göztepe Training and Research Hospital, Medeniyet University, İstanbul, Turkey
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Dang A, Reddy AJ, Pokala V, Rabara J, Brahmbhatt H. An Analysis of the Use of Proparacaine in Cataract Surgery. Cureus 2022; 14:e22175. [PMID: 35308736 PMCID: PMC8923310 DOI: 10.7759/cureus.22175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/12/2022] Open
Abstract
A cataract is the primary cause of preventable blindness and is characterized by a congenital, developmental, or acquired opacity of the human lens. Cataracts are predominantly treated through surgical procedures utilizing a combination of anesthetic agents such as proparacaine to reduce patient discomfort. Proparacaine is used to inhibit voltage-gated sodium channels on neuronal membranes to prevent signal propagation and pain signaling in the patient. Current clinical standards call for the utilization of 0.5% proparacaine when used for local anesthesia in cataract surgeries. In this review, the authors extracted the reported application site and concentrations of proparacaine in conjunction with various combination agents to accurately describe its usage in cataract surgery. It was found that most surgeons adhered to the standard concentrations of proparacaine and generally used tropicamide, an eye dilator, as a combination agent in cataract surgery. Additionally, surgeons preferred anesthetic application to the retrobulbar block. The authors find that although surgeons are following standard protocol, adjustments for lowering the standard dose of proparacaine could prove beneficial in preventing proparacaine toxicity. Furthermore, the authors find that more research can be conducted in the future examining other combination agents for use with proparacaine to improve patient outcomes.
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Pedrotti E, Bonacci E, Kilian R, Pagnacco C, Fasolo A, Anastasi M, Manzini G, Bosello F, Marchini G. The Role of Topical Povidone-Iodine in the Management of Infectious Keratitis: A Pilot Study. J Clin Med 2022; 11:jcm11030848. [PMID: 35160298 PMCID: PMC8837158 DOI: 10.3390/jcm11030848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this prospective explorative study was to evaluate the safety and the effectiveness of topical polyvinylpyrrolidone-iodine (PVP-I) administered during the time-to-results period for pathogen identification and susceptibility testing in patients with infectious keratitis (IK). A corneal swab (CS) for antimicrobial evaluation was performed at enrollment (T0) and topical 0.66%-PVP-I was administered until the laboratory results were available (T1). Ulcer and infiltrate areas and infiltrate depths were compared between T0 and T1 (i.e., time-to-result period). Patients were then shifted to a specific antimicrobial therapy and followed up until resolution of their infiltrates (Tlast-TL). Twenty-five eyes were enrolled, and none showed clinical worsening leading to protocol withdrawal. At T1, ulcer and infiltrate areas showed significant improvement in Gram-positive IK (n = 13–52%; p = 0.027 and p = 0.019, respectively), remained stable in fungal IK (n = 5–20%; both p = 0.98) and increased in those with Gram-negative bacteria (n = 4–16%; p = 0.58 and p = 0.27). Eyes with negative cultures (n = 3–12%) showed complete resolution at T1 and did not initiate any additional antimicrobial therapy. The administration of 0.66% PVP-I during the time-to-result period seems to be a safe strategy in patients with IK while often sparing broad-spectrum antimicrobial agents. In addition, it showed to be effective in eyes with a Gram-positive bacterial infection.
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Affiliation(s)
- Emilio Pedrotti
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Erika Bonacci
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Raphael Kilian
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
- Correspondence:
| | - Camilla Pagnacco
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Adriano Fasolo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
- Research Center, The Veneto Eye Bank Foundation, 30174 Venezia, Italy
| | - Marco Anastasi
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Gessica Manzini
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Francesca Bosello
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Giorgio Marchini
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
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Mironovich MA, Mitchell MS, Liu CC, Carter RT, Lewin AC. The effect of topical ophthalmic proparacaine, fluorescein, and tropicamide on subsequent bacterial cultures in healthy dogs. Vet Ophthalmol 2021; 25:44-51. [PMID: 34142756 DOI: 10.1111/vop.12914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether tropicamide, fluorescein, and proparacaine applied topically before sample collection affect the quantity or species of bacteria isolated via aerobic culture. ANIMALS STUDIED 12 female adult research beagle cross-breed dogs. PROCEDURES A conjunctival swab was taken before and after the sequential application of proparacaine, tropicamide, and fluorescein to the same eye (P/T/F) with a five-minute gap between medications. Paired swabs were submitted for aerobic culture. Bacterial enumeration was performed using the spread plate method. Following a one-week washout period, the procedure was repeated using balanced salt solution (BSS). Following a second one-week washout period, the experiment was repeated using ofloxacin 0.3% solution. Colony counts were compared using one-way ANOVA and Tukey post hoc comparison. Bacterial species reduction was compared using a Friedman rank test and Dunn's method. RESULTS The bacterial colony count for P/T/F and BSS was significantly higher than the ofloxacin group (p = 0.0052, p = 0.0022). There was no significant difference for colony counts between P/T/F and BSS (p = 0.9295). The most frequently isolated bacteria included: Psychrobacter spp., Staphylococcus spp., Corynebacterium spp., and Streptococcus spp. The bacterial species reduction for P/T/F and BSS was significantly lower than for ofloxacin (p < 0.0001, p = 0.0160). There was no significant difference for species reduction between P/T/F and BSS (p = 0.3749). CONCLUSIONS The application of proparacaine, tropicamide, and fluorescein did not significantly decrease the amount or species of bacteria isolated from the conjunctiva in this canine population. The application of these solutions prior to ocular swab collection in healthy dogs is unlikely to affect subsequent culture results.
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Affiliation(s)
- Melanie A Mironovich
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Maria S Mitchell
- Louisiana Animal Disease Diagnostic Laboratory, Louisiana State University, Baton Rouge, LA, USA
| | - Chin-Chi Liu
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Renee T Carter
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Andrew C Lewin
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
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Abstract
Purpose: This study aims to evaluate the effect of coronavirus disease 2019 (COVID-19) on conjunctival flora in patients hospitalized with COVID-19.Methods: This prospective, controlled study was conducted between June 2020 and December 2020. The study group consisted of 45 confirmed COVID-19 patients and 43 control subjects. The collected samples were inoculated into the Thioglycollate broth media without delay. The samples with growth were then passed on eosin methylene blue agar, sabouraud dextrose agar, chocolate agar, and 5% sheep blood agar solid media.Results: The mean age of the COVID-19 patients was 64.24 ± 15.4 years, and the control subjects were 59.72 ± 11.4 years. The culture positivity of conjunctiva samples in COVID-19 patients (95.6%) was statistically significantly higher than control subjects (76.7%) (p = .024). Coagulase-negative staphylococcus and Staphylococcus aureus' positivity was significantly higher in COVID-19 patients than control subjects (p < .05).Conclusion: Patients with COVID-19 demonstrate significantly higher culture positivity on conjunctival flora than the control subjects.
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Affiliation(s)
- Ayten Gunduz
- Faculty of Medicine, Department of Medical Microbiology, Malatya Turgut Ozal University, Malatya, Turkey
| | - Emrah Ozturk
- Department of Ophthalmology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Ozlem Cagasar
- Department of Infectious Diseases and Clinical Microbiology, Malatya Training and Research Hospital, Malatya, Turkey
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Reynolds MM, Mercill SL, Wirkus AL, Greenwood Quaintance K, Pulido JS. Topical proparacaine eye drops to improve the experience of patients undergoing intravitreal injections: A randomized controlled trial. Eur J Ophthalmol 2020; 30:1454-1460. [PMID: 31983237 DOI: 10.1177/1120672120902026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We sought to evaluate whether additional topical anesthetic, specifically proparacaine 0.5%, improved patient experience with intravitreal injections without hindering antisepsis. METHODS A prospective, randomized controlled trial was conducted including 36 eyes of 36 patients undergoing intravitreal injections. Patients were randomized to treatment with additional topical proparacaine 0.5% versus control after undergoing informed consent. All patients prior to intravitreal injection underwent conjunctival culture after one drop of topical proparacaine 0.5% was placed. Half of patients then received an additional drop of proparacaine and then underwent a second conjunctival culture. The other half of patients had a drop of povidone iodine and then a second conjunctival culture. Intravitreal injection followed conjunctival cultures. To evaluate their experience, patients were provided with a survey. RESULTS In total, 36 patients were enrolled in the study. Three of 36 (8.3%) patients had positive conjunctival cultures after proparacaine eye drops alone. One of 17 (5.8%) patients had a positive conjunctival culture after a second drop of proparacaine. One of 19 (5.3%) patients had a positive culture after proparacaine and povidone iodine. By noninferiority analysis, proparacaine was inferior to povidone iodine (p = .28). Patient experience surveys did not differ between groups. CONCLUSION Patient perception did not significantly differ whether or not additional proparacaine drops were used prior to intravitreal injection in a randomized controlled trial. While proparacaine has some antiseptic properties, these were found to be inferior to those of povidone iodine. Therefore, while povidone iodine is essential for antisepsis, additional proparacaine drops should not interfere with antisepsis.
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Affiliation(s)
- Margaret M Reynolds
- Department of Ophthalmology, Washington University in St. Louis, St. Louis, MO, USA
| | - Sharon L Mercill
- Department of Nursing, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Amber L Wirkus
- Department of Nursing, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Kerryl Greenwood Quaintance
- Department of Laboratory Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.,Department of Infectious Disease, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.,Department of Molecular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
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Banks KC, Ericsson AC, Reinero CR, Giuliano EA. Veterinary ocular microbiome: Lessons learned beyond the culture. Vet Ophthalmol 2019; 22:716-725. [PMID: 31070001 DOI: 10.1111/vop.12676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/27/2019] [Accepted: 04/12/2019] [Indexed: 01/08/2023]
Abstract
Ocular pathogens cause many painful and vision-threatening diseases such as infectious keratitis, uveitis, and endophthalmitis. While virulent pathogens and pathobionts play important roles in disease pathogenesis, the scientific community has long assumed disruption of the ocular surface occurs prior to microbial colonization and subsequent infection. While nonpathogenic bacteria are often detected in corneal and conjunctival cultures from healthy eyes, cultures also frequently fail to yield growth of common ocular pathogens or nonpathogenic bacteria. This prompts the following question: Is the ocular surface populated by a stable microbial population that cannot be detected using standard culture techniques? The study of the microbiome has recently become a widespread focus in physician and veterinary medicine. Research suggests a pivotal symbiotic relationship with these microbes to maintain healthy host tissues, and when altered is associated with various disease states ("dysbiosis"). The microbiota that lives within and on mammalian bodies have long been known to influence health and susceptibility to infection. However, limitations of traditional culture methods have resulted in an incomplete understanding of what many now call the "forgotten organ," that is, the microbiome. With the introduction of high-throughput sequencing, physician ophthalmology has recognized an ocular surface with much more diverse microbial communities than suspected based on traditional culture. This article reviews the salient features of the ocular surface microbiome and highlights important future applications following the advent of molecular techniques for microbial identification, including characterizing ocular surface microbiomes in our veterinary species and their potential role in management of infectious and inflammatory ocular diseases.
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Affiliation(s)
- Kayla C Banks
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Aaron C Ericsson
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri
| | - Carol R Reinero
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Elizabeth A Giuliano
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
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Fentiman KE, Rankin AJ, Meekins JM, Roush JK. Effects of topical ophthalmic application of 0.5% proparacaine hydrochloride on aerobic bacterial culture results for naturally occurring infected corneal ulcers in dogs. J Am Vet Med Assoc 2018; 253:1140-1145. [DOI: 10.2460/javma.253.9.1140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Edwards SG, Maggs DJ, Byrne BA, Kass PH, Lassaline ME. Effect of topical application of 0.5% proparacaine on corneal culture results from 33 dogs, 12 cats, and 19 horses with spontaneously arising ulcerative keratitis. Vet Ophthalmol 2018; 22:415-422. [PMID: 30193404 DOI: 10.1111/vop.12604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/18/2018] [Accepted: 07/07/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effect of topically applied proparacaine on bacterial and fungal culture results and to compare cytologic and culture results in patients with ulcerative keratitis. PROCEDURE Corneal samples were collected from 33 dogs, 19 horses, and 12 cats with spontaneously arising ulcerative keratitis. Samples for bacterial (dogs, cats, horses) and fungal (horses) cultures were collected prior to and following application of 0.5% proparacaine or saline. All patients then received a topical anesthetic, and samples were collected for cytology. Frequency of cultivatable bacteria before (Swab 1) and after (Swab 2) application of proparacaine or saline was compared using Fisher's exact test. Homogeneity of culture and cytology results was assessed using McNemar's test. RESULTS No difference was detected in number of animals from which bacteria were isolated from Swab 1 or Swab 2 for proparacaine (21/37 and 17/37, respectively) or saline (10/27 and 12/27, respectively). Small numbers prevented analysis of fungal culture results in horses between Swab 1 and Swab 2 for proparacaine (2/12 and 1/12, respectively) or saline (both, 1/8). Bacteria were isolated from 10 of 20 horses and detected cytologically in 3 of these; fungi were isolated from 3 of 20 horses and detected cytologically in 2 of these. Bacteria were detected more frequently using culture (31/64) than cytology (19/64). CONCLUSION Proparacaine did not significantly alter bacterial or fungal culture results in cats, dogs, or horses; however, clinical significance warrants investigation. Culture and cytology provided complementary data; both should be performed to maximize organism detection in patients with ulcerative keratitis.
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Affiliation(s)
- Sydney G Edwards
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California
| | - David J Maggs
- Department of Surgical and Radiological Sciences, University of California, Davis, California
| | - Barbara A Byrne
- Department of Pathology, Microbiology & Immunology, University of California, Davis, California
| | - Philip H Kass
- Department of Population Health & Reproduction, School of Veterinary Medicine, University of California, Davis, California
| | - Mary E Lassaline
- Department of Surgical and Radiological Sciences, University of California, Davis, California
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Tam ALC, Côté E, Saldanha M, Lichtinger A, Slomovic AR. Bacterial Keratitis in Toronto: A 16-Year Review of the Microorganisms Isolated and the Resistance Patterns Observed. Cornea 2017; 36:1528-34. [PMID: 28938380 DOI: 10.1097/ICO.0000000000001390] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the incidence, distribution, current trends, and resistance patterns of bacterial keratitis isolates in Toronto over the past 16 years. METHODS Microbiology records of suspected bacterial keratitis that underwent a diagnostic corneal scraping and cultures from January 1, 2000, through December 31, 2015, were retrospectively reviewed. The distribution of the main isolated pathogens and in vitro laboratory minimum inhibitory concentration testing results were used to identify resistance patterns. RESULTS A total of 2330 corneal scrapings were taken over 16 years. A pathogen was recovered in 1335 samples (57.3%), with bacterial keratitis accounting for 1189 of the positive cultures (86.0% of all isolates). The total number of gram-positive and gram-negative isolates was 963 and 324, respectively. Coagulase-negative Staphylococcus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative bacteria isolates, respectively. A decreasing trend in the number of isolates in gram-positive bacteria (P = 0.01), specifically among Staphylococcus aureus (P < 0.0001) and Streptococcus species (P = 0.005), was identified. When analyzing the susceptibilities of gram-positive and gram-negative isolates, an increasing trend in antibiotic resistance was observed in erythromycin (P = 0.018), ceftazidime (P = 0.046), and piperacillin/tazobactam (P = 0.005). The susceptibility of tested gram-positive microorganisms to vancomycin was 99.6%. CONCLUSIONS There has been a decreasing trend in the number of isolates in gram-positive microorganisms over the past 16 years. An increasing trend in resistance for various antibiotics against gram-negative and gram-positive isolates was identified. High susceptibility to vancomycin reinforced the empirical use of fortified tobramycin and vancomycin in the initial management of severe bacterial keratitis.
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Onerci Celebi O, Celebi ARC. The Effect of Topical Ocular Anesthetic Proparacaine on Conjunctival and Nasal Mucosal Flora in Dry Eye Disease Patients. J Clin Med 2018; 7:E73. [PMID: 29642528 DOI: 10.3390/jcm7040073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the effect of topically applied ocular anesthetic proparacaine on conjunctival and nasal bacterial mucosal flora in patients with dry eye disease. A Schirmer test was done with (group 1) and without (group 2) topical anesthetic proparacaine to 40 patients in each group. Conjunctival and nasal cultures were obtained before and 10 min after performing the Schirmer test. The bacterial culture results and the isolated bacteria were recorded in two groups. Patients' mean age was 62 years (70 female, 10 male). Before the application of topical anesthetic, 50 (62.5%) and 62 (77.5%) had positive conjunctival and nasal culture, respectively, with the most commonly isolated organism being coagulase-negative Staphylococcus in each group. In group 1 the conjunctival bacterial culture positivity rate decreased from 26 (65%) to six (15%) eyes (p < 0.001); however, this rate decreased slightly from 24 (60%) to 20 (50%) eyes in group 2 (p > 0.05). For the nasal cultures, the bacterial culture positivity rate decreased from 80% to 20% and from 75% to 65% in groups 1 (p < 0.001) and 2 (p > 0.05), respectively. Topical ocular anesthetic proparacaine has antibacterial activity in both conjunctival and nasal flora in patients with dry eye disease.
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Abstract
PURPOSE The effect of ocular artificial teardrop containing benzalkonium chloride (BAC) on nasal mucosa was investigated. MATERIALS AND METHODS There were two different treatment trial groups. Each dry eye syndrome (DES) patient received the ocular lubricant treatment four times a day in both groups (one group containing BAC, the other group was not). Moistened sterile cotton-tipped applicators were placed in both nostrils and were immediately cultured prior to ocular lubricant treatment and at the end of treatment trial. The bacterial culture-positivity rate, species of bacteria, and drug sensitivity were recorded in the two groups during pre-treatment and post-treatment. RESULTS There were 20 patients in each group with a mean age of 53.14 years (36 female, 4 male). At the beginning of the treatment trial, Staphylococcus epidermidis was the most frequently isolated organism from the nasal cavity accounting in 24/40 patients (60%). Of the 40 organisms isolated from the nares prior to treatment trial, 37 (92.5%) were sensitive to gentamycin. At the end of 1 month of treatment trial in patients who were treated with ocular lubricants containing BAC, none of the nasal cultures showed growth of any organisms. However, patients who were treated with ocular lubricants not containing BAC demonstrated persistent positive nasal cultures with the same species and the same antibiotic susceptibility profile at the end of the treatment trial period. CONCLUSION Topically applied ocular lubricants including BAC has an anti-bacterial activity on nasal flora in DES patients.
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Affiliation(s)
- Ozlem Onerci Celebi
- a Department of Otorhinolaryngology , Eregli State Hospital , Eregli, Konya , Turkey
| | - Ali Riza Cenk Celebi
- b Department of Ophthalmology , Acibadem University School of Medicine, Atakent Education and Research Hospital , Kucukcekmece, Istanbul , Turkey
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Termote K, Joe AW, Butler AL, McCarthy M, Blondeau JM, Iovieno A, Holland SP, Yeung SN. Epidemiology of bacterial corneal ulcers at tertiary centres in Vancouver, B.C. Can J Ophthalmol 2018; 53:330-336. [PMID: 30119785 DOI: 10.1016/j.jcjo.2017.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/30/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To report the epidemiology of culture-positive bacterial corneal ulcers in Vancouver, B.C., Canada. DESIGN Retrospective, observational case series. METHODS Predetermined search terms were entered into the hospitals' electronic microbiology databases to create a cohort of patients who had undergone corneal scrapings for ulcers from April 2006 to March 2011. All specimens were plated on culture media. Cultured species were identified, and antimicrobial sensitivities were obtained. Clinical charts were then reviewed to identify associated risk factors. RESULTS In total 281 corneal scrapings were included, with a positive culture recovery rate of 75%. Bacterial keratitis accounted for 84.8% of culture-positive ulcers, followed by fungi (10%) and finally Acanthamoeba (5.2%); 73% of ulcers were monomicrobial in origin and 28% polymicrobial. We found an increase in Gram-negative micro-organisms over time. General sensitivity to antibiotics did not change over time. A major risk factor for Gram-positive involvement was ocular surface disease, whereas contact lens wear was a major risk factor for Gram-negative involvement. CONCLUSIONS Bacterial keratitis was found to be the major cause of infectious keratitis in Vancouver, B.C. The majority of bacterial ulcers were caused by Gram-positive bacteria. However, we found an increase in Gram-negative involvement over time. Contact lens wear was identified as the major risk factor for development of Gram-negative ulcers. Pre-existing ocular disease was associated with Gram-positive infection. Susceptibility of Gram-negative bacteria to common broad-spectrum antibiotics was high, but susceptibility of Gram-positive bacteria to these antibiotics was lower and more variable.
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Affiliation(s)
- Karolien Termote
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C.; Cornea, Cataract and Refractive Surgery Unit, Department of Ophthalmology, University Hospital Brussels, Brussels, Belgium.
| | - Aaron W Joe
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Andrea L Butler
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C.; Providence Health Care, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Martin McCarthy
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Joseph M Blondeau
- Department of Clinical Microbiology, Royal University Hospital Saskatoon, Saskatchewan, Sask
| | - Alfonso Iovieno
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Simon P Holland
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
| | - Sonia N Yeung
- Eye Care Center, Cornea Unit, Department of Ophthalmology, University of British Columbia, Vancouver, B.C
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Affiliation(s)
- Nihat Polat
- Department of Ophthalmology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Abuzer Gunduz
- Department of Ophthalmology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Ayten Gunduz
- Department of Microbiology, Malatya State Hospital, Malatya, Turkey
| | - Tongabay Cumurcu
- Department of Ophthalmology, Medical Faculty, Inonu University, Malatya, Turkey
| | - Göksel Gunduz
- Department of Ophthalmology, Medical Faculty, Inonu University, Malatya, Turkey
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Reynolds MM, Greenwood-Quaintance KE, Patel R, Pulido JS. Selected Antimicrobial Activity of Topical Ophthalmic Anesthetics. Transl Vis Sci Technol 2016; 5:2. [PMID: 27441100 PMCID: PMC4942249 DOI: 10.1167/tvst.5.4.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/01/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Endophthalmitis is a rare complication of intravitreal injection (IVI). It is recommended that povidone-iodine be the last agent applied before IVI. Patients have reported povidone-iodine application to be the most bothersome part of IVIs. Topical anesthetics have been demonstrated to have antibacterial effects. This study compared the minimum inhibitory concentration (MIC) of topical anesthetic eye drops (proparacaine 0.5%, tetracaine 0.5%, lidocaine 2.0%) and the antiseptic, 5.0% povidone-iodine, against two organisms causing endophthalmitis after IVI. METHODS Minimum inhibitory concentration values of topical anesthetics, povidone-iodine, preservative benzalkonium chloride (0.01%), and saline control were determined using five isolates of each Staphylococcus epidermidis and viridans group Streptococcus species (VGS). A broth microdilution technique was used with serial dilutions. RESULTS Lidocaine (8.53 × 10-5mol/mL) had MICs of 4.27 to 8.53 × 10-5 mol/mL, and tetracaine (1.89 × 10-5 mol/mL) had MICs of 9.45 × 10-6 mol/mL for all isolates. Proparacaine (1.7 × 10-5 mol/mL) had MICs of 1.32 to 5.3 × 10-7 and 4.25 × 10-6 mol/mL for S. epidermidis and VGS, respectively). Benzalkonium chloride (3.52 × 10-7 mol/mL) had MICs of 1.86 × 10-9 to 1.1 × 10-8 and 4.40 × 10-8 mol/mL for S. epidermidis and VGS, respectively. Povidone-iodine (1.37 × 10-4 mol/mL) had MICs of 2.14 to 4.28 × 10-6 and 8.56 × 10-6 mol/mL for S. epidermidis and VGS, respectively. CONCLUSION Proparacaine was the anesthetic with the lowest MICs, lower than that of povidone-iodine. Benzalkonium chloride had lower MICs than proparacaine. All tested anesthetics and povidone-iodine inhibited growth of S. epidermidis and VGS at commercially available concentrations. TRANSLATIONAL RELEVANCE For certain patients, it could be possible to use topical anesthetic after povidone-iodine for comfort without inhibiting and perhaps contributing additional antimicrobial benefit.
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Affiliation(s)
| | - Kerryl E Greenwood-Quaintance
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA ; Department of Infectious Disease, Mayo Clinic, Rochester, MN, USA
| | - Robin Patel
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA ; Department of Infectious Disease, Mayo Clinic, Rochester, MN, USA
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA ; Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA ; VRS Foundation Board Member, Mayo Clinic, Rochester, MN, USA
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Abstract
AIM We aimed to investigate the effect of alcohol abuse on the conjunctival flora. MATERIALS AND METHODS The cases were evaluated as two groups. The study group consisted of 55 heavy-drinking males diagnosed with alcohol abuse, while the control group consisted of 55 males without a history of alcohol abuse. Samples were taken from the inferior fornix conjunctiva with sterile cotton-tipped swabs (Amies transport medium) for culture. The samples were inoculated into blood agar, chocolate agar, eosine methylene blue agar and Saboraud-Dextrose agar (Oxoid/UK) with the dilution method. RESULTS The microorganisms that grew in study group subjects were Coagulase Negative Staphylococcus (CNS) in 30 (54.5%), Staphylococcus aureus in 14 (25.5%), Moraxella spp. in 3 (5.5%), Streptococcus spp. in 3 (5.5), Bacillus spp. in 3 (5.5%), Corynebacterium spp. in 3 (5.5%), Candida spp. in 3 (5.5%), Haemophilus spp. in 2 (3.6%), Acinetobacter spp. in 2 (3.6%), Neisseria spp. in 1 (1.8%) and Micrococcus spp. in 1 (1.8%). The results for control group were CNS in 31 (56.4%), Bacillus spp. in 7 (12.7%), S. aureus in 5 (9.1%), and Corynebacterium spp. in 2 (3.6%). Moraxella spp., Streptococcus spp., Candida spp., Haemophilus spp., Acinetobacter spp., Neisseria spp. and Micrococcus spp. microorganisms grew in the conjunctival flora samples of the study group but not in the control group. S. aureus colonization was significantly higher in the study group than the control group (p < 0.05). CONCLUSION The S. aureus colonization rate was statistically significantly higher in the study group. Some microorganisms only grew in the conjunctival flora samples of the study group. These findings indicate that the conjunctival flora in persons with chronic alcoholism is different than the normal population.
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Affiliation(s)
| | | | | | | | - Yusuf Yakupogulları
- c Department of Microbiology and Clinical Microbiology , Inonu University School of Medicine , Malatya , Turkey
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Robert M, Eid EP, Saint-antoine P, Harissi-dagher M. Microbial Colonization and Antibacterial Resistance Patterns after Boston Type 1 Keratoprosthesis. Ophthalmology 2013; 120:1521-8. [DOI: 10.1016/j.ophtha.2013.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 12/21/2012] [Accepted: 01/02/2013] [Indexed: 11/23/2022] Open
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Balbaba M, Ulaş F, Toplu SA. Effect of Hemodialysis Duration on Conjunctival Bacterial Flora and Susceptibility of Conjunctival Bacterial Isolates to Fluoroquinolones. Ocul Immunol Inflamm 2013; 21:197-200. [DOI: 10.3109/09273948.2012.758747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lichtinger A, Yeung SN, Kim P, Amiran MD, Iovieno A, Elbaz U, Ku JY, Wolff R, Rootman DS, Slomovic AR. Shifting Trends in Bacterial Keratitis in Toronto. Ophthalmology 2012; 119:1785-90. [DOI: 10.1016/j.ophtha.2012.03.031] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 11/25/2022] Open
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Alabiad CR, Miller D, Schiffman JC, Davis JL. Antimicrobial resistance profiles of ocular and nasal flora in patients undergoing intravitreal injections. Am J Ophthalmol 2011; 152:999-1004.e2. [PMID: 21861973 DOI: 10.1016/j.ajo.2011.05.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 05/20/2011] [Accepted: 05/24/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify the resistance profiles of conjunctival and nasal bacterial isolates in patients undergoing intravitreal injections and to determine if frequent exposures to topical fluoroquinolones increased antimicrobial resistance among these organisms. DESIGN Prospective cohort study. METHODS Patients undergoing intravitreal injection at our institution were enrolled in this study. The conjunctiva and nares of both sides of the patient's face were swabbed and cultured before antiseptic preparation for intravitreal injection. At the time of the study, all patients received 3 days of moxifloxacin eye drops after each intravitreal injection as prophylaxis against endophthalmitis. Resistance to antimicrobials was analyzed using the chi-square test and t test. RESULTS Two hundred eight conjunctival and nasal specimens were cultured from 104 patients. Forty-two (45%) of 93 patients had at least 1 fluoroquinolone-resistant organism in the nose or conjunctiva. Twelve (48%) of 25 patients with no previous injections had at least 1 resistant organism; 14 (45%) of 31 patients with 1 to 4 previous injections had at least 1 resistant organism; 8 (33%) of 24 patients with 5 to 9 previous injections had at least 1 resistant organism; and 8 (62%) of 13 patients with 10 or more previous injections had at least 1 resistant organism (P = .88; chi-square test, linear by linear association). CONCLUSIONS In this small study, there was no correlation between the number of exposures to topical fluoroquinolones and resistance to fluoroquinolones in nasal and conjunctival flora, but there was a high prevalence of fluoroquinolone resistance among all patient groups.
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Affiliation(s)
- Chrisfouad R Alabiad
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Florida, USA.
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Hung CH, Wang JJ, Chen YC, Chu CC, Chen YW. Intrathecal oxybuprocaine and proxymetacaine produced potent and long-lasting spinal anesthesia in rats. Neurosci Lett 2009; 454:249-53. [DOI: 10.1016/j.neulet.2009.03.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 02/28/2009] [Accepted: 03/05/2009] [Indexed: 11/27/2022]
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Abstract
Development of new local anesthetic agents has been focused on the potency of their nerve-blocking effects, duration of action and safety and has resulted in a substantial number of agents in clinical use. It is well established and well documented that the nerve blocking effects of local anesthetics are secondary to their interaction with the Na+ channels thereby blocking nerve membrane excitability and the generation of action potentials. Accumulating data suggest however that local anesthetics also possess a wide range of anti-inflammatory actions through their effects on cells of the immune system, as well as on other cells, e.g. microorganisms, thrombocytes and erythrocytes. The potent anti-inflammatory properties of local anesthetics, superior in several aspects to traditional anti-inflammatory agents of the NSAID and steroid groups and with fewer side-effects, has prompted clinicians to introduce them in the treatment of various inflammation-related conditions and diseases. They have proved successful in the treatment of burn injuries, interstitial cystitis, ulcerative proctitis, arthritis and herpes simplex infections. The detailed mechanisms of action are not fully understood but seem to involve a reversible interaction with membrane proteins and lipids thus regulating cell metabolic activity, migration, exocytosis and phagocytosis.
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Affiliation(s)
- J Cassuto
- Department of Anesthesiology and Intensive Care and Institution of Surgical Specialties, Sahlgrenska University Hospital, Mölndal, Sweden.
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