Screening for multiresistant pathogens before cataract surgery / Multirezisztens kórokozók szurése szürkehályog-mutét elott

Összefoglaló. Bevezetés: A multirezisztens kórokozók által okozott fertozések komoly gondot okoznak. Szemészeti szempontból az ebbe a körbe tartozó meticillinrezisztens Staphylococcus aureus (MRSA) baktérium bír kiemelkedo jelentoséggel. Célkituzés: Multirezisztens kórokozók irányában cataractamutét elott álló betegektol mintavétel és adatelemzés. Módszer: 257, cataractamutét elott álló beteg esetében végeztünk multirezisztens kórokozók szurésére vizsgálatot a conjunctivazsákból. A mikrobiológiai tenyésztés során multirezisztens kórokozóra pozitív eredményt adó betegek esetében a preoperatív kórtörténetet és az általános kíséro betegségeket feltártuk és elemeztük. Eredmények: A minták 17 beteg esetében multirezisztens kórokozóra pozitívak voltak. 11 esetben szisztémás rizikófaktorokat is találtunk. A pozitív betegeknél a mutétet csak a felszabadító mikrobiológiai eredmények birtokában végeztük el. A dekolonizált betegeknél ezt követoen a szakmai protokoll normális antibiotikumprevencióját alkalmaztuk. A 257 beteg 6,6%-ában találtunk multirezisztenskórokozó- és 5%-ában MRSA-pozitivitást. Posztoperatív endophthalmitis nem fordult elo. Következtetés: A cataractamutéteknél alkalmazott antibiotikus endophthalmitisprevenció multirezisztens kórokozóra pozitív betegeknél kevéssé hatékony lehet. Ezért javasolt a veszélyeztetett betegek multirezisztens kórokozókra történo szurése és dekolonizációja. Orv Hetil. 2021; 162(3): 106-111. INTRODUCTION: Infections caused by multiresistant pathogens may have serious consequences. In ophthalmological practice, methicillin-resistant Staphylococcus aureus (MRSA) is the most important multiresistant pathogen. OBJECTIVE: We took samples for multiresistant pathogens from patients assigned for cataract surgery. METHOD: We carried out multiresistant pathogen screening from conjunctival sac in 257 patients, who were assigned for cataract surgery. Preoperative case history and concomitant systemic diseases were evaluated in patients, who turned out to be positive for multiresistant pathogens during the screening procedure. RESULTS: The samples were positive for multiresistant pathogens in 17 patients. In the case history of 11 multiresistant pathogen positive patients, previous systemic risk factors could be explored. Multiresistant pathogen positive patients were operated only after the decolonisation. After the decolonisation, the normal antibiotic prevention was used before the surgery. Multiresistant pathogen positive was 6.6%, MRSA positive was 5% of the 257 patients. There were no cases of endophthalmitis in any of these patients. CONCLUSION: Endophthalmitis prevention with antibiotics, according to the guidelines, may not be efficient in multiresistant pathogen positive patients. Therefore, it is advisable to screen multiresistant pathogens and decolonisation at risk patients before cataract surgery. Orv Hetil. 2021; 162(3): 106-111.

The Microbiome of the Meibum and Ocular Surface in Healthy Subjects.

Purpose: The purpose of this study was to investigate the microbiome in the meibum, conjunctival sac, and eyelid skin in young and elderly healthy subjects, and analyze the effect that age, sex, and region have on microbiome composition. Methods: This study involved 36 healthy subjects (young-age subjects: 9 men/9 women, age range: 20-35 years; elderly age subjects: 9 men/9 women, age range: 60-70 years). In all subjects, lower-eyelid meibum, lower conjunctival sac, and lower-eyelid skin specimens were collected from one eye, and then stored at -20°C. Taxonomic composition of the microbiome was obtained via 16S rRNA gene sequencing, and then analyzed. Results: The meibum microbiome showed a high α-diversity (within-community diversity), particularly in the young subjects. However, in approximately 30% of the elderly subjects, a low-diversity microbiome dominated by Corynebacterium sp. or Neisseriaceae was observed. In the young subjects, the microbiome of the meibum resembled that of the conjunctival-sac, yet in the elderly subjects, the microbiome of the conjunctival-sac became more similar to that of the eyelid skin. The eyelid-skin microbiome was relatively simple, and was typically dominated by Propionibacterium acnes in the young subjects, or by Corynebacterium sp. or Neisseriaceae in the elderly subjects. In both age groups, no significant difference was seen between the men and women in regard to the meibum, conjunctival-sac, and eyelid-skin microbiome. Conclusions: Our findings confirmed that the meibum of healthy adult-age subjects harbors highly diverse microbiota, and revealed that the meibum microbiome, especially the decrease of its diversity, alters with aging and may affect the homeostasis of the ocular surface.

Tuberculosis presenting as dacryoadenitis in the USA.

A 25-year-old Filipino woman living in the USA was evaluated for a 5-month history of left eye pain and a subsequent orbital mass. Histopathological analysis of the lacrimal mass showed a mixed inflammatory process with necrotising granulomas and positive cultures for Mycobacterium tuberculosis She was treated with antituberculosis therapy, with resolution of symptoms. Tuberculosis dacryoadenitis is extremely rare in the USA and other developed countries. It requires a high degree of clinical suspicion with special attention to the patient's history to make the correct diagnosis. It can be treated successfully with antituberculosis therapy.

Preoperative topical liposomal ozone dispersion to reduce bacterial colonization in conjunctival sac and periocular skin: Preliminary study in dogs.

Prophylaxis represents a keystone to reduce periocular skin and ocular conjunctiva bacterial load before surgical procedures. Despite many prophylactic agents are available the preferred perioperative ocular surface antimicrobial is still unknown. The purpose of this study was to assess the effectiveness of preoperative liposomal ozone dispersion in reducing bacterial colonization from the conjunctival sac and periocular skin in dogs, in comparison with povidone-iodine and fluoroquinolone. Twenty-two owned dogs consisting with 44 eyes in total scheduled for ophthalmic surgical procedure were enrolled for the study and divided in four groups receiving either ozone dispersion or povidone iodine in eyelid and conjunctiva, fluoroquinolone or placebo. A swab was taken before and after the antisepsis protocol evaluating total microbial count, coagulase positive and negative staphylococci. Statistical analysis revealed a significant decrease in colony forming units (CFU) for total microbial count, coagulase positive and negative staphylococci both for liposomal ozone dispersion and povidone iodine. No statistical differences were detected in median CFU for both one-day placebo and fluoroquinolone preoperative prophylactic topical therapy. The results of this preliminary study demonstrate that liposomal ozone-dispersion is as effective as povidone iodine to reduce preoperative bacterial load in ocular surface.

The Role of Bacterial Etiology in the Tear Duct Infections Secondary to Congenital Nasolacrimal Duct Obstructions.

PURPOSE: To define the microbiological features of dacryocystitis in childhood. METHODS: Patients with dacryocystitis secondary to CNLDO between 2017 and 2019 in Izmir, Turkey were included in the study. Inclusion criteria of the study were: mucopurulent secretion, being under 4 years old and not having received prior antibiotic treatment. Samples from secretion were cultivated in sheep blood agar, eosin methylene blue, and chocolate agar. Reproduction was checked intermittently. Clinically significant growths were reported. RESULTS: Seventy patients with dacryocystitis secondary to CNLDO were included in the study. Sixty percent of patients were female (n = 42) and 40% (n = 28) percent of patients were male. The average age of participants was 2.09 ±â€Š0.68 (1-3) years old. Positive bacterial proliferation results were noted in 20 patients (28.6%). Eighty percent (n = 16) of culture-positive bacterias were gram-negative bacterias and 20% (4) were gram-positive bacterias. Twenty percent of culture-positive bacterias were aerobic and 80% were facultative bacterias. The most common bacteria seen in culture specimen was Haemophilus 40% (Haemophilus haemolyticus [20%] and Haemophilus influenzae [20%]). CONCLUSIONS: Gram-negative organisms especially Haemophilus were most prevalent. These findings could be helpful for antibiotic selection.

Prevalence of Staphylococcus Species Colonization in Healthy and Sick Cats.

Staphylococcus is one of the most frequently isolated genera of opportunistic bacteria in animals and human beings. Staphylococci in mammals mostly inhabit the skin and mucous membranes. The objectives of the study were to investigate the distribution of staphylococcal species in healthy and sick cats in order to find diagnostic markers. The risk factors associated with colonization were also explored. Isolates from healthy (n=520) and sick cats (n=67) were identified at the species level using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS). Swabs from conjunctival sacs, nares, skin, anus, and wounds were investigated using this technique. The diversity of the Staphylococcus species was high: 26 and 17 species in healthy and sick cats, respectively, and predominantly coagulase-negative staphylococci (CoNS) were isolated. The most frequently observed were S. felis and S. epidermidis in healthy cats, whereas S. felis and S. haemolyticus were most often found in sick animals. S. aureus strains were only isolated from healthy cats, whereas the only coagulase-positive Staphylococcus (CoPS) which occurred in the sick cats group was S. pseudintermedius. The sick, more frequently than the healthy animals, were colonized with S. pseudintermedius and S. haemolyticus and the relationship was statistically significant. Mostly, regardless of the state of their health, similar Staphylococcus species were isolated from cats; therefore, particular attention should be paid during the interpretation of diagnostic results.

Concurrent Microbial Keratitis and Nasolacrimal Duct Obstruction: Concordance, Etiopathogenesis, and Outcome.

PURPOSE: Nasolacrimal duct obstruction (NLDO) is believed to be a risk factor for microbial keratitis (MK). The primary objective of this study was to look at microbiological concordance between corneal scraping and lacrimal sac flora in patients with concurrent MK and NLDO. The secondary objective was to compare microbiological isolates from MK and NLDO, MK alone, NLDO alone, and healthy subjects. METHODS: A prospective comparative study of 146 subjects with standard microbiological analyses was performed between February 2014 and October 2017. RESULTS: Of the 146 subjects, 35 had concurrent MK and NLDO, 35 had MK, 41 had NLDO, and 35 were healthy subjects. Overall, mean age and sex distribution among groups were similar. In the MK and NLDO group, coagulase-negative staphylococci (CNS) were the most common isolates from the corneal scraping (n = 12/35, 34%) and lacrimal sac (n = 10/35, 29%) with 58% concordance. CNS were also the most common isolates from the NLDO group and healthy subjects, fungus being the most common isolate in the MK group. Anatomical success was achieved in 31 patients (89%) after dacryocystorhinostomy (DCR) in the MK and NLDO group. The difference between the number of patients who had successful DCR surgery but failure of medical therapy for MK (1/31) versus those who failed DCR and medical therapy for MK (3/4) was statistically significant (P = 0.002, Fisher exact test). CONCLUSIONS: CNS are the most common organisms in concurrent MK and NLDO (58% concordance), in patients with NLDO alone, and as commensals in healthy subjects. Persistence of NLDO may be responsible for a poorer outcome of MK in a concurrent setting.

Conjunctival aerobic bacterial flora in healthy Silesian foals and adult horses in Poland.

BACKGROUND: Commensal bacterial and fungal flora of the conjunctival sac has been described in horses and other animals. The identification of commensal flora of the conjunctival sac may aid in the diagnosis of ocular inflammatory diseases, such as conjunctivitis or more severe ulcerative keratitis, common in horses. Moreover, damage of ocular protective barriers may lead to an opportunistic infection. The study was carried out in Silesian horses kept at a single breeding center in South-western Poland, in order to limit any breed-dependant and climate-dependant variables affecting the results. Following an ophthalmic examination that revealed no abnormalities, sterile swabs were collected from conjunctival sac in 26 adult horses and 11 foals. The obtained swabs were subjected to bacterial culture testing. In case of Staphylococcus spp. isolation, susceptibility to methicillin was evaluated. RESULTS: Forty- three bacterial isolates, representing eleven genera of bacteria were cultured from 30 (81%) horses. Gram-positive bacteria were the dominant isolates (72%) (p < 0.001). The most commonly isolated Gram-positive bacteria were Staphylococcus spp., while Moraxella spp. were the most frequently isolated Gram-negative bacteria. There was no significant influence of sex and age on the frequency and type of microbial isolates. CONCLUSIONS: Commensal flora is present in the conjunctival sac of healthy horses in Poland. Age does not affect the abundance and type of microbial isolates.

Orbital tuberculosis: perspectives from Victoria, Australia.

PURPOSE: Orbital tuberculosis (TB) is a rare extra-pulmonary manifestation of tuberculosis and its clinical diagnosis poses unique challenges, with potential for destructive complications as well as social and public health implications. The aim of this study is to report our experience of patients presenting with orbital TB and to identify common aspects. METHODS: A systematic search for mandatory notifications of orbital tuberculosis between January 01, 1994 and December 12, 2016 was undertaken in the Victorian Tuberculosis database. In addition, members of the Australian and New Zealand Society of Ophthalmic Plastic Surgeons (ANZSOPS) were surveyed to identify cases of orbital tuberculosis diagnosed on biopsy in the past 20 years. Medical case notes of identified cases were reviewed retrospectively. RESULTS: Three cases were identified as having occurred in Victoria, aged 44-59 years old. All cases had emigrated from endemic countries with higher tuberculosis burden. Diagnosis of tuberculosis was often difficult due to few or non-viable acid fast bacilli and low yield of positive culture in paucicellular orbital specimens. CONCLUSIONS: Orbital TB is rare but remains an important differential diagnosis of orbital mass lesions. The diagnosis of orbital TB requires a high index of clinical suspicion and targeted investigations in patients originating from endemic areas. Diagnosis and treatment rely on effective collaboration between ophthalmologists, infectious disease physicians, and pathologists.

An unusual cause of recurrent bloody tear.

We describe a female patient who presented with watering followed by swelling in the left infraorbital area of 5 years duration. She had previously been prescribed topical antibiotics on several occasions with no improvement. On pressure over the swelling, there was blood-tinged discharge from the left eye and nostril. Magnetic resonance imaging revealed an enhancing, well-defined mass lesion in the inferomedial aspect of the left orbit, likely of nasolacrimal origin. Computed tomography dacryocystogram with three-dimensional reconstruction showed a well-circumscribed mass with an irregular surface, originating from the lacrimal sac. Gram staining and potassium hydroxide mount from the regurgitant fluid revealed thick-walled cysts with sporangia suggestive of Rhinosporidium seeberi infection. Excision biopsy of the lesion confirmed R. seeberi as the causative agent. The patient has been put on long-term dapsone therapy to prevent a recurrence and has been asked to follow-up 6 months later.

Canaliculitis With Isolation of Myroides Species.

Genera Myroides belongs to the family flavobacteriaceae and are a group of Gram-negative bacilli which are nonmotile, nonfermentative, and oxidase positive. Myroides spp. are routinely found in the soil and water and rarely cause infections in the immunocompromised patients and are usually multidrug resistant. The authors describe the first case of chronic canaliculitis caused by Myroides spp. along with a brief review of literature. The patient responded to nonincisional canalicular curettage and topical moxifloxacin.

Combination Effect of Cefuroxime and Levofloxacin Against Bacteria Isolated from the Healthy Conjunctival Sac and Endophthalmitis Cases Using a Fractional Inhibitory Concentration Index.

PURPOSE: Intracameral cefuroxime (CXM) and antibiotic eye drops such as fluoroquinolone are widely used for preventing endophthalmitis after cataract surgery. However, few reports are available regarding their interactions. This study was conducted to examine the in vitro interaction of CXM and levofloxacin (LVFX) against bacterial isolates from the healthy conjunctival sac before cataract surgery and from endophthalmitis cases. METHODS: The activity of each drug was determined using a broth dilution method. Checkerboard synergy testing was performed for 43 isolates from the healthy conjunctival sac before cataract surgery and 15 isolates from endophthalmitis cases, respectively. Antimicrobial combinations were classified as synergistic, additive, indifferent, or antagonistic based on their fractional inhibitory concentration (FIC). RESULTS: Minimum inhibitory concentrations of CXM and LVFX against endophthalmitis isolates were compared against conjunctival sac isolates. The average FIC indices of combined CXM and LVFX used in endophthalmitis isolates were significantly lower than those in conjunctival sac isolates (P < 0.001). The synergistic activities of CXM and LVFX combinations were observed in 50% of endophthalmitis isolates and no conjunctival sac isolates. No consistent additive or synergistic effect was observed in Enterococcus faecalis isolates from endophthalmitis cases. CONCLUSIONS: CXM and LVFX resistance was frequently identified in the endophthalmitis isolates. However, CXM and LVFX combination showed a synergistic effect against endophthalmitis isolates and increased the antibiotic activity of each drug, suggesting that the combination may improve effects of both antibiotics and combat drug-resistant bacteria that cause endophthalmitis.

Dacryoliths causing intermittent epiphora associated with a patent lacrimal system / Dacriolitíase causando epífora intermitente associada a um sistema lacrimal de patente

ABSTRACT We present two patients with dacryoliths and patent lacrimal drainage with intermittent tearing and without infection. Dacryoliths can be present in the lacrimal sac or lacrimal duct without acute or chronic inflammation. In these cases, we believe dacryolith formation was a causative factor of intermittent epiphora even with a patent drainage system, and we propose that dacryoliths and even fungal colonization formation may be the first event before dacryocystitis and should be considered as a cause of epiphora.

RESUMO Apresentamos dois pacientes com dacriolitíase e drenagem lacrimal patente com lacrimejamento intermitente, sem infecção. Os dacriolitos podem estar presentes no saco lacrimal ou duto lacrimal, sem inflamação aguda ou crônica. Neste caso nós acreditamos que a dacriolitíase foi um fator causador da epífora intermitente mesmo com sistema de drenagem patente e propomos que dacriolitíase e até mesmo a colonização fúngica pode ser o primeiro evento antes dacriocistite, e deve ser adicionada como uma das causas de epífora.

First case report of isolated aspergillus dacryoadenitis.

We report a case of isolated Aspergillus dacryoadenitis. A 23-year-old male presented with dull ache, diffuse swelling in superolateral quadrant of the right orbit and proptosis for 4 months. Ocular examination showed conjunctival congestion, discharge in the fornix and palpable lacrimal gland (LG) mass. Routine hematological investigations followed by computed tomography scan of orbits were done. He did not respond to a course of systemic and topical antibiotics. Lateral orbitotomy with extended lid crease incision was performed with excision biopsy of LG. Abundant blackish material was found in the LG intraoperatively. The specimen was sent for histopathological examination (HPE). HPE report showed Aspergillus. Thorough ENT and systemic evaluation ruled out any other site with the fungus. To the best of our knowledge, this is the first case report of Aspergillus infection in LG.

Bacteriological profile in conjunctival, lacrimal sac, and nasal specimens and conjunctival normalization time following external, endoscopic, and transcanalicular multidiode laser dacryocystorhinostomy.

PURPOSE: To compare the conjunctival, lacrimal sac, and nasal flora cultures and conjunctival normalization time following external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) dacryocystorhinostomy (DCR) and to evaluate the relationship between culture positivity and surgical success. We further performed antibiotic sensitivity analyses for lacrimal sac culture samples. METHODS: A total of 90 patients with primary acquired nasolacrimal duct obstruction were recruited and divided into EX-DCR (n=32), EN-DCR (n=28), and TC-DCR (n=30) groups. Conjunctival, nasal, and lacrimal sac cultures and antibiograms were analyzed. RESULTS: In all three groups, coagulase-negative Staphylococcus (CNS) was predominantly isolated preoperatively from the conjunctiva, nose, and lacrimal sac and postoperatively from the conjunctiva. Preoperative and postoperative conjunctival culture positivity rates were similar between all the groups (p>0.05). A statistically significant difference in the growth rate of culture in the lacrimal sac was observed between the three groups (p=0.001). CNS and Staphylococcus aureus cultures were predominantly sensitive to linezolid, teicoplanin, tigecycline, vancomycin, and mupirocin. Conjunctival normalization times were similar between the three groups (p>0.05). Anatomical and functional success rates were not found to be significantly correlated with preoperative conjunctival and lacrimal sac culture positivity (p>0.05). CONCLUSIONS: Similar rates of preoperative and 1-week postoperative conjunctival culture positivity were observed in all the groups; a significantly lower bacterial growth rate was observed in postoperative conjunctival cultures. CNS was the most commonly isolated organism. Bacterial growth rates in the lacrimal sac samples were significantly higher in the EN-DCR group. Bacterial growth rates obtained preoperatively from the conjunctival and lacrimal sac culture samples were not correlated with DCR success.

Bacteriological profile in conjunctival, lacrimal sac, and nasal specimens and conjunctival normalization time following external, endoscopic, and transcanalicular multidiode laser dacryocystorhinostomy / Perfil bacteriológico e tempo de normalização conjuntival de espécimes de conjuntiva, saco lacrimal e nasais após dacriocistorrinostomia externa, endoscópica e transcanalicular com laser de multi diodo

ABSTRACT Purpose: To compare the conjunctival, lacrimal sac, and nasal flora cultures and conjunctival normalization time following external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) dacryocystorhinostomy (DCR) and to evaluate the relationship between culture positivity and surgical success. We further performed antibiotic sensitivity analyses for lacrimal sac culture samples. Methods: A total of 90 patients with primary acquired nasolacrimal duct obstruction were recruited and divided into EX-DCR (n=32), EN-DCR (n=28), and TC-DCR (n=30) groups. Conjunctival, nasal, and lacrimal sac cultures and antibiograms were analyzed. Results: In all three groups, coagulase-negative Staphylococcus (CNS) was predominantly isolated preoperatively from the conjunctiva, nose, and lacrimal sac and postoperatively from the conjunctiva. Preoperative and postoperative conjunctival culture positivity rates were similar between all the groups (p>0.05). A statistically significant difference in the growth rate of culture in the lacrimal sac was observed between the three groups (p=0.001). CNS and Staphylococcus aureus cultures were predominantly sensitive to linezolid, teicoplanin, tigecycline, vancomycin, and mupirocin. Conjunctival normalization times were similar between the three groups (p>0.05). Anatomical and functional success rates were not found to be significantly correlated with preoperative conjunctival and lacrimal sac culture positivity (p>0.05). Conclusions: Similar rates of preoperative and 1-week postoperative conjunctival culture positivity were observed in all the groups; a significantly lower bacterial growth rate was observed in postoperative conjunctival cultures. CNS was the most commonly isolated organism. Bacterial growth rates in the lacrimal sac samples were significantly higher in the EN-DCR group. Bacterial growth rates obtained preoperatively from the conjunctival and lacrimal sac culture samples were not correlated with DCR success.

RESUMO Objetivo: Comparar a flora conjuntival, do saco lacrimal e nasal com o tempo de normalização após dacriocistorrinostomia (DCR) externa (EX-), endoscópica (EN-) e transcanalicular a laser de multi diodo (TC-) para correlacionar a positividade da cultura com o sucesso cirúrgico, assim como identificar a sensibilidade aos antibióticos em amostras de saco lacrimal. Métodos: Neste estudo prospectivo, 90 pacientes com obstrução do canal nasolacrimal adquirida primária foram incluídos e divididos em grupos EX-DCR (n=32), EN-DCR (n=28) e TC-DCR (n=30). Culturas e antibiogramas conjuntivais, nasais e do saco lacrimal foram analisados. Resultados: Staphylococcus coagulase-negativo (CNS) foi o organismo predominante isolado no pré-operatório (conjuntiva e nariz), no transoperatório (saco lacrimal) e pós-operatório (conjuntiva), nos 3 grupos. Taxas de positividade de cultura da conjuntiva pré- e pós-operatórias nos três grupos foram semelhantes (p>0,05). A diferença nas taxas de crescimento do saco lacrimal dos três grupos foi estatisticamente significativa (p=0,001). CNS e S. aureus foram mais sensíveis a linezolida, teicoplanina, a tigeciclina, vancomicina e mupirocina. O tempo de normalização conjuntival foi semelhante nos três grupos (p>0,05). Não houve relação estatisticamente significativa entre as taxas de sucesso anatômicas e funcionais e a positividade da cultura conjuntival e de saco lacrimal pré-operatória (p>0,05). Conclusões: Pacientes submetidos a EX-DCR, EN-DCR, e TC-DCR apresentaram positividades de cultura conjuntival semelhantes no pré-operatório e na 1a semana pós-operatória. Houve uma redução significativa na taxa de crescimento das culturas da conjuntiva pós-operatórias. O organismo mais comumente isolado foi o CNS. A taxa de crescimento de bactérias a partir do saco lacrimal foi significativamente maior no grupo PT-DCR. O crescimento bacteriano da conjuntiva no pré-operatório e de amostras do saco lacrimal no transoperatório não se relacionaram com o sucesso da DCR.

Dacryoliths causing intermittent epiphora associated with a patent lacrimal system.

We present two patients with dacryoliths and patent lacrimal drainage with intermittent tearing and without infection. Dacryoliths can be present in the lacrimal sac or lacrimal duct without acute or chronic inflammation. In these cases, we believe dacryolith formation was a causative factor of intermittent epiphora even with a patent drainage system, and we propose that dacryoliths and even fungal colonization formation may be the first event before dacryocystitis and should be considered as a cause of epiphora.

Microbiology and Biofilm Trends of Silicone Lacrimal Implants: Comparing Infected Versus Routinely Removed Stents.

PURPOSE: To investigate the pathogens and biofilms responsible for clinically significant infection of silicone stents implanted within the lacrimal system. METHODS: Retrospective review of culture results and patient demographics for all silicone lacrimal stents removed early for clinically significant infection and sent to the Bascom Palmer Microbiology Laboratory through the end of year 2010. As a control, routinely removed, clinically noninfected stents from the same institution were prospectively sent for culture over a 6-month period. Four clinically infected and 6 clinically noninfected stents showing mucus within the lumen at removal were sent for scanning electron microscopy. Images were randomized and graded by a microbiologist for the presence of organisms, matrix deposits, organisms within matrix, and overall impression of significant biofilm formation. RESULTS: Nineteen stents were included in the study; 100% of clinically infected (n = 10) and noninfected (n = 9) stents were culture positive. Culture positivity for nontuberculous mycobacterium was found in 90% of infected stents and none of the noninfected stents (p < 0.001). Of infected stents, 50% grew Gram-positive organisms compared with 89% of noninfected stents (p = 0.07). Fifty percent of infected versus 67% of noninfected stents were culture positive for Gram-negative organisms (p = 0.46). Electron microscopy of stents revealed organisms consistent with culture results (size, shape) in planktonic and biofilm form. Masked observer image grading revealed a statistically significant higher amount of organism and biofilm on infected versus noninfected specimen. CONCLUSION: Nontuberculous mycobacteria comprise the primary pathogens responsible for clinically significant infection of silicone stents in the lacrimal system in South Florida. Robust biofilm production by this organism likely plays a role in pathogenesis. Further research into biofilm-related lacrimal implant infection may aid in the development of useful prevention and treatment strategies.

Bacteriological profile and drug susceptibility patterns in dacryocystitis patients attending Gondar University Teaching Hospital, Northwest Ethiopia.

BACKGROUND: Bacterial pathogens isolated from dacryocystitis patients are diverse and complex in terms of their distribution, prevalence, and antimicrobial susceptibility pattern. The clinical importance of microbial causes of dacryocystitis and pattern of drug resistance has not been reported in northwest Ethiopia. Moreover, the management of dacryocystitis is based on only clinical observation Therefore, this study attempted to identify and define clinical and microbiological characteristics of microbial agents of dacryocystitis and its antibiotic susceptibility patterns. METHODS: A cross sectional study was conducted from January 2011-January 2012 among dacryocystitis patients attending ophthalmology outpatient department of Gondar University teaching Hospital. Sociodemographic and clinical data collection, microbiological analysis and antibiotic susceptibility test patterns were done following standard procedures. RESULTS: From the total of 51 dacryocystitis cases, bacterial origins were isolated among 31(60.8%) cases. The dominant isolates were Coagulase negative Staphylococci (CNS) 9(29.0%), Staphylococcus aureus (S. aureus) 6(19.4%), and Pseudomonas species 3(9.7%). S. pneumoniae, Entrobacter species, K. pnemoniae and H. influenzae were each accounted 6.5% isolation rate. Among the commonly prescribed antimicrobials tested for susceptibility pattern; amoxicillin 38.7%, ciprofloxacin 25.8%, chloramphinicol 25.8%, co-trimoxazole 25.8%, and ampicillin 19.4% were resistant to the overall bacterial isolates identified. Only Citrobacter species were sensitive to all antibiotics tested but the rest bacterial isolates were resistant for at least to one, two, three, four and more antibiotics tested. Overall, 9(29.0%) of the bacterial isolates were resistant to only one antibiotics and resistance to two, three and four antibiotics each accounted 5(16.1%) rate. CONCLUSIONS: Though the information derived from this study was very meaningful, further studies encompassing viral, fungal, parasitic and anaerobic bacterial origin are important to better define the spectrum and relative incidence of pathogens causing dacryocystitis. Microbiological analysis and antimicrobial susceptibility pattern is mandatory for the selection of a specific antimicrobial therapy and to the control of further resistance development of bacterial strains.