Current alternative therapies for treating drug-resistant Neisseria gonorrhoeae causing ophthalmia neonatorum.

Ophthalmia neonatorum is a microbial contraction, damaging eyesight, occurring largely among neonates. Infants are particularly vulnerable to bacterial infections acquired during birth from infected mothers, especially from Neisseria gonorrhoeae and Chlamydia trachomatis. Over the decades, N. gonorrhoeae is alarmingly developing a resistance to most antibiotics currently prescribed. To counter this challenge, it is imperative to find potent and cost-effective therapeutic agents for prophylaxis and treatment, to which the N. gonorrhoeae cannot easily develop resistance. This review showcases alternate therapies such as antimicrobial-fatty acids, -peptides, -nano-formulations etc., currently evident against N. gonorrhoeae-mediated ophthalmia neonatorum, which remains a major cause of ocular morbidity, blindness and even death among neonates in developing countries.

Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae. N. gonorrhoeae can infect a newborn's eyes during birth by an infected mother. These babies can develop redness, irritation and discomfort in the eye(s), a condition called ophthalmia neonatorum. This condition can lead to blindness. Antibiotics are used to treat N. gonorrhoeae infections, but in recent decades, it has been fast evolving to avoid the action of most antibiotics. This is known as antibiotic resistance. There is, therefore, an urgent need for easily accessible non-antibiotic therapies. In this article, various alternate therapies currently available to treat N. gonorrhoeae have been reviewed.

Severe ophthalmia neonatorum in Southwest China: a 5-year review of demographics, microbiological results, and risk factors.

PURPOSE: To evaluate the microbiological characteristics and risk factors of severe ophthalmia neonatorum (ON) in Southwest China. METHODS: In this retrospective review, data on demography, microbiological results, and risk factors were analyzed. Data were obtained from medical records of patients with severe ON treated at Children's Hospital of Chongqing Medical University from January 2015 to December 2019. To understand the risk factors for severe ON, maternal and neonatal factors were compared between the severe and non-severe ON groups. RESULTS: A total of 1397 neonates with ON were included, of whom 12% (n = 172) had severe ON, and 88% (n = 1225) had non-severe ON. Microbial detection and drug susceptibility tests were performed on 169 patients with severe ON. Culture results were positive for 76 patients, with gram-positive bacteria in 71.1% (n = 54), gram-negative bacteria in 25.0% (n = 19), and multiple microorganisms in 3.9% (n = 3) neonates. The most commonly detected organisms were Staphylococcus aureus (29%) and Staph. epidermis (27%), followed by Escherichia coli (8%). Neisseria gonorrhea (8%), Moraxella catarrhal (5%), Streptococcus pneumoniae (4%), Haemophilus influenza (4%), and Chlamydia trachomatis (1%). The main risk factors for severe ON were obstruction of the nasolacrimal duct (χ2 = 10.794, P = 0.001), meconium aspiration syndrome (χ2 = 6.252, P = 0.012), and cesarian section (χ2 = 5.118, P = 0.024). Neonatal ocular prophylaxis was a protective factor for severe conjunctivitis (χ2 = 6.905, P = 0.009). CONCLUSIONS: Staphylococcus is the most common pathogen of severe ON. Nasolacrimal duct obstruction (NLDO) is a risk factor for ON.

Using Historical Data to Support Approval of Drug Products for Ophthalmia Neonatorum: Innovative Approach Toward Evidence-Based Medicine.

Importance: Off-label treatment was common for ophthalmia neonatorum because only erythromycin ointment had been approved by the US Food and Drug Administration (FDA) for this indication. Ophthalmia neonatorum was previously considered a different indication from bacterial conjunctivitis in older children and adults because of uncertain similarities in the cause of disease and the treatment course between the 2 populations. Prospective therapeutic clinical studies were required to demonstrate the effectiveness of treatment for ophthalmia neonatorum. Objective: To review the therapeutic clinical trials for patients with bacterial conjunctivitis to evaluate the similarity in the cause of disease and the treatment response between neonates and older children and adults. Design, Setting, and Participants: In this comparative effectiveness research review of pooled data from the most recent 30 bacterial conjunctivitis trials (N = 2018) submitted to the FDA to support the approval of topical ophthalmic solutions for older children and adults, 95% CIs were constructed from clinical cure rates. Cure rates in 3 neonatal randomized clinical trials (N = 392) of patients treated with ophthalmic anti-infective solutions of ciprofloxacin, gatifloxacin, and moxifloxacin were constructed and compared. The baseline ocular swab cultures were analyzed. Main Outcomes and Measures: Cure rates of neonatal trials were compared with the 95% CIs among older children and adults. The bacterial organisms isolated from these 2 populations were compared. Results: The 3 neonatal trials enrolled a total of 392 patients, and the 30 trials of older children and adults enrolled a total of 2018 patients. Neonatal clinical cure rates for moxifloxacin (day 4, 48%), ciprofloxacin (day 4, 49%; day 5, 61%), and gatifloxacin (day 7, 79%) were within the 95% CI for products approved to treat older children and adults with bacterial conjunctivitis. Bacterial organisms were consistent between these 2 populations. Conclusions and Relevance: Comparison of the pooled analysis of these historical trial data suggests similarity in the cause of disease and the treatment response between neonates and older children and adults with bacterial conjunctivitis. Therefore, it was appropriate to extrapolate the effectiveness from older children and adults to neonates to support the approval of therapies for ophthalmia neonatorum. Based on this analysis, ophthalmic solutions of ciprofloxacin, gatifloxacin, and moxifloxacin are now approved for all age groups. This analysis presents an approach of using pooled data from previously underpowered individual trials to establish the similarities in the cause of disease and in treatment response between children and adults, which are the fundamental elements used to evaluate whether extrapolation of effectiveness can be used to support drug approval.

In Vitro Models of Eye Infection with Neisseria gonorrhoeae.

Prophylaxis with silver nitrate and later antibiotics has significantly reduced the cases of infant blindness from gonococcal infection at birth to the point where it has all but been forgotten in the developed world as the devastating disease that it was in the pre-antibiotic era. As a result, while it is known that the bacteria are transmitted to the eyes during passage through the infected birth canal, little is known about Neisseria gonorrhoeae colonization of the eye and the establishment and progression of keratitis. Treatment failures due to rising antimicrobial resistance necessitate investigations into all aspects of gonococcal disease, including eye infections, so that new treatment strategies can be developed. Here we present models for N. gonorrhoeae eye infection using excised bovine corneas and coculture of gonococci with primary human corneal epithelial cells. These models can be used to explore the interactions of the bacteria with corneal tissues and cells and to investigate novel therapeutics against infection.

Gonococcal infection: An unresolved problem. / Infección gonocócica: un problema aún sin resolver.

Gonococcal infection is a current public health problem worldwide, being the second most prevalent bacterial sexually transmitted infection. The etiologic agent is Neisseria gonorrhoeae, a gram-negative diplococcus, and mainly causes urethritis in men. In women up to 50% of infections can be asymptomatic. N. gonorrhoeae has a great ability to develop antibiotic resistance, so the last remaining therapeutic option are extended spectrum cephalosporins. Many guides recommend dual therapy with ceftriaxone and azithromycin, but in recent years the resistance to azithromycin is also increasing, so that dual treatment is being questioned by scientific societies.

A Survey of Current Prophylactic Treatment for Ophthalmia Neonatorum in Croatia and a Review of International Preventive Practices.

BACKGROUND Ophthalmia neonatorum, or neonatal conjunctivitis, is an acute infection that occurs within the first 28 days of life. This aim of this survey was to evaluate the current methods of preventive treatment for ophthalmia neonatorum in maternity hospitals in Croatia. MATERIAL AND METHODS The annual hospital birth rate in Croatia is approximately 40,000. A clinical survey was undertaken with data collected using questionnaires sent to all 32 maternity hospitals in Croatia. There was a 100% response rate to the questionnaires. RESULTS Preventive treatment for ophthalmia neonatorum was administrated to all newborns in 75% (24/32) of Croatian maternity hospitals. In 45.8% of maternity hospitals, (11/32) these procedures were performed within the first hour after birth. In 54.2% of maternity hospitals (13/32), preventive treatment for ophthalmia neonatorum was administrated to all newborns from one to three hours after birth. The main treatment agent was tobramycin (83.3%). Other topical prophylactic treatments included povidone-iodine (8.3%), erythromycin (4.2%), and silver nitrate (4.2%). In 25% of obstetric units, prophylaxis for ophthalmia neonatorum was not used routinely, but in cases of diagnosed neonatal conjunctivitis, antibiotic treatment with tobramycin was mainly used. CONCLUSIONS A survey of all 32 maternity hospitals in Croatia showed variation in the prevalence of preventive treatment for ophthalmia neonatorum and the methods used. These findings support the need to implement standardized preventive measures that both conform to international clinical guidelines and recognize treatment availability in Croatia, where topical povidone-iodine is currently preferred for the prevention of ophthalmia neonatorum.

Mutations in Neisseria gonorrhoeae grown in sub-lethal concentrations of monocaprin do not confer resistance.

Neisseria gonorrhoeae, due to its short lipooligosaccharide structure, is generally more sensitive to the antimicrobial effects of some fatty acids than most other Gram negative bacteria. This supports recent development of a fatty acid-based potential treatment for gonococcal infections, particularly ophthalmia neonatorum. The N. gonorrhoeae genome contains genes for fatty acid resistance. In this study, the potential for genomic mutations that could lead to resistance to this potential new treatment were investigated. N. gonorrhoeae strain NCCP11945 was repeatedly passaged on growth media containing a sub-lethal concentration of fatty acid myristic acid and monoglyceride monocaprin. Cultures were re-sequenced and assessed for changes in minimum inhibitory concentration. Of note, monocaprin grown cultures developed a mutation in transcription factor gene dksA, which suppresses molecular chaperone DnaK and may be involved in the stress response. The minimum inhibitory concentration after exposure to monocaprin showed a modest two-fold change. The results of this study suggest that N. gonorrhoeae cannot readily evolve resistance that will impact treatment of ophthalmia neonatorum with monocaprin.

Diagnosis of a neonatal ophthalmic discharge, Ophthalmia neonatorum, in the molecular age: investigation for a correct therapy.

An early double case of acute Ophthalmia neonatorum in 3-day-old twins is reported. Culture of eye swabs showed a wide bacterial polymorphism, in which common bacteria, such as Klebsiella pneumoniae, Streptococcus pneumoniae, Corynebacterium ulcerans and other Enterobacteriaceae, coexisted with atypical Mycoplasmataceae and Chlamydiaceae from resident cervical-vaginal maternal microbiota. The neonates were in an apparently healthy state, but showed red eyes with abundant greenish-yellow secretion, mild chemosis and lid edema. The maternal cervical-vaginal ecosystem resulted differently positive to the same common cultivable, atypical bacteria culturally and molecularly determined. This suggested a direct maternal-foetal transmission or a further foetal contamination before birth. An extended culture analysis for common bacteria to atypical ones was decisive to describe the involvement of Mycoplasmas (M. hominis and U. urealyticum) within the scenario of the Ophthalmia neonatorum in a Caucasian couple. The introduction of a routine PCR molecular analysis for Chlamydiaceae and N. gonorrhoeae allowed to establish which of these were present at birth, and contributed to determine the correct laboratory diagnosis and to define an adequate therapeutic protocol obtaining a complete resolution after one year for culture and atypical bacteria controls. This study suggests to improve the quality of laboratory diagnosis as unavoidable support to a correct clinical diagnosis and therapy, in a standardized modality both for swabbing and scraping, to check the new-born microbial programming starting in uterus, overtaking the cultural age to the molecular age, and to revise the WHO guidelines of SAFE Strategy for trachoma eye disease, transforming it into SAFES Strategy where the S letter is the acronym of Sexual ecosystem and behavioural valuation/education.

Morganella as a cause of ophthalmia neonatorum.

A 2 day-old-girl with a complicated birth history, including prolonged rupture of membranes and Caesarian section delivery, presented with a purulent bacterial conjunctivitis of the left eye despite standard prophylaxis. Bacterial cultures yielded 1+ Morganella morganii, a facultative anaerobe and a rare cause of ocular pathology. The patient was treated with topical tobramycin four times daily for 7 days, resulting in resolution of her conjunctivitis.

A chronological study of the bacterial pathogen changes in acute neonatal bacterial conjunctivitis in southern China.

BACKGROUND: The aim of the project is to retrospectively study the changes in bacterial pathogens in acute neonatal bacterial conjunctivitis from 2002 to 2016 in Southern China. The results may provide the guidance for drug choice for acute neonatal bacterial conjunctivitis. METHODS: Secretion specimens for bacterial culture were taken from 485 cases with clinically diagnosed acute bacterial neonatal conjunctivitis. Bacterial pathogens were detected by Gram staining and subsequent bacterial culture. RESULTS: From the analysis of the bacterial pathogens in 485 cases of acute neonatal conjunctivitis patients from 2002 to 2016 in Southern China, there is an overall trend of decreasing detection of Gram-positive bacteria and increasing detection of Gram-negative bacteria from the conjunctival sac secretions. Gram-positive bacteria in the bacteria-positive samples dropped year by year from 82.6% in 2002 to 72.4% in 2016. Accordingly, the ratio of Gram-negative bacteria increased from 17.4% in 2002 to 27.6% in 2016. Of note, despite the overall trend, there was a significant increase in detection of Gram-positive bacteria and decrease in detection of Gram-negative bacteria from 2011 to 2012. Among the Gram-positive bacteria, there is a trend of increasing percentage of the opportunistic pathogens (an ~60% increase in Staphylococcus epidermidis and Staphylococcus saprophytic) and decreasing percentage of Staphylococcus aureus (~30% decrease) and hemolytic streptococcus (~20% decrease) in the last 15 years. The main Gram-negative bacterium is Neisseria gonorrhoeae. Overall, there is a change in the pattern of bacterial species in acute neonatal bacterial conjunctivitis in Southern China in the last 15 years. CONCLUSION: Our study provides a trend analysis of the bacterial pathogens in the conjunctival sac secretions of the acute neonatal bacterial conjunctivitis patients in Southern China in recent years. This data could provide useful information regarding the treatment options for neonatal bacterial conjunctivitis.

Prevention of Ophthalmia Neonatorum Caused by Neisseria gonorrhoeae Using a Fatty Acid-Based Formulation.

Ophthalmia neonatorum, also called neonatal conjunctivitis, acquired during delivery can occur in the first 28 days of life. Commonly caused by the bacterial pathogen Neisseria gonorrhoeae, infection can lead to corneal scarring, perforation of the eye, and blindness. One approach that can be taken to prevent the disease is the use of an ophthalmic prophylaxis, which kills the bacteria on the surface of the eye shortly after birth. Current prophylaxes are based on antibiotic ointments. However, N. gonorrhoeae is resistant to many antibiotics and alternative treatments must be developed before the condition becomes untreatable. This study focused on developing a fatty acid-based prophylaxis. For this, 37 fatty acids or fatty acid derivatives were screened in vitro for fast antigonococcal activity. Seven candidates were identified as bactericidal at 1 mM. These seven were subjected to irritation testing using three separate methods: the bovine corneal opacity and permeability (BCOP) test; the hen's egg test-chorioallantoic membrane (HET-CAM); and the red blood cell (RBC) lysis assay. The candidates were also tested in artificial tear fluid to determine whether they were effective in this environment. Four of the candidates remained effective. Among these, two lead candidates, monocaprin and myristoleic acid, displayed the best potential as active compounds in the development of a fatty acid-based prophylaxis for prevention of ophthalmia neonatorum.

Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010-2015.

Perinatal transmission of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) can result in conjunctivitis in infants. We examined national rates of reported CT/GC conjunctivitis among infants. Surveillance of these infections is heavily affected by the completeness of reported data on specimen source and age. Alternative data sources should be evaluated.

[Gonococcal ophthalmia neonatorum: Clinical illustration, prevention, and future prospects]. / Conjonctivite néonatale à Neisseria Gonorrhoeae : illustration clinique, prophylaxie et perspectives d'avenir.

A 6-day-old infant presented with a bilateral suppurative ocular discharge with a conjunctival erythema. Polymerase chain reaction was performed on the pus and showed the presence of Neisseria gonorrhoeae DNA. Therapy with intravenous cefotaxime was initiated and completed with local application of tobramycin. This infection was associated with a small unilateral corneal lesion, with rapid resolution. This case provides the opportunity to focus on newborn suppurative conjunctivitis and its treatment. The different prophylaxes available (silver nitrate, povidone-iodine, local antibiotics, etc.) and their respective advantages and disadvantages are reviewed. There is no clear consensus on the most effective solution. Additionally, universal prophylaxis is challenged in several countries, where it is no longer recommended.

Erythromycin Prophylaxis for Neonatal Conjunctivitis: Ointment Versus Drops.

BACKGROUND: Due to a shortage of individualized erythromycin ointment (IEO), we switched to shared erythromycin drops (SED). Following this change, nurses claimed observing more cases of eye discharge. OBJECTIVES: To test whether switching from IEO to SED affected the rate of neonatal conjunctivitis (NC). METHODS: The study group included 14,916 neonates > 35 weeks of gestation, further divided into two birth periods of 12 months each: 1 January 2013 to 31 December 2013 (IEO) and 1 February 2014 to 31 January 2015 (SED). We compared the two birth periods with regard to three variables: clinical NC (number of conjunctival swabs/1000 neonates), bacterial NC (number of culture-positive swabs/1000 neonates), and bacterial growth percentage (number of culture-positive swabs/100 samples). RESULTS: Compared to 2012-2013, the period 2014-2015 included fewer cesarean deliveries and shorter length of stay (LOS). Clinical NC, bacterial NC and bacterial-growth percentage were not different between the two periods. Variables that were independently significantly associated with increased clinical NC included male gender (OR 1.48, CI 1.21-1.81) and LOS (OR 1.24, CI 1.18-1.29). LOS was associated with bacterial NC (OR 1.19, CI 1.11-1.28). Coagulase-negative staphylococci, Escherichia coli and Pseudomonas aeruginosa were the prevalent pathogens, though without difference between periods. CONCLUSIONS: Rates of clinical NC, bacterial NC and bacterial-growth percentage were not different between the study periods. Switching from IEO to SED had no effect on the NC rate.

Klebsiella pneumonia: An unusual cause of ophthalmia neonatorum in a healthy newborn.

Ophthalmia neonatorum is one of the most common infections during the neonatal period. Chlamydia trachomatis and Neisseria gonorrhoea must be ruled out, given their high virulence and systemic complications. We describe a case of ophthalmia neonatroum from Klebsiella pneumonia. Gram-negative organisms have been reported in hospital-acquired conjunctivitis (HAC), but we are unaware of any published reports of K. pneumonia conjunctivitis in an otherwise healthy full-term infant born in the United States who has received prophylaxis. It is important to promptly identify and treat Klebsiella conjunctivitis because it can lead to severe complications.

Prevalence of Chlamydia trachomatis among asymptomatic women.

BACKGROUND: Chlamydia trachomatis is a ubiquitous pathogen worldwide and causes ocular. urogenital, and respiratory infections in humans. C. trachomatis infection of lower genital tract is one of the most prevalent sexually transmitted diseases (STDs) in different parts of the world. Their treatment, follow-up, and hopefulness for future is very important. Objectives of this study were to see the prevalence of Chlamydia trachomatis infection among women of child bearing age and to determine the incidence of Chlamydia infection in neonates of women infected with Chlamydia. METHODS: This observational study was carried out in Department of Obstetrics & Gynaecology, CMH Abbottabad, and Department of Ophthalmology, Women Medical College Abbottabad from January 2012 to June 2012. Urine samples were collected from 200 women aged 20-39 years attending Obs/Gyn Department of CMH Abbottabad. After delivery, babies who were born to mothers with infection of their genital tracts were examined with a 2.5 x binocular loupe within a week of birth to rule out eye infection (Chlamydia Ophthalmic neonatorum). RESULTS: The overall prevalence of Chlamydia trachomatis was 4% in 200 eligible patients. The overall incidence of Chlamydia trachomatis in neonates was 1.66%. CONCLUSION: A significant proportion of women resident of Abbottabad District expressed evidence of exposure to Chlamydia trachomatis and significant number of neonate eyes were infected with the pathogen.

[What remains today of neonatal conjunctivitis in prefecture of Kozah in Togo?]. / Que reste-t-il aujourd'hui des conjonctivites néonatales dans la préfecture de la Kozah au Togo ?

AIM: The purpose of this study is to screen the neonatal conjunctivitis in order to evaluate its incidence and especially to seek for the causative germs. PATIENTS AND METHODS: We have realized cross-sectional study in three health centers of the prefecture of Kozah from March 24 to May 12, 2009. All the newborns followed in these centers are examined in the search of signs of conjunctivitis. A biological diagnosis of conjunctival secretions was carried out at the suspect newborns. RESULTS: During the study period, 348 newborns were examined including 185 boys and 163 girls corresponding to a sex-ratio (M/F) of 1.1. The middle age was 3.7 days. Twenty-eight newborns presented conjunctivitis, that is to say a rate of incidence of 8%. The cases of conjunctivitis were observed the first four days of life in 39.3% of cases. Eighteen of the newborns presenting conjunctivitis were vaginal deliveries (64.3%) against ten (35.7%) by caesarian. All the mothers of the ill newborns had a syndrome of sexually transmissible infection (STI) during the third quarters of pregnancy. After biological diagnosis, Staphylococcus aureus was found in 25% of the cases. CONCLUSION: Despite the common herd of neonatal conjunctivitis prophylaxis by Crede's method, its remains in the prefecture of Kozah. In hope for neonatal conjunctivitis eradication, treatment of STI on pregnant women associated to education and communication on the prevention of the infection in neonatal health care centers and at home by hygiene rule application are necessary.

Ophthalmia neonatorum.

OBJECTIVE: To measure the frequency of ophthalmia neonatorum among all babies born in MCH Center, PIMS (Pakistan Institute of Medical Sciences), Islamabad, in one month's time and to determine their causative organisms. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: The MCH Center, PIMS, during the month of November 2008. METHODOLOGY: All babies born from 1st to 30th November, 2008 in the MCH Center, PIMS, Islamabad, Pakistan were included in the study. All babies were examined for signs of conjunctivitis on days 1, 3, 7, 14, 21 and 28 of life. Conjunctival swabs were taken for gram staining and culture from those with clinical diagnosis of conjunctivitis. Frequency of known maternal and neonatal risk factors for the disease were assessed. Proportions were compared using chi-square test with significance at p < 0.05. RESULTS: Seventeen percent of the 1010 babies developed conjunctivitis. Staphylococcus aureus (65% of all positive cultures) was the most common causative organism. No case of gonococcus was isolated. Meconium stain liquor (p=0.004) and caesarain section (p < 0.001) were found to be the most frequent associated conditions in conjunctivitis. CONCLUSION: There was a high frequency of neonatal conjunctivitis, with Staphylococcus aureus as the most common causative agent. Poor hygienic conditions and practices could be an important risk factor in Pakistan.

A five-year study in Iran of ophthalmia neonatorum: prevalence and etiology.

BACKGROUND: The aim was to determine the prevalence of conjunctivitis and its bacteriological causes in neonates hospitalized in two hospitals in Iran and to evaluate the maternal and newborns' data in conjunctivitis cases. MATERIAL/METHODS: All newborns presenting at Imam Khomeini and Vali-e-Asr hospitals (2001-2006) with clinical suspicion of conjunctivitis and positive microbiology were studied. The medical files of those with conjunctivitis were assessed. RESULTS: Of 4021 neonates examined for the presence of conjunctivitis, 198 (4.9%) had conjunctivitis. Sixty-five percent of the cases had been delivered by cesarean section, 47% and 11% had histories of maternal premature rupture of membrane (PROM) and genitourinary infection, respectively, 65% were preterm, and 61% and 32% had low weight and APGAR score below 7 at birth, respectively. In addition, 22% had septicemia. The most common organism causing ophthalmia was S. aureus (31%), followed by E. coli (23%), S. epidermis (22%), Klebsiella (10%), N. gonorrhea (3%), C. trachomatis (2%), and Pseudomonas aeruginosa (2%). In the neonates with septicemia the most common cause of conjunctivitis was E. coli (38%). Neonates with E. coli conjunctivitis had a significantly (P<0.05) higher rate of a history of maternal genitourinary infection and a higher rate of septicemia than non-E. coli cases. CONCLUSIONS: The prevalence of 4.9% found here is consistent with other reports ranging from 1.6 to 12% of neonates. Data such as birth weight, APGAR score, presence of septicemia, maternal genitourinary infections, and PROM may play a role in the development of neonatal conjunctivitis by different pathogens.