RESUMEN
Streptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.
Asunto(s)
Antibacterianos/uso terapéutico , Endoftalmitis/patología , Infecciones Neumocócicas/patología , Streptococcus pneumoniae/patogenicidad , Vitrectomía/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Catarata/complicaciones , Catarata/microbiología , Catarata/patología , Extracción de Catarata/efectos adversos , Ceftriaxona/uso terapéutico , Cefuroxima/uso terapéutico , Úlcera de la Córnea/complicaciones , Úlcera de la Córnea/microbiología , Úlcera de la Córnea/patología , Endoftalmitis/etiología , Endoftalmitis/microbiología , Enucleación del Ojo/métodos , Enucleación del Ojo/estadística & datos numéricos , Lesiones Oculares/complicaciones , Lesiones Oculares/microbiología , Lesiones Oculares/patología , Femenino , Humanos , Levofloxacino/uso terapéutico , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Moxifloxacino/uso terapéutico , Penicilinas/uso terapéutico , Infecciones Neumocócicas/etiología , Infecciones Neumocócicas/microbiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/crecimiento & desarrollo , Taiwán , Centros de Atención Terciaria , Trabeculectomía/efectos adversos , Resultado del Tratamiento , Vancomicina/uso terapéutico , Vitrectomía/métodosRESUMEN
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.
Asunto(s)
Catarata/microbiología , Endoftalmitis/prevención & control , Aparato Lagrimal/microbiología , Staphylococcus aureus Resistente a Meticilina , Extracción de Catarata , Humanos , Tamizaje Masivo , Estudios RetrospectivosRESUMEN
Purpose: Rapidly progressing cataract is one of the ocular manifestations in leptospiral uveitis patients. We examined whether molecular mimicry between the leptospira antigens and lens proteins exists that could result in cataract in these patients.Methods: Immunoblot analysis using patient sera was done with proteins from normal lens and cataract lens from leptospiral uveitis patients and the cross-reacting lens proteins were identified by mass spectrometry analysis.Results: Retinal dehydrogenase 1 and crystallins (α-B, α-A2, ß-B2), were recognized by the antibodies in the serum of leptospiral uveitis patients. And, retinal dehydrogenase 1 is homologous to the leptospiral protein, betaine aldehyde dehydrogenase.Conclusions: Leptospiral uveitis patient serum contains antibodies that cross-react with multiple lens proteins that have a role in maintaining lens transparency. And, these antibodies could act as a potential trigger for cataractogenesis.
Asunto(s)
Betaína Aldehído Deshidrogenasa/inmunología , Catarata/inmunología , Cristalino/enzimología , Leptospira/enzimología , Leptospirosis/inmunología , Imitación Molecular/fisiología , Retinal-Deshidrogenasa/inmunología , Uveítis/inmunología , Secuencia de Aminoácidos , Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/inmunología , Catarata/microbiología , Reacciones Cruzadas/inmunología , Electroforesis en Gel de Poliacrilamida , Ensayo de Inmunoadsorción Enzimática , Infecciones Bacterianas del Ojo/inmunología , Infecciones Bacterianas del Ojo/microbiología , Humanos , Immunoblotting , Leptospirosis/microbiología , Espectrometría de Masas , Datos de Secuencia Molecular , Uveítis/microbiologíaRESUMEN
Purpose: To analyze and report ToRCH-serology screening profile (Toxoplasma gondii [TOX], rubella [RV], cytomegalovirus [CMV], and herpes simplex virus [HSV-I/II]) in pediatric cataract. Methods: In this prospective analytical study, 1,026 consecutive children were screened, of which 46 children with clinically diagnosed congenital (n = 26) and developmental cataract (n = 20) were included. Post-traumatic and familial cataracts were excluded. Sera of all children were tested both qualitatively and quantitatively for IgG/IgM-antibodies against ToRCH agents in a sequential manner. Results: Overall, IgM/IgG-seropositivity against ≥1 ToRCH agent was reported in 91.3% (42/46) children. IgM (±IgG) positivity against ≥1 ToRCH agent was reported in 26.08% (12/46) children (nine congenital and three developmental cataract; P = 0.18), which included 8.7% (4/46) children reported positive against ≥2 agents. Finally, 13% (6/46) children were reported to be sero-clinical-positive (three were infants and three were> 1 year age, P = 0.55; five congenital and one developmental cataract, P = 0.21). Either alone or combined, RV attributed to the majority (50%; 6/12) of the IgM (±IgG) and sero-clinical-positive (50%; 3/6) children. None of the children were HSV-II IgM-positive. Laboratory-confirmed congenital rubella syndrome was reported in 4.3% (2/46) children. One sero-clinical-positive infant with rare coexisting bilateral persistent fetal vasculature was also reported. IgG-alone positivity was reported highest with CMV in 67.4% (31/46) children, whereas 43.4% (20/46) children were found nonimmune to RV. Conclusion: The current study emphasizes the need to interpret ToRCH-screening in pediatric cataract with caution. Interpretation should include both serial qualitative and quantitative assays in tandem with clinical correlation to minimize the diagnostic errors. Clinicians should remain vigilant regarding sero-clinical-positivity in older children too who might pose a threat to the spread of infection.
Asunto(s)
Catarata , Infecciones por Citomegalovirus , Herpes Simple , Rubéola (Sarampión Alemán) , Toxoplasma , Catarata/diagnóstico , Catarata/epidemiología , Catarata/microbiología , Niño , Infecciones por Citomegalovirus/complicaciones , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Rubéola (Sarampión Alemán)/diagnóstico , Rubéola (Sarampión Alemán)/epidemiología , Centros de Atención TerciariaRESUMEN
Cataract and uveitis are rare in newborns but potentially blinding. Three newborns with cataract and severe anterior uveitis underwent cataract surgery. Spiroplasma ixodetis was detected in lens aspirates using bacterial 16S-rRNA PCR and transmission electron microscopy. These findings, which suggest maternal-fetal infection, are consistent with previous experimental Spiroplasma-induced cataract and uveitis.
Asunto(s)
Catarata/diagnóstico , Spiroplasma/aislamiento & purificación , Uveítis/diagnóstico , Catarata/microbiología , Femenino , Francia , Humanos , Recién Nacido , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/microbiología , Masculino , Uveítis/microbiologíaRESUMEN
We report two cases of postoperative endophthalmitis after cataract surgery caused by the same strain of Mycobacterium abscessus confirmed by arbitrarily primed polymerase chain reaction, sequencing of the erythromycin ribosome methyltransferase gene and pulsed-field gel electrophoresis. The outcomes were poor despite aggressive treatments. This is the first report of nontuberculous mycobacteria as a causative pathogen for a cluster of endophthalmitis.
Asunto(s)
Catarata/microbiología , Endoftalmitis/microbiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Micobacterias no Tuberculosas/clasificación , Micobacterias no Tuberculosas/aislamiento & purificación , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Adolescente , Anciano , Amicacina/uso terapéutico , Betametasona/uso terapéutico , Electroforesis en Gel de Campo Pulsado/métodos , Endoftalmitis/patología , Ojo/microbiología , Femenino , Humanos , Masculino , Metiltransferasas/genética , Persona de Mediana Edad , Tipificación Molecular , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Reacción en Cadena de la Polimerasa , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Taiwán , VitrectomíaRESUMEN
Three mongrel dogs, aged 10 months (case 1), 14 months (case 2) and 7.5 years (case 3), were presented because of ophthalmologic disorders of 4 months, 6 months and 7 years duration, respectively. All three dogs were offspring of stray dogs from Hungary and Serbia and had positive serum antibody titres against Encephalitozoon (E.) cuniculi. The two young dogs showed unilateral, the older dog bilateral chronic anterior uveitis with posterior synechia and focal anterior cortical cataract. The fundi that could be evaluated developed focal tapetal hyporeflective lesions in the course of the disease. Dogs 1 and 2 underwent removal of the lens via phacoemulsification. PCR of the lens material was positive for E. cuniculi strains IV and II, respectively. In dog 2 findings suggestive of microsporidia were detected underneath the anterior lens capsule by immunohistochemical staining. In all cases medical treatment consisted of systemic fenbendazole, prednisolone, and topical anti-inflammatory drugs, and additional brinzolamid/timolol for dog 3. For the time being all cases (follow up 23 months, 6 months and 3 months, respectively) are still on topical anti-inflammatory therapy. It is concluded that E. cuniculi infections can cause cataract and chorioretinal lesions in dogs.
Asunto(s)
Catarata/veterinaria , Enfermedades de los Perros/microbiología , Encephalitozoon cuniculi/aislamiento & purificación , Encefalitozoonosis/veterinaria , Infecciones Fúngicas del Ojo/veterinaria , Uveítis/veterinaria , Animales , Antiinflamatorios/uso terapéutico , Antifúngicos/uso terapéutico , Catarata/tratamiento farmacológico , Catarata/microbiología , Catarata/patología , Enfermedades de los Perros/tratamiento farmacológico , Enfermedades de los Perros/patología , Perros , Encefalitozoonosis/tratamiento farmacológico , Encefalitozoonosis/microbiología , Encefalitozoonosis/patología , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Infecciones Fúngicas del Ojo/patología , Femenino , Masculino , Uveítis/diagnóstico , Uveítis/tratamiento farmacológico , Uveítis/patologíaRESUMEN
BACKGROUND: Clinical data have shown that tick-borne diseases caused by Borrelia burgdorferi sensu lato, Bartonella spp., Coxiella burnetii, and Rickettsia spp. can affect the central nervous system, including the eye. The aim of this study was to establish a relationship between the incidence of cataract and evidence of bacterial infections transmitted by ticks. MATERIAL AND METHODS: Fluid with lenticular masses from inside of the eye and blood from 109 patients were tested by PCR and sequencing. Sera from patients and the control group were subjected to serological tests to search specific antibodies to the bacteria. RESULTS: Microbiological analysis revealed the presence of Bartonella sp. DNA in intraoperative specimens from the eye in 1.8% of patients. Serological studies have shown that infections caused by B. burgdorferi sensu lato and Bartonella sp. were detected in 34.8% and 4.6% of patients with cataract surgery, respectively. CONCLUSIONS: Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development.
Asunto(s)
Bacterias/metabolismo , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/microbiología , Extracción de Catarata , Catarata/etiología , Catarata/microbiología , Enfermedades por Picaduras de Garrapatas/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Bartonella/fisiología , Borrelia burgdorferi/fisiología , Coxiella burnetii/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rickettsia/fisiología , Estudios Seroepidemiológicos , Enfermedades por Picaduras de Garrapatas/complicacionesAsunto(s)
Oftalmopatías/historia , Fotofobia/historia , Tuberculosis/historia , Catarata/historia , Catarata/microbiología , Oftalmopatías/microbiología , Historia del Siglo XX , Humanos , Italia , Fotofobia/microbiología , Desprendimiento de Retina/historia , Desprendimiento de Retina/microbiología , Suecia , Tuberculosis/complicacionesRESUMEN
We report 3 patients who were delivered prematurely and who developed a lens opacity with signs of ocular inflammation at a postgestational age of 10-52 weeks. All patients had been treated for Candida sepsis as neonates. Each patient underwent lensectomy and anterior vitrectomy. In 2 infants Candida albicans was cultured from the lens/anterior chamber membrane; in 1 Candida parapsilosis was cultured from a lens aspirate. Despite eradication of the fungal infection, outcomes were poor: 2 eyes developed glaucoma, and 1 developed a retinal detachment with subsequent phthisis.
Asunto(s)
Candida/aislamiento & purificación , Candidemia/complicaciones , Infecciones Fúngicas del Ojo/microbiología , Enfermedades del Cristalino/microbiología , Catarata/microbiología , Femenino , Humanos , Lactante , MasculinoRESUMEN
PURPOSE: Identification of Encephalitozoon cuniculi (E. cuniculi) as a possible causative agent for cataracts and uveitis in cats. METHODS: Within a 12-month study period, cats that were presented with focal anterior cortical or mature cataract and secondary uveitis underwent a complete ophthalmic examination, complete blood count, serum biochemistry, serologic tests for E. cuniculi and tests for feline immunodeficiency virus (FIV), feline infectious peritonitis (FIP), feline leukemia virus (FeLV) and Toxoplasma gondii (T. gondii). PCR for DNA detection of E. cuniculi and T. gondii as well as cytologic examination of aqueous humor after paracentesis and phacoemulsified lens material were also performed. In addition histopathologic examination of the resected anterior lens capsule and attached lens epithelial cells was performed. Serologic testing for antibodies against E. cuniculi was also performed in 100 ophthalmologically healthy cats. RESULTS: Eleven (19 eyes) European shorthair cats with a median age of 3.5 years were included. Nine of 11 cats had bilateral cataracts, with 12/19 eyes having focal anterior cortical cataracts and 7/19 eyes having mature cataracts. In 14/19 eyes anterior uveitis was present. All cats had a positive antibody titer (1:80-1:10,000) for E. cuniculi. Encephalitozoon cuniculi DNA was detected by PCR and sequencing in 18/19 lenses and in 10/19 aqueous samples. Five tentative positive results were detected by cytologic examination. Spores were detected in 15/19 samples of lens material with histopathologic staining. Only 2/100 ophthalmologically healthy cats showed a positive antibody titer for E. cuniculi. CONCLUSION: Encephalitozoon cuniculi is a cause of focal anterior cortical cataract and anterior uveitis in cats.
Asunto(s)
Enfermedades de los Gatos/microbiología , Catarata/veterinaria , Encephalitozoon cuniculi , Encefalitozoonosis/veterinaria , Cristalino/microbiología , Animales , Enfermedades de los Gatos/diagnóstico , Enfermedades de los Gatos/patología , Catarata/diagnóstico , Catarata/microbiología , Gatos , Encefalitozoonosis/complicaciones , Encefalitozoonosis/diagnóstico , Encefalitozoonosis/patología , Femenino , Cristalino/patología , Masculino , Reacción en Cadena de la Polimerasa/veterinaria , Toxoplasma , Toxoplasmosis Animal/diagnóstico , Uveítis/diagnóstico , Uveítis/microbiología , Uveítis/veterinariaRESUMEN
Objetivo: Conocer y proveer de evidencia acerca de la sensibilidad de la flora bacteriana normal de la superficie ocular aislada en dos diferentes grupos sociales y etáreos de pacientes prontos a someterse a cirugía de Catarata y LASIK en nuestro país. Materiales y Métodos: Se cultivaron muestran conjuntivales de 221 pacientes previo a LASIK y de 180 pacientes de un grupo de Cataratas. De haber un cultivo positivo se realizó aislamiento e identificación bacteriana utilizando la técnica de difusión en disco de Kirby-Bauer para doce antibióticos. El análisis estadístico se hizo con chi-cuadrado y el test exacto de Fisher. Resultados: Hubo 66,8 por ciento de cultivos positivos, más frecuentemente gran positivos. SCN fue el aislado en mayor porcentaje (92,2 por ciento) y mostró una alta sensibilidad a Cloramfenicol, Tobramicina, Moxifloxacino y Gatifloxacino, intermedia para Levofloxacino, Gentamicina y Ciprofloxacino y menor para Eritromicina, Oxacilina, Cefalotina y Ceftriaxona (p<0,01). Todos los cultivos fueron sensibles a Vancomicina. No hubo diferencia estadísticamente significativa entre ambos grupos. Conclusiones: 1. Por primera vez nuestros resultados muestran que la flora y sensibilidad antibiótica son similares en pacientes a ser sometidos a LASIK y Catarata, siendo los SCN los más frecuentemente encontrados en ambos grupos de pacientes. 2. Las bacterias más comúnmente aisladas permanecen altamente sensibles a Cloramfenicol, Tobramicina, Moxifloxacino y Gatifloxacino.
Purpose: To know and provide a background on antibiotic susceptibility of normal ocular surface bacterial flora isolated from two different social and age groups of patients undergoing LASIK and cataract surgery in our country. Material and Methods: Conjunctival samples of 221 patients in a LASIK group and 180 patients in a cataract surgery group were cultivated. When there were a positive cultures, isolation and identification of the bacteria were made and antibiotic susceptibility tests were carried out, using the Kirby-Bauer disc diffusion technique for twelve antibiotics. Statistical analysis was performed using chi-square and exact Fisher test. Results: There were 66.8 percent of positive cultures, most of them gram positives. The most frequently isolated bacteria were the CNS (92,2 percent) that showed high sensitivity for Chloramphenicol, Tobramycin, Moxifloxacin and Gatifloxacin, intermedia for Levofloxacin, Gentamicin and Ciprofloxacin and lowest for Erytomycin, Oxacillin, Cefalotin and Ceftriaxone (p<0,01). All the cultures were susceptible to Vancomycin. There was not statistically difference between LASIK and cataract group. Conclusions: 1. For the first time, our results have shown that the conjunctival flora and its sensitivity to antibiotics are similar in the conjunctival flora of the patients undergoing LASIK surgery and Cataract, being CNS the bacterium most frequently found in both different groups of patients. 2. The most frequently isolated conjunctival bacteria remained highly sensitive to Chloramphenicol, Tobramycin, Moxifloxacin and Gatifloxacin.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Antibacterianos/farmacología , Bacterias/aislamiento & purificación , Bacterias , Conjuntiva/microbiología , Factores de Edad , Bacterias Grampositivas/aislamiento & purificación , Bacterias Grampositivas , Distribución de Chi-Cuadrado , Catarata/microbiología , Cloranfenicol/farmacología , Farmacorresistencia Bacteriana , Pruebas de Sensibilidad Microbiana , Cuidados Preoperatorios , Quinolinas/farmacología , Factores Socioeconómicos , Tobramicina/farmacologíaRESUMEN
OBJECTIVE: To study the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and determine the efficacy of reducing conjunctival bacteria with different methods. METHODS: A total of 135 eyes of 135 patients scheduled to undergo cataract surgery were randomized into 3 groups (45 each). They received topical prophylactic treatment with three different kinds of antibiotics (0.5% levofloxacin, 0.3% levofloxacin and 0.3% tobramycin). Each group was randomized into one-day group and three-day group. All the eyes underwent irrigation of fornices with 2.5% povidone-iodine (PVI) before surgery. Conjunctival cultures were obtained at various time points. RESULTS: The total positive rate of conjunctival cultures was 66.7%. The eliminating rate of conjunctival bacteria in one-day groups were 72.7%, 72.7% and 61.1% (P = 0.667) while 70.0%, 70.0% and 55.5% in the three-day groups respectively (P = 0.751). Immediately after PVI irrigation, the eliminating rate in one-day groups added up to 86.4%, 77.3% and 88.9% (P = 0.564) as compared with 90.0%, 80.0% and 66.7% in the three-day groups respectively (P = 0.749). And there was no statistically significant difference between one-day groups and three-day groups in the eliminating rate of conjunctival bacterial after the topical antibiotic application. The MIC test revealed that the antibiotic sensitivity of Gram-positive cocci (G(+)C) to levofloxacin was 94.8% versus 74.1% to tobramycin (P = 0.000) while the antibiotic sensitivity of Gram-negative bacillus (G(-)B) to levofloxacin was 94.4% versus 83.3% to tobramycin (P = 0.289). CONCLUSION: G(+)C accounts for the most among the conjunctival bacteria flora in eyes of patients undergoing cataract surgery and there is no statistically significant difference in the efficacy of reducing conjunctival bacteria between the application of topical antibiotic for one day and for three days. Both G(+)C and G(-)B retain a high sensitivity to levofloxacin. Topical antibiotic in combination with 2.5% PVI irrigation further reduces conjunctival bacteria.
Asunto(s)
Profilaxis Antibiótica , Extracción de Catarata/métodos , Catarata/terapia , Conjuntiva/microbiología , Anciano , Catarata/microbiología , Humanos , Levofloxacino , Persona de Mediana Edad , Ofloxacino/uso terapéutico , Tobramicina/uso terapéuticoRESUMEN
BACKGROUND: Investigation of two independent outbreaks of post cataract surgery endophthalmitis identified the reservoir of epidemic strains of P. aeruginosa. METHODS: Patient isolates cultured from vitreous fluid of all the nine cases and from the peripheral devices of phacoemulsification machine were subjected to high-resolution Fluorescent Amplified Fragment Length Polymorphism (FAFLP) analysis. RESULTS: FAFLP based genotyping of the isolates confirmed nosocomial transmission. Although biochemical characterization and antibiotic susceptibility profiles grouped all the isolates together, FAFLP based genotyping revealed that, all the outbreak isolates were derived from 2 different strains, with independent origins. One group of isolates was traced to phacoprobe and the second one to the internal tubing system of the phacoemulsification machine used in cataract surgery. In silico analysis indicated possible evolution in both the clusters of P. aeruginosa isolates due to genetic polymorphisms. The polymorphisms were mapped to gene products (cell envelope, outer membrane proteins) possibly having significant role in pathogenesis. CONCLUSION: The present study is probably the first one to apply FAFLP typing successfully to investigate outbreaks of postoperative endophthalmitis (POE) in an ophthalmic setting, which was able to identify the source, and helped to make rational decisions on sterilization procedures that halted more cases of infection in these hospitals.
Asunto(s)
Extracción de Catarata/efectos adversos , Catarata/microbiología , Endoftalmitis/microbiología , Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa/clasificación , Pseudomonas aeruginosa/genética , Cuerpo Vítreo/microbiología , Enfermedad Aguda , Secuencia de Bases , ADN/genética , ADN/aislamiento & purificación , Cartilla de ADN , Brotes de Enfermedades , Endoftalmitis/epidemiología , Genotipo , Humanos , Incidencia , India/epidemiología , Quirófanos , Pseudomonas aeruginosa/aislamiento & purificación , Mapeo RestrictivoRESUMEN
Leprosy control programmes are highly successful. As a result, leprosy control will be more and more integrated into the general health services. The existing vertical, specialized control programmes will be dismantled. Eye complications in leprosy have decreased. This is a result of earlier diagnosis and highly effective multidrug treatment (MDT) of leprosy, combined with timely treatment of secondary nerve damage by steroids. Most ocular morbidity is now found among elderly and disabled leprosy patients who were diagnosed before effective MDT treatment became available. Many of these patients live in leprosy settlements. Age-related cataract has become the leading cause of blindness in leprosy. The second cause of blindness is corneal opacification, mainly as a result of neglected exposure keratitis and corneal anaesthesia. The miotic pupils in late multibacillary leprosy, in combination with small central lens opacities, may also lead to blindness. The Vision 2020 Initiative prioritises cataract surgery. Leprosy patients should be actively included. Disabled leprosy patients can also benefit from screening programmes for refractive errors and the provision of spectacles and low vision aids. Determining the most feasible surgical methods for lagophthalmos surgery remains a challenge. For all health and eye care staff, training in leprosy and its eye complications is needed, as well as a change in attitude towards leprosy patients. Staff must be prepared to welcome them in the general health services.
Asunto(s)
Ceguera/microbiología , Ceguera/prevención & control , Cooperación Internacional , Lepra/complicaciones , Catarata/microbiología , Enfermedades de la Córnea/microbiología , Infecciones Bacterianas del Ojo/complicaciones , Promoción de la Salud , Humanos , Evaluación de Programas y Proyectos de SaludRESUMEN
Bacterial endophthalmitis is rare in the neonatal period. It occurs in susceptible individuals such as preterm infants. Pseudomonas aeruginosa, a Gram-negative bacillus, has been identified as the causative organism in more than 75% of invasive neonatal eye infections. The source may be endogenous; secondary to septicemia or exogenous, including reports of nosocomial infections and those infections arising from the birth canal. We report the case of a preterm infant who developed pseudomonas endophthalmitis, septicemia, and meningitis after a corneal abrasion.
Asunto(s)
Endoftalmitis/microbiología , Recien Nacido Prematuro , Infecciones por Pseudomonas , Pseudomonas aeruginosa , Catarata/microbiología , Lesiones de la Cornea , Endoftalmitis/cirugía , Evisceración del Ojo , Dedos/patología , Humanos , Recién Nacido , Masculino , Meningitis Bacterianas , Necrosis , Infecciones por Pseudomonas/etiología , Infecciones por Pseudomonas/patología , Desprendimiento de Retina/microbiología , Sepsis , Heridas y Lesiones/complicacionesRESUMEN
PURPOSE: 1) To evaluate the microbacterial flora of the conjunctival sac and the sensitivity of the isolated microorganisms to 0.3% gentamicin solution and 5.0% PVP-Jodi solution, which is used to disinfect conjunctival sac. 2) To evaluate the role of the adhesive foil in prevention of the infection of the operative field. MATERIAL AND METHODS: 170 patients with senile cataract were examined. Before admission to Ophthalmology Department each patient received 0.3% gentamicin solution three times a day. All patients had their conjunctival sac disinfected with the use of 5% PVP-Jodi before surgery. Patients were divided into two groups. In the first group (120 patients), first samples were taken on admission to the Ophthalmology Department. Next in the day of the procedure, in the operation room--first before and second after disinfection of conjunctival sac. Adhesive foil was not used in this group. In the second group (50 patients), we used adhesive foil before surgery and samples were taken before and after disinfection of conjunctival sac. RESULTS: On admission, positive cultures were obtained in 40.0% cases. Most of the bacterial flora were Gram-positive bacteria. The number of the positive cultures before disinfection with 5.0% PVP-Jodi solution diminished to 5.8%, compared with positive results obtained on admission to the Ophthalmology Department. Secondary infection of the conjunctival sac has been revealed in 10% after disinfection with the use of the 5.0% PVP Jodi. It was due to bacterial flora coming from the skin and limbs of the lids (in the group without adhesive foil), whereas positive samples were obtained in 2.0% in the group where adhesive foil was used. CONCLUSIONS: 1) Gentamicin significantly reduces the amount of bacterial flora in conjunctival sac in patients before cataract surgery. 2) Adhesive foil is efficient to protect operative field from infection.
Asunto(s)
Antibacterianos/uso terapéutico , Catarata/microbiología , Conjuntiva/microbiología , Conjuntivitis Bacteriana , Gentamicinas/uso terapéutico , Pruebas de Sensibilidad Microbiana/métodos , Administración Tópica , Anciano , Antibacterianos/administración & dosificación , Catarata/epidemiología , Conjuntivitis Bacteriana/tratamiento farmacológico , Conjuntivitis Bacteriana/epidemiología , Conjuntivitis Bacteriana/microbiología , Femenino , Gentamicinas/administración & dosificación , Humanos , Masculino , Resultado del TratamientoRESUMEN
PURPOSE: Evaluation of conjunctival microflora in patients with cataract, during the early post-operative period. MATERIAL AND METHODS: One hundred twenty patients scheduled for cataract extraction were evaluated. In each patient, conjunctival swab was taken directly after cataract surgery and two to three days postoperatively. Following surgical procedure all patients received topical antibiotics alone or along with steroids. The agents were placed into conjunctival sac of the operated eye. Ophthalmic ointments were administered HS and eye drops QID. RESULTS: 9.2% (11 patients) of the cultures of conjunctival swabs collected right after surgical procedure were positive for growth with predominantly Gram-positive organisms, mainly Staphyloccocus spp. These, were compared with 24.2% (29 patients) of positive cultures from conjunctival swabs collected two to three days later. 4.2% of the latter were also positive when taken in the operating room, immediately after a surgical procedure. The remaining 20.0% of positive cultures swabbed two to three days after surgery were resulted from the contamination of conjunctival sac with germs during the postoperative hospitalisation. CONCLUSIONS: There is a risk of early post-operative infection in patients undergoing cataract surgery. It is caused by the appearance of microflora in the conjunctival sac.
Asunto(s)
Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/microbiología , Extracción de Catarata/métodos , Catarata/epidemiología , Catarata/microbiología , Conjuntivitis Bacteriana/epidemiología , Conjuntivitis Bacteriana/microbiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Femenino , Humanos , Masculino , Periodo Posoperatorio , Factores de TiempoRESUMEN
PURPOSE: The aim of the study was to estimate changes in bacterial flora of conjunctival sac changes in patients prophylacticaly treated with different antibiotics (chloramphenicol, gentamycin, ofloxacin, norfloxacin) before cataract operation. MATERIAL AND METHODS: The studied group consisted of 166 patients hospitalized for cataract surgery. The control group consisted of 33 persons, neither treated topically with antimicrobial drugs nor suffering from infectious or inflammatory diseases. On the first day and on the operation day conjunctival swabs were obtained and typical microbiological diagnosis was performed. During hospitalization only one antimicrobial drug was administrated topically (chloramphenicol, gentamycin, ofloxacin or norfloxacin) in the studied group. RESULTS: Prophylaxis with antibiotics before cataract surgery changes bacterial flora of conjunctival sac: quantitative changes were observed most frequently, but also hospital antibiotic resistant strains were detected. None of tested antibiotics caused total elimination of conjunctival flora in all patients. CONCLUSIONS: None of the antibiotics used in our study could cause total elimination of conjunctival flora. According to our results, the most effective antibiotics in prophylaxis before eye surgery are fluoroquinolones. Some patients before eye surgery have the pathogenetic conjunctival flora not causing the disease, yet increasing the risk of postoperative endophthalmitis.
Asunto(s)
Profilaxis Antibiótica , Extracción de Catarata/métodos , Conjuntiva/microbiología , Conjuntivitis Bacteriana/tratamiento farmacológico , Conjuntivitis Bacteriana/microbiología , Catarata/microbiología , Cloranfenicol/administración & dosificación , Femenino , Gentamicinas/administración & dosificación , Humanos , Masculino , Norfloxacino/administración & dosificación , Ofloxacino/administración & dosificaciónRESUMEN
PURPOSE: To assess differences in conjunctival bacterial flora between patients undergoing glaucoma and cataract surgery. PATIENTS AND METHODS: A prospective study comparing conjunctival bacterial cultures obtained from 339 patients undergoing either cataract (n = 258) or glaucoma (n = 81) surgery. All cultures were acquired during the preoperative visit, approximately three to seven days prior to surgery. The culture samples were inoculated onto blood and chocolate agar, as well as blood culture broth media. All bacterial isolates were identified and statistical analyses were performed to determine if there were differences in flora between the eyes undergoing cataract versus glaucoma surgery. RESULTS: Two hundred fifteen of 258 eyes (83%) undergoing cataract surgery were found to have positive bacterial growth, compared with 62 of 81 eyes (77%) of those undergoing glaucoma surgery (P = 0.2246). Coagulase-negative Staphylococci, the most common bacterial isolate, was cultured from 167 eyes (65%) in the cataract group and 42 (52%) in the glaucoma group (P = 0.0514). Among all bacterial isolates, only Corynebacterium species was found to be statistically different between the two patient groups with 92 (36%) and 11 (14%) eyes testing positive in the cataract and glaucoma groups, respectively (P = 0.0003). CONCLUSIONS: There was no statistically significant difference in the proportion of conjunctival culture samples testing positive for bacterial growth in eyes undergoing glaucoma surgery compared with those undergoing cataract surgery. Glaucoma medications, or their preservatives, do not appear to significantly alter conjunctival flora. Techniques used for endophthalmitis prophylaxis prior to cataract surgery are likely appropriate for glaucoma surgery as well.