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In vitro susceptibilities of bacterial ocular isolates to fluoroquinolones.

PURPOSE: To evaluate and compare the in vitro antimicrobial activity of levofloxacin versus ciprofloxacin and ofloxacin against ocular isolates from patients with bacterial conjunctivitis. METHODS: The in vitro antimicrobial susceptibilities of ocular isolates to levofloxacin, ofloxacin, and ciprofloxacin were determined using both the agar disk diffusion and broth dilution methods. RESULTS: Disk diffusion susceptibility testing disclosed that 99% (100 of 101 isolates) of gram-negative isolates and 98% (127 of 129 isolates) of gram-positive isolates were susceptible to levofloxacin; 96% (97 of 101 isolates) of gram-negative isolates and 78% (100 of 129 isolates) of gram-positive isolates were susceptible to ofloxacin; and 94% (95 of 101 isolates) of gram-negative isolates and 61% (79 of 129 isolates) of gram-positive isolates were susceptible to ciprofloxacin. Broth dilution testing disclosed that 99% (72 of 73 isolates) of gram-negative isolates and 98% (111 of 113 isolates) of gram-positive isolates were susceptible to levofloxacin; 96% (70 of 73 isolates) of gram-negative isolates and 92% (104 of 113 isolates) of gram-positive isolates were susceptible to ofloxacin; and 95% (69 of 73 isolates) of gram-negative isolates and 82% (93 of 113 isolates) of gram-positive isolates were susceptible to ciprofloxacin. CONCLUSIONS: In this study, levofloxacin demonstrated superior in vitro activity against human bacterial conjunctival isolates compared with either ofloxacin or ciprofloxacin (levofloxacin > ofloxacin > ciprofloxacin).

Anti-Infective Agents↗

Fusidic acid in other infections.

Fusidic acid, both systemic and topical, has been used for a wide variety of less common infections. Efficacy for oral fusidic acid has been demonstrated in the treatment of Clostridium difficile colitis and in staphylococcal infections in patients with cystic fibrosis. Topical fusidic acid gel is also effective in bacterial conjunctivitis and other minor external eye infections, and may be effective in reducing bacterial flora in the conjunctival sac prior to eye surgery. Studies suggest a potential role for fusidic acid in neurosurgical prophylaxis, as adjunctive therapy in bacterial endophthalmitis and Legionella pneumonia, and in leprosy. Topical fusidic acid has no effect in the treatment of chlamydial conjunctivitis or the prevention of staphylococcal infections in patients on continuous ambulatory peritoneal dialysis.

Anti-Bacterial Agents↗

Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus ocular surface infection efficacy of chloramphenicol eye drops.

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MR-CNS) are two major multidrug-resistant pathogens. In this paper we report the prevalence of MRSA and MR-CNS in ocular surface infections. METHODS: We investigated the proportion of MRSA and MR-CNS in bacterial isolates from conjunctiva of elderly patients with and without bacterial conjunctivitis. The relationship between conjunctival MRSA carriers and general background conditions was studied. We evaluated the efficacy of chloramphenicol eye drops in the treatment of MRSA conjunctivitis. We also investigated the presence of MRSA and MR-CNS in lid skin and conjunctiva of patients with atopic dermatitis. RESULTS: In conjunctival bacterial flora of elderly patients the proportion of MRSA in S. aureus was 57%, and the proportion of MR-CNS in coagulase-negative Staphylococcus was 25%. Conjunctival MRSA carriers were more likely to have anemia, malignant tumor, liver dysfunction, and dementia, and to be postoperation and chronically bedridden. The efficacy rate of chloramphenicol eye drops in the treatment of MRSA conjunctivitis was 81%. In conjunctival sacs of patients with atopic dermatitis, S. aureus was the most frequent species (48%), and the proportion of MRSA was 18%. CONCLUSION: Methicillin-resistant S. aureus and MR-CNS are widespread in elderly hospitalized patients and in patients with atopic dermatitis. Chloramphenicol eye drops were useful for the treatment of MRSA ocular surface infections.

Aged↗

Gnat sore eyes: seasonal, acute conjunctivitis in a southern state.

In late summer 1981, a widespread outbreak of acute bacterial conjunctivitis occurred in southeast Georgia, affecting primarily grade-school children. This outbreak was similar to previously described seasonal conjunctivitis in the South. As suggested in previous studies, the eye gnat, Hippelates pusio, may serve as a mechanical vehicle in the transmission of the suspected causative agent, a possible Haemophilus species. The 1981 Georgia outbreak illustrates that "gnat sore eyes" is not obsolete and apparently can occur unpredictably during warm months in the southern states. Physicians and other health-care workers should be aware of the unique clinical and epidemiologic features of acute seasonal conjunctivitis.

Acute Disease↗

Studies in the epidemiology and control of seasonal conjunctivitis and trachoma in southern Morocco.

It has been noted in many parts of the world that bacterial conjunctivitis is a major cause of total or partial loss of vision. In addition, trachoma is aggravated if there are associated bacterial infections and these lead to more frequent corneal complications.In the trials described the seasonal variation of bacterial infections was studied in addition to trachoma in 3 pilot sectors in southern Morocco. The frequency of complications and late sequelae from these infections in the whole population of these sectors was also studied.In one of the sectors 3 different methods of limiting the regular seasonal increase in bacterial infections and of curing trachoma were evaluated separately or in combination. These included the effect of fly-suppression on the transmission of infection, a possible method of chemoprophylaxis, and intermittent treatment with chlortetracycline ointment.The effect of the latter, when applied to a whole population group by auxiliary personnel, was compared with the long-term effect of self-treatment, in this and the two other sectors.The total observation period covered 12 years.

Adolescent↗

The giant fornix syndrome: an unrecognized cause of chronic, relapsing, grossly purulent conjunctivitis.

AIM: To describe a group of elderly patients presenting with chronic, relapsing, copiously purulent conjunctivitis, in which the condition was often perpetuated by the sequestration of a large number of bacteria on a protein coagulum lodged in the recesses of a large upper conjunctival fornix. PATIENTS AND METHODS: Retrospective review of a noncomparative case series, drawn from patients attending the lacrimal clinic at Moorfields Eye Hospital. OUTCOME MEASURES: Characterization of this unrecognized syndrome and its response to treatment. RESULTS: Twelve patients (10 female) presented between the ages of 77 and 93 years (mean, 85; median, 86) with a history of chronic relapsing bacterial conjunctivitis affecting, with 2 exceptions, just one eye. All had experienced multiple episodes of markedly purulent conjunctivitis and chronic ocular discharge for between 8 and 48 months (mean, 23.5; median, 24) before referral, and the patients had received multiple courses of treatment. Three had successful external dacryocystorhinostomy (for nasolacrimal duct occlusion) before the final diagnosis of giant fornix syndrome was made, 9 had developed corneal vascularization and scarring before referral, and 5 had suffered prior spontaneous corneal perforation or thinning. All patients had deep upper conjunctival fornices in association with the changes of age-related dehiscence of the levator muscle aponeurosis. Copious amounts of thick, purulent debris and a yellow coagulum were lodged in the depths of the upper fornix-this debris universally culturing Staphylococcus aureus. The condition settled rapidly on appropriate systemic antibiotics (ciprofloxacin or ofloxacin), intensive topical antibiotics, and high-dose, high-potency steroids; some patients required repeated treatment or needed to continue the use of a single drop of a combined steroid-antibiotic to prevent relapse. CONCLUSION: The capacious upper fornix of the elderly may harbor a coagulum colonized by S. aureus, leading to chronic conjunctivitis that may lead to severe sight impairment due to toxic keratopathy and secondary corneal vascularization.

Aged↗

Epidemiology of neonatal conjunctivitis.

Chlamydial conjunctivitis was diagnosed in 46 of 100 infants less than two months old presenting with conjunctivitis. Streptococcus, Staphylococcus, and Hemophilus species were most frequently identified in the remainder. All infants with chlamydial conjunctivitis were black and were born by vaginal delivery (P less than 0.001). Average age at presentation was 13 days for chlamydial and 21 days for other causes of bacterial conjunctivitis (P less than 0.001) with symptoms present an average of five to six days prior to presentation. There was no statistically significant difference in sex, birthweight, APGAR scores, bilaterality, fever, or prophylactic drops administered. Mothers of infants with chlamydial conjunctivitis averaged 19.5 years old versus 23.0 for the bacterial group (P less than 0.001). There was no statistically significant difference in past obstetrical or sexually transmitted disease history. Persistent chlamydial conjunctivitis following a two-week course of oral erythromycin as recommended by Centers for Disease Control was documented in 19% of patients with chlamydial infection.

Anti-Bacterial Agents↗

The differential diagnosis of red eye: a survey of medical practitioners from Eastern Europe and the Middle East.

A survey amongst ophthalmologists and general medical practitioners from nine countries in Eastern Europe and the Middle East was conducted to estimate the percentage of patients presenting with a red eye and to examine differential diagnosis and treatment. Practitioners recorded brief details of every patient seen and detailed information concerning signs and symptoms, differential diagnosis and treatment for all patients presenting with a red eye during 20 consecutive days in the period between May and September 2004. Red eyes accounted for approximately 15% of consultations with ophthalmologists and almost 6% with general medical practitioners. Allergic conjunctivitis was the most common diagnosis (35%), followed by dry eye (25%) and bacterial conjunctivitis (24%). General medical practitioners were far more likely to prescribe a combination topical antibiotic and steroid preparation than ophthalmologists. This survey illustrates that red eye remains a very important problem for both ophthalmologists and general medical practitioners. Identification of dry eye as a common cause of red eye symptoms and more appropriate treatment of dry eye, allergic conjunctivitis and viral conjunctivitis are key messages to emerge.

Adolescent↗

A new perspective on canine keratoconjunctivitis sicca. Treatment with ophthalmic cyclosporine.

Keratoconjunctivitis sicca is the major cause of chronic or recurrent conjunctivitis in dogs. The diagnosis of KCS is often delayed or mistaken for allergic or bacterial conjunctivitis and inappropriate or insufficient treatment leads to progressive corneal scarring and blindness in many dogs. The cause of KCS in dogs has not been proven, but evidence supports an immune-mediated etiology for the majority of cases. In an attempt to specifically treat the cause of KCS, a new immunosuppressant drug, cyclosporine, has been used in a topical preparation. Treatment results using ophthalmic cyclosporine are dramatic compared with historical treatments. Resolution of corneal scarring and increased lacrimation are seen in most dogs. Investigations of the mechanism of action of ophthalmic cyclosporine suggest the efficacy may have been serendipitous. A local neuroendocrine effect of cyclosporine on the lacrimal gland may actually be responsible for the increased lacrimation. Early diagnosis of KCS and treatment with ophthalmic cyclosporine may avert a major cause of blindness in dogs.

Animals↗

Topically administered norfloxacin compared with topically administered gentamicin for the treatment of external ocular bacterial infections. The Worldwide Norfloxacin Ophthalmic Study Group.

In this double-masked study, we randomly assigned 488 patients with clinical signs of acute bacterial conjunctivitis or blepharitis, or both, to treatment with either norfloxacin ophthalmic solution 0.3% (245) or gentamicin ophthalmic solution 0.3% (243) for one week. Of the patients with positive cultures, 71% (85 of 120) of the norfloxacin-treated patients and 65% (86 of 133) of the gentamicin-treated patients were clinically cured. An additional 25% (30 of 120) of norfloxacin-treated patients and 32% (43 of 133) of gentamicin-treated patients were clinically improved. On the basis of posttreatment cultures, 89% of all cultured bacteria were eradicated (146 of 179 organisms) or suppressed (14 of 179 organisms) after treatment with norfloxacin. The condition of five norfloxacin-treated patients did not clinically improve, compared with the condition of eight gentamicin-treated patients. Both antibiotics had similar efficacy against gram-positive and against gram-negative organisms. One norfloxacin-treated patient and two gentamicin-treated patients withdrew from the study because of local intolerance. Norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the eyelids or conjunctiva, or both. In this study, norfloxacin was clinically and microbiologically similar in activity to gentamicin.

Administration, Topical↗

An outbreak of epidemic keratoconjunctivtis in a pediatric unit due to adenovirus type 8.

OBJECTIVES: To investigate and control an outbreak of epidemic keratoconjunctivitis (EKC) occurring in a neonatal intensive care unit (NICU) and to determine signs specific for EKC in newborns. DESIGN: Outbreak investigation and case-control study. SETTING: NICU of a 1,600-bed university hospital in Heidelberg, Germany. PATIENTS: Case-patients were defined as individuals who had adenoviral antigen detected by ELISA or by PCR from conjunctival swabs or who had clinical signs of conjunctivitis. Twelve newborns from the NICU who had EKC between October and November 1998 were compared with 11 who had bacterial conjunctivitis. INTERVENTION: Control measures included cohorting patients in contact isolation, using gloves and gowns for patient care, and using a hand rub and disinfectants with virucidal activity. RESULTS: Thirteen patients, 6 healthcare and 11workers, relatives of the patients had EKC, according to our case definition. Case-patients were more likely than control-patients to develop lacrimal swelling (P < .001), eye redness (P = .004), and lacrimation (P = .037) involving both eyes (P = .002). Prior examination by an ophthalmologist was a significant risk factor for EKC (P = .004). For diagnosis or treatment of retinopathy, premature newborns were seen by an ophthalmologist from a nearby eye care center where an EKC outbreak was ongong. No new cases were diagnosed more than 10 days after the implementation of control measures. CONCLUSION: In newborns, lacrimal swelling, eye redness, and lacrimation in both eyes should evoke suspicion of EKC. Ophthalmologists who have had contact with known EKC cases should use antiseptics and disinfectants with virucidal activity before contact with newborns or abstain from examining newborns.

Adenoviridae↗

Ophthalmic infections and their anti-infective challenges.

This introduction provides an overview of the succeeding articles contained within this supplement on the new fourth-generation fluoroquinolone antibiotic product, moxifloxacin ophthalmic solution 0.5% (VIGAMOX, Alcon Laboratories, Inc., Fort Worth, TX). Moxifloxacin was developed specifically to address the increasing incidence of resistance to earlier-generation antibiotic molecules. Structural modifications to the moxifloxacin molecule have decreased the likelihood of the development of resistant organisms. This antibiotic has been shown to possess greater activity than previous-generation molecules against gram-positive bacteria while maintaining excellent potency against gram-negative organisms and nontuberculous (atypical) mycobacteria. Moxifloxacin ophthalmic solution 0.5% exhibits enhanced bioavailability due to a unique molecular structure that combines high lipophilicity for enhanced corneal penetration with high aqueous solubility at physiological pH. Numerous studies have shown that moxifloxacin ophthalmic solution 0.5% has high potency against a broad range of microbial species and a favorable profile in terms of safety and tolerability. The results presented in this supplement provide additional evidence for the potential benefits of moxifloxacin ophthalmic solution 0.5% in surgical prophylaxis and treatment of sight-threatening infections, such as bacterial conjunctivitis, endophthalmitis and keratitis.

Aza Compounds↗

Ocular side effects associated with 13-cis-retinoic acid therapy for acne vulgaris: clinical features, alterations of tearfilm and conjunctival flora.

Isotretinoin (13-cis-retinoic acid) is commonly used for the treatment of acne vulgaris. We included 55 patients in this prospective study, and inspected them before, while and after therapy with isotretinoin regarding ocular side effects. Careful slit-lamp inspection, measurement of break-up-time and Schirmer-test and microbiological investigations of the conjunctival flora were performed. While staphylococcus aureus was cultured from the conjunctival sac before application of isotretinoin in 7.3%, this percentage increased to 61.8% during therapy. A pathological decrease of break-up-time was realized in 69.1% of the cases, the development of blepharitis in 40%. But in spite of the alteration of conjunctival flora, bacterial conjunctivitis developed in just 7.3% of the cases. However, only 34.5% of the patients showed symptoms of a conjunctivitis sicca, in spite of the impressive diminution of break-up-time in so many cases. All ocular side effects of isotretinoin were treatable and disappeared completely within 1 month after stopping therapy.

Acne Vulgaris↗

Ten years' surveillance of viral conjunctivitis in Sapporo, Japan.

BACKGROUND: We set out to establish the epidemiology of viral conjunctivitis over a 10-year period in Sapporo, northern Japan. METHODS: A total of 965 patients with clinically suspected viral conjunctivitis during the 10-year period from 1985 to 1994 in Sapporo were evaluated. RESULTS: Among the 965 patients, cumulative frequency of adenovirus (Ad) was 721 (75%). The dominant serotype of Ad changed with time; each serotype peaked at 3- to 5-year intervals. Adenoviral conjunctivitis occurred most often in July and August each year. Ad3 and Ad4 were predominantly identified in patients 30-39 years old. No enterovirus 70 has been detected. Herpes simplex virus (HSV) and Chlamydia trachomatis had no significant peak. HSV was isolated throughout the year, and C. trachomatis had two peaks of detection: in March and from July to September. HSV and C. trachomatis were predominantly detected in patients 20-29 years old. CONCLUSION: In this study, the main etiological agent of viral conjunctivitis in Sapporo, Japan, was Ad; however, attention should be paid to non-adenoviral agents, such as HSV and C. trachomatis, as possible causes of acute conjunctivitis.

Adenovirus Infections, Human↗

Investigating the antimicrobial activity of natural honey and its effects on the pathogenic bacterial infections of surgical wounds and conjunctiva.

Antimicrobial activities of 10-100% (wt/vol) concentrations of new honey, stored honey, heated honey, ultraviolet-exposed honey, and heated stored honey were tested against common human pathogens, including Escherichia coli, Entrobacter cloacae, Pseudomonas aeruginosa, Shigella dysenteriae, Klebsiella sp., Haemophilus influenzae, Proteus sp., Staphylococcus aureus, Streptococcus hemolyticus group B, and Candida albicans. Antimicrobial activity of honey was tested in acidic, neutral, or alkaline media. These were compared with similar concentrations of glucose in nutrient broth. Surgical wounds were made on the dorsum of mice and infected with S. aureus or Klebsiella sp. The wounds were treated with local application of honey four times a day or appropriate antibiotics and compared with control values. Bacterial conjunctivitis due to E. coli, Proteus sp., S. aureus, Klebsiella sp., and P. aeruginosa was induced in rats. Conjunctival application of honey four times a day or appropriate antibiotics was used for treatment and compared with control values. Growth of all the isolates was completely inhibited by 30-100% honey concentrations. The most sensitive microbes were E. coli, P. aeruginosa, and H. influenzae. Glucose showed less antimicrobial activity than honey, and many microbes showed positive culture even in 100% glucose. Heating to 80 degrees C for 1 hour decreased antimicrobial activity of both new and stored honey. Storage of honey for 5 years decreased its antimicrobial activity, while ultraviolet light exposure increased its activity against some of the microorganisms. Antimicrobial activity of honey was stronger in acidic media than in neutral or alkaline media. Single doses of honey used to prepare the 60% concentration in nutrient broth were bacteriocidal for P. aeruginosa and bacteriostatic for S. aureus and Klebsiella sp. during certain periods. Local application of raw honey on infected wounds reduced redness, swelling, time for complete resolution of lesion, and time for eradication of bacterial infection due to S. aureus or Klebsiella sp. Its potency was comparable to that of local antibiotics. Honey application into infective conjunctivitis reduced redness, swelling, pus discharge, and time for eradication of bacterial infections due to all the isolates tested.

Animals↗