Abstract

Introduction: Ocular infections constitute a significant portion of curable eye diseases. However, in developing countries like Nepal, bacterial and fungal spectrum is not well established for ocular infections. Therefore, ocular infections still remain as the major cause of blindness. This study was sought determine the bacterial and fungal etiology of various ocular infections and assess the antibiotic susceptibility pattern of the bacterial pathogens.

Methods: This cross-sectional study was conducted at BP Koirala Lions Center for Ophthalmic Studies, Kathmandu, Nepal from June 2012 through April 2013. Various ophthalmic specimens of clinical values such as the corneal scraps, conjunctival swab and eye pus and biopsy materials were collected aseptically and processed for culture. After sufficient incubation, isolates were identified by colony morphology, Gram staining and relevant biochemical tests. Identified bacteria; isolates were then subjected under Antibiotic Susceptibility test (AST) by modified Kirby-Bauer disc diffusion method to determine Multi Drug Resistant (MDR) isolates and Minimum Inhibitory Concentration (MIC).

Results: A total number of 810 ocular specimens, mainly from the case of conjunctivitis (644/810) were processed. Of which, 31.97% (270/810) showed growth on culture medium: 267 (98.85%) were bacterial, 2 (0.77%) were fungal (Penicillium spp and Fusarium spp) and 1 (0.38%) was yeast (Rhodotorula) isolate. Gram positives alone accounted for 96.25% (257/267) among bacterial isolates. Staphylococcus aureus (52.96%) and Escherichia coli (1.48%) were the most common Gram positive and Gram-negative isolates respectively. Gram positive isolates showed resistance to ciprofloxacin (39.29%), cephalexin (38.13%) and amikacin (31.52%) while gram negatives were resistant to cefazolin (80%). All isolates of E. coli, Hemophilus influenzae and Serratia spp together with 48.95% of S. aureus were MDR. Among 5 methicillin resistant S. aureus (MRSA) isolates, 2 isolates were vancomycin intermediate S. aureus (VISA). Further, the minimum inhibitory concentration (MIC) break points for S. aureus to chloramphenicol, ciprofloxacin and vancomycin were also determined.

Conclusion: Conjunctivitis among adults was the most prevalent case found so far, yielding higher culture positivity. Along with MDR bacterial agents, fungal agents were observed to be posing significant threat in the disease management. Early diagnosis, proper management and empirical treatment are advised to prevent infections related blindness.

Keywords: Ocular Infections; Conjunctivitis; AST; MDR; MRSA; VISA; MIC

References

1. Teweldemedhin M., et al. “Bacterial profile of ocular infections: a systematic review”. BMC Ophthalmology 17 (2017): 212.
2. Montessori V., et al. “Epidemic kerato-conjunctivitis outbreak at a tertiary referral eye care clinic”. American Journal of Infection Control 4 (1998): 399-405.
3. Crain EF., et al. “Identifying children at low risk for bacterial conjunctivitis”. The Archives of Pediatrics and Adolescent Medicine 1 (2010): 263-267.
4. Thomas M and Taylor S. “Antibiotic choices for common infections”. Bangalore Political Action Committee (NZ) (2010).
5. Epling John. “Bacterial conjunctivitis”. BMJ Clinical Evidence 1 (2007): 704-706.
6. Pascolini D and Mariotti SP. “Global estimates of visual impairment: 2010”. British Journal of Ophthalmology 5 (2012): 614-618.
7. Tewari A., et al. “Epidemiological and microbiological profile of infective keratitis in Ahmedabad”. Indian Journal of Ophthalmology 4 (2012): 267-272.
8. Amza A., et al. “Community risk factors for ocular Chlamydia infection in Niger: pre-treatment results from a cluster- randomized trachoma trial”. PLOS Neglected Tropical Diseases 4 (2012): 1586-1593.
9. Leck AK., et al. “Aetiology of suppurative corneal ulcers in Ghana and south India, and epidemiology of fungal keratitis”. British Journal of Ophthalmology 11 (2002): 1211-1215.
10. Dhakhwa K., et al. “Causative organisms in microbial keratitis, their sensitivity pattern and treatment outcome in western Nepal”. Nepalese Journal of Ophthalmology 7 (2012): 119-127.
11. Pandey PR. “Study of Ocular Emergencies in Nepal Eye Hospital”. PMJNI2 (2009).
12. Florakis GJ., et al. “Scanning slit confocal microscopy of fungal keratitis”. Archives of Ophthalmology 11 (1997): 1461-1463.
13. Sridhar MS., et al. “Treatment and outcome of nocardia Keratitis”. Cornea5 (2001): 458-462.
14. Wani VP., et al. “Endophthalmitis after virectomy and virectomy combined with phacoemulsification: incidence and visual outcomes”. The European Journal of Ophthalmology 6 (2009): 1044-1049.
15. McDonald M and Blondeau JM. “Emerging antibiotic resistance in ocular infections and the role of fluoroquinolones”. Journal of Cataract and Refractive Surgery 1 (2010): 1588-1598.
16. Mather R., et al. “Fourth generation fluoroquinolones: new weapons in the arsenal of ophthalmic antibiotics”. American Journal of Ophthalmology 4 (2002): 463-466.
17. Synder RW and Glasser DB. “Antibiotic therapy for ocular infection”. Westmed Medical 1 (1994): 579-584.
18. Campos Jose., et al. “Susceptibility Studies of Multiply Resistant Haemophilus influenza Isolated from Pediatric Patients and Contacts”. Antimicrob Agents Chemother1 (1984): 706-709.
19. Isenberg HD. “Ocular cultures”. In: Clinical Microbiology Procedure Handbook. Hall GS and York MK (editions), 2^nd edition, Volume 1, section 3.10. ASM press, Washington DC (2004).
20. Prajna L and Rajlakshmi CP. “Ocular microbiology”. Aravinda Eye hospitals and Postgraduate institute of Ophthalmology, Madurai, India (2005).
21. Cheesebrough M. “District Laboratory Practice in Tropical Countries”. Part 2 Cambridge University Press, London (2000): 225-392.
22. Jones DB., et al. “Laboratory diagnosis of ocular infections”. Washington DC: American Society for Microbiology (1981).
23. Larone DH. “Medical important fungi, a guide to identification, 3^rd Edition”. ASM press (2005).
24. Clinical and laboratory standard institute (CLSI). Performance standards for antimicrobial susceptibility testing; Twenty-First information Supplement”. CLSI, M100-S20.CLSI, Wayne PA (2011).
25. Magiorakos AP., et al. “Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance”. Clinical Microbiology and Infection 1 (2012): 268-281.
26. Simner PJ., et al. “Prevalence and characterization of extended-spectrum beta-lactamase-and AmpC beta-lactamase-producing Escherichia coli: results of the CANWARD 2007-2009 study”. Diagnostic Microbiology and Infectious Disease 3 (2011): 326-334.
27. Suwal S., et al. “Microbiological profile of corneal ulcer cases diagnosed in a tertiary care ophthalmological institute in Nepal”. BMC Ophthalmology 16 (2016): 209.
28. Allan BDS and Dart JKG. “Strategies for the management of microbial keratitis”. The British Journal of Ophthalmology 1 (1995): 777-786.
29. Stephen BK., et al. “Simplifying collection of corneal specimens in cases of suspected bacterial keratitis”. Journal of Clinical Microbiology 7 (2003): 3192-3197.
30. Al- Shakarachi F. “Initial therapy for suppurative microbial keratitis in Iraq”. British Journal of Ophthalmology 12 (2007): 1583-1587.
31. Bourcier T., et al. “Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases”. British Journal of Ophthalmology 1 (2003): 834-838.
32. Alexandrakis G., et al. “Shifting trend of bacterial keratitis in south Florida and emerging resistance to fluoroquinolones”. Ophthalmology1 (2000): 1497-1502.
33. Mozayemi RM and Lam S. “Phyctenular keraconjunctivitis and marginal Staphylococcal Keratitis”. Indian Journal of Ophthalmology 1 (1996): 1392-1395.
34. Norina TJ., et al. “Microbial keratitis: aetiological diagnosis and clinical features in patient admitted to hospital university sains Malaysia”. Singapore Medical Journal 1 (2008): 67-71.
35. Liesegang TJ and Forster RK. “Spectrum of microbial keratitis in South Florida”. American Journal of Ophthalmology 1 (1980): 38-47.
36. Goldstein MH., et al. “Emerging fluoroquinolone resistance in bacterial keratitis: a 5-year review”. Ophthalmology1 (1999): 1313-1318.
37. Tiwari HK., et al. “Assessment of different tests to detect methicillin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital in northern parts of India”. BMC Infectious Diseases 1 (2009): 156.
38. Song JH., et al. “The Asian network for surveillance of resistant pathogens (ANSORP) study group”. Antimicrobial Agents and Chemotherapy 12 (2004): 4926-4928.
39. Tiwari HK and Sen MR. “Emergence of vancomycin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital in northern parts of India”. BMC Infectious Diseases 1 (2006): 156.
40. Chen CJ and Starr CE. “Epidemiology of Gram-negative conjunctivitis in neonatal intensive care unit patients”. American Journal of Ophthalmology 6 (2008): 966-970.
41. Sherman NE., et al. “Pseudomonas aeruginosa and a proteomic approach to bacterial pathogenesis”. Disease Markers 4 (2001): 285-293.
42. Sanjana RK., et al. “Prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) in CMS- teaching hospital: a preliminary report”. Journal of Nepal Medical Association 1 (2010): 1-6.
43. Paez PL., et al. “Impact of ciprofloxacin and chloramphenicol on the lipid bilayer of Staphylococcus aureus: Changes in membrane potential”. BioMed Research International 10 (2013): 1155.
44. Goldstein FW and Acar JF. “Epidemiology of quinolone resistance: Europe and North and South America”. Drugs2 (1995): 36-42.
45. Dutta GN., et al. “Inactivation of chloramphenicol by Staphylococcus aureus biotype C from humans and animals”. Indian Journal of Medical Research 1 (2001): 11-13.
46. Hiramatsu K., et al. “Methicillin resistant Staphylococcus aureus clinical strains with reduced vancomycin susceptibility”. Journal of Antimicrobial Chemotherapy 1 (1997): 135-136.
47. Centers for Disease Control and Prevention (CDC). “Staphylococcus aureus resistant to vancomycin United States”. Morbidity and Mortality Weekly Report 51 (2002): 565-567.
48. Ujwol B., et al. “Status of inducible clindamycin resistance among macrolide resistant Staphylococcus aureus”. African Journal of Microbiology Research 9 (2016): 280-284.
49. Venubabu T., et al. “Vancomycin resistance among methicillin resistant Staphylococcus aureus isolates from intensive care units of tertiary care hospitals in Hyderabad”. Indian Journal of Medical Research 5 (2011): 704-708.
50. Sueke H., et al. “Minimum inhibitory concentrations of standard and novel antimicrobials for isolates from bacterial keratitis”. Investigative Ophthalmology and Visual Science 5 (2010): 2519-2524.

Citation

Citation: Komal Raj Rijal., et al. “Etiology of Ocular Infections and Minimum Inhibitory Concentration of Multidrug- Resistant Staphylococcus aureus Isolates to Vancomycin, Ciprofloxacin and Chloramphenicol". Acta Scientific Microbiology 3.6 (2020): 134-145.

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Copyright: © 2020 Komal Raj Rijal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.