The Invitro Sensitivity of Bacterial Conjunctivitis Agents to Routinely Used Antibiotics

Abstract

Objective: The most commonly seen ocular infection worldwide is bacterial conjunctivitis. It is widespread practice to use broad spectrum empirical treatment for bacterial conjunctivitis without production of the agent micro-organism or performing antibiotic sensitivity tests. In the current study, it was aimed to find an effective empirical treatment by isolating bacterial conjunctivitis agents and determining the antibiotic sensitivity percentages in invitro conditions.

Methods: Culture samples were taken from the mucopurulent discharge of 65 patients diagnosed with bacterial conjunctivitis. The samples were taken with a swab stick into transport medium, then seeded and the bacteria colonies produced were identified using a fully automated BD Phoenix system (Becton Dickinson , USA). Each of the produced bacteria were evaluated using netilmicin, tobramycin, ofloxacin, tetracycline, chloramfenicol, gentamicin, lomefloxacin, moxifloxacin, and ciprofloxacin discs with the Kirby-Bauer disc diffusion method.

Results: The 65 patients with bacterial conjuntivitis comprised 30 females and 35 males, age between 21 and 86 (average: 48.23 ±10.47). The agent bacteria was isolated in 46 (70.7%) cases. Of the produced bacteria, 86.9% were gram positive cocci, and of these, coagulase negative staphylococci was the most frequently isolated. The sensitivity percentages of the examined antibiotics were found to be netilmicin 93.3%, chloramphenicol 92.5%, tobramycin 90.0%, gentamicin 88.2%, moxifloxacin 84.3%, ofloxacin 80.9%, tetracycline 75.0%, ciprofloxacin 70.5% and lomefloxacin 63.3%.

Conclusion: The results of this study showed that rather than using broad spectrum fluoroquinolones in empirical treatment of patients with bacterial conjuctivitis, the first-line use of aminoglycoside-derived antibiotics would have a positive effect on the treatment process.

Keywords

• Bacterial conjunctivitis,invitro antibiotic sensitivity,Empirical Treatment

Bakteriyel Konjonktivit Etkenlerinin Rutinde Kullanılan Antibiyotiklere İnvitro Duyarlılıkları

Abstract

Amaç: Dünyada en sık görülen oküler enfeksiyon, bakteriyel konjonktivitlerdir. Bakteriyel konjonktivitlerde etken mikroorganizma üretilmeden ve antibiyotik duyarlılık testleri yapılmadan geniş spektrumlu ampirik tedavi kullanımı yaygındır. Biz bu çalışmada, bakteriyel konjonktivit etkenlerini izole ederek invitro şartlarda antibiyotik duyarlılık yüzdelerini saptayarak etkin ampirik tedaviyi bulmayı amaçladık.

Gereç ve Yöntem: Bakteriyel konjonktivit tanısı almış 65 hastanın mukopürülan akıntılarından eküvyon çubuğu ile transport besiyeri içerisine kültür örnekleri alındı. Kültür örneklerinin ekimleri yapılarak üreyen bakteri kolonileri BD Phoenix (Becton Dickinson, USA) tam otomatize sistem kullanılarak tanımlandı. Üreyen bakterilerin herbirine; netilmisin, tobramicin, ofloksasin, tetrasiklin, kloramfenikol, gentamisin, lomefloksasin, moksifloksasin, siprofloksasin diskleri ile Kirby-Bauer disk difüzyon yöntemi uygulandı.

Bulgular: Çalışmaya dahil edilen yaşları 21 ile 86 (yaş ortalaması: 48.23 ±10.47) aralığında bakteriyel konjonktivit tanısı almış 30 kadın 35 erkek toplam 65 bakteriyel konjonktivitli hastanın 46’sında (%70,7) etken bakteri izole edildi. Üreyen bakterilerin %86,9’u gram pozitif koklar olup bunlardan da koagülaz negatif stafilokoklar en sık izole edildi. Çalışılan antibiyotiklerin duyarlılık yüzdeleri sırasıyla netilmisin %93,3, kloramfenikol %92,5, tobramisin %90,0, gentamisin %88,2 moksifloksasin %84,3, ofloksasin %80,9, tetrasiklin75,0, siprofloksasin %70,5 lomefloksasin %63,3 olarak bulundu.

Sonuç: Yapmış olduğumuz çalışmamızın sonuçlarıyla bakteriyel konjonktivitli hastaların ampirik tedavisinde geniş spekturumlu florokinolonların yerine aminoglikozid türevi antibiyotiklerin ilk sırada kullanılmasının tedavi sürecinde olumlu etki yaratacağı kanaatindeyiz.

Keywords

• Bakteriyel konjonktivit,invitro antibiyotik duyarlılığı,Ampirik Tedavi

References

1. Referans1 Ayşe Willke Topçu, Güner Söyletir, Mehmet Doğanay. Enfeksiyon hastalıkları ve mikrobiyolojisi 3. Baskı, Bölüm 21, Murat İrkeç, Banu Bozkurt, Sayfa 1585-1586.
2. Referans2 Akal A, Oğuz H. Konjonktivitler. Conjunctivitis. Turkish Journal of Ophthalmology / Turk Oftalmoloji Dergisi. 42, 48-51, Dec. 2, 2012. ISSN: 13000365.
3. Referans3 Kanski JJ. Conjonctiva; in Kanski JJ (ed): Clinical Ophthalmology: A Systematic Approach,. (6th ed) Oxford, Butterworth Heinemann, 2007;215-47.Referans4 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement; pp.62-4 (2013).
4. Referans5 The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 1.3, January 5, 2011. Available at: http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Disk_test_documents/EUCAST_breakpoints_v1.3_pdf.pdf
5. Referans6 Eser İ, Akçal A, Arzu Taşkıran Ç, Kömür B, Özbey N, Otkun M. Bakteriyet Konjonktivit Tedavisinde Antibiyotik Tercihi ne Olmalı?. Turkish Journal Of Ophthalmology / Turk Oftalmoloji Dergisi [serial online]. November 2010;40(6):354-358. Available from: Academic Search Complete, Ipswich, MA. Accessed January 25, 2018.
6. Referans7 Getahun E, Gelaw B, Assefa A, Assefa Y, Amsalu A. Bacterial pathogens associated with external ocular infections alongside eminent proportion of multidrug resistant isolates at the University of Gondar Hospital, northwest Ethiopia. BMC Ophthalmol. 2017;17(1).
7. Referans8 Namitha BN, Mahalakshmi, Rao A. Aerobic Bacteriological Profile in Cases of Ocular Infections in a Tertiary Care Hospital (Navodaya Medical College and Research Centre, Raichur). IOSR-JDMS. 2014;13(11):14–21.
8. Referans9 Khosravi AD, Mehdinejad M, Heidari M. Bacteriological findings in patientswith ocular infection and antibiotic susceptibility patterns of isolated pathogens. Singapore Med J. 2007;48(8):741–3.

9. Referans10 Alexandrakis G, Alfonso EC, Miller D. Shifting trends in microbial keratitis in South Florida and emerging resistance to fluoroquinolones. Ophthalmology 2000;107:1497–1502.
10. Referans11 Thimmappa S, Gentile RC, Shah MK, et al. Ten year analysis of fluoroquinolone resistance patterns for bacterial keratitis [ARVO abstract]. Invest Ophthalmol Vis Sci 2000;41:S149.
11. Referans12 Hooper DC. New uses for new and old quinolones and the challenge of resistance. Clin ınfect Dis 2000;31 (suppl 2):24-8.
12. Referans13 Abut Lİ, Durmaz B, Tekerekoğlu MS, Taştekin N. Yatan hastalardan izole edilen stafilokokların florokinolonlara direnci. İnönü Ünv. Tıp Fakültesi Dergisi 8(4);201-203; 2001
13. Referans14 Gülay Z. Kinolon direnci.Flora 2002;7(4):225-232.
14. Referans15 Gallenga PE, Lobefalo L, Colangelo L, et al. Topical lomefloxacin 0.3% twice daily versus tobramycin 0.3% in acute bacterial conjunctivitis: a multicenter double blind phase III study. Ophthalmologica 1999;213:250–7.
15. Referans16 Campoli-Richards DM, Chaplin S, Sayce RH, et al. Netilmicin. Drugs 1989;38:703–56.
16. Referans17 Bonfiglio G, Scuderi AC, Russo G. Netilmicin: in vitro activity, timekill evaluation and postantibiotic effect on microorganisms isolated from ocular infections. Chemotherapy 2001;47:117–22.
17. Referans18 Weiss A. Acute conjunctivitis in childhood. Curr Probl Pediatr 1994;24(1): 4-11.
18. Referans19 McGhee CN, Anastas CN. Widespread ocular use of topical chloramphenicol: is there justifiable concern regarding idiosyncratic aplastic anaemia? Br J Ophthalmol. 1996;80:182-4. [Abstract] / [PDF]
19. Referans20 Iwalokun A, Oluwadun A, Akinsinde A. Niemogha and Nwaokorie O. Bacteriologic and plasmid analysis of etiologic agents of conjunctivitis in Lagos, Nigeria. J Ophthal Inflamm Infect. 2011;1:95–103.
20. Referans21 Eguchi H. Ocular Infections Caused by Corynebacterium Species Additional information is available at the end of the chapter http://dx.doi.org/10.5772/56214