Floral Differences of Conjunctiva in Patients with Renal Diseases

Abstract

Objectives: This study aimed to evaluate whether conjunctival flora is different in patients with chronic renal disease (CR) among its subgroups and healthy subjects. Methods: A total of 105 adult CR patients; 35 hemodialysis (HD), 35 diabetic hemodialysis (DHD), 35 renal transplantation (RT), and 40 healthy subjects were enrolled. After ophthalmologic examination, a swab was taken from the lower fornix of the right eye using a cotton-tipped applicator and directly sub-cultured on 5% sheep’s blood agar, chocolate agar, and eosin methylene blue agar. Differences in both bacterial growth and flora diversity of the groups were compared. Results: The order of bacterial growth rates in the groups are RT 65%), DHD (57%), HD (56%), and control (48%). The RT group had a statistically significant difference from the control group (p<0.05), but there is no difference among other groups. There is also no correlation between the duration of diabetes, hemodialysis, or transplantation with bacterial growth. The most frequently isolated bacteria are Staphylococcus hominis (23%) and Kocuria rosea (11%) in HD; Staphylococcus epidermidis (20 %) and S. hominis (15%) in DHD; K. rosea (17%) and S. hominis (14%) in RT and S. epidermidis (22%) and K. rosea (10%) in controls. Conclusion: The most prominently isolated bacteria in the RT group and overall were coagulase-negative staphylococcus species. Unlike previous reports, S aureus, a more pathogenic microorganism, was less isolated, but Kocuria species were detected as one of the most prevalent types in this study. The study suggests the condition of hemodialysis and diabetes have little effect on bacterial flora, and the RT group receiving immunosuppressive drugs significantly differed in both bacterial growth and flora diversity.

Keywords

• Ocular flora
• Chronic renal disease
• Ocular surface; Diabetes
• Renal Transplantation

Kaynakça

1. 1. Miller D, Iovieno A. The role of microbial flora on the ocular surface. Curr Opin Allergy Clin Immunol 2009; 9(5):466-470.
2. 2. Lee SH, Oh DH, Jung JY, Kim JC, Jeon CO. Comparative ocular microbial communities in humans with and without blepharitis. Invest Ophthalmol Vis Sci 2012; 53 (9):5585-5593.
3. 3. el-Naggar AM, Abo-Shousha E. Seasonal variations of bacterial flora of the conjunctival sac and their relation to infection of intra-ocular operations. Bull Ophthalmol Soc Egypt 1971; 64(68):339-344.
4. 4. Valdez-Garcia JE, Climent A, Chavez-Mondragon E, Lozano-Ramirez JF. Anterior chamber bacterial contamination in cataract surgery. BMC Ophthalmol 2014; 30:14:57.
5. 5. Suto C, Morinaga M, Yagi T, Tsuji C, Toshida H. Conjunctival sac bacterial flora isolated prior to cataract surgery. Infect Drug Resist 2012; 5:37-41.
6. 6. Hsu HY, Lind JT, Tseng L, Miller D. Ocular flora and their antibiotic resistance patterns in the midwest: a prospective study of patients undergoing cataract surgery. Am J Ophthalmol 2013;155(1):36-44.e2.
7. 7. Mino De Kaspar H, Ta CN, Froehlich SJ, et al. Prospective study of risk factors for conjunctival bacterial contamination in patients undergoing intraocular surgery. Eur J Ophthalmol 2009; 19:717-722.
8. 8. Mistlberger A1, Ruckhofer J, Raithel E, Muller M, Alzner E, Egger SF, Grabner G. Anterior chamber contamination during cataract surgery with intraocular lens implantation. J Cataract Refract Surg 1997; 23(7):1064-1069.

9. 9. Leong JK, Shah R, McCluskey PJ, Benn RA, Taylor RF. Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery. J Cataract Refract Surg 2002; 28(5):826-833.
10. 10. Speaker MG, Milch FA, Shah MK, Eisner W, Kreiswirth BN. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 1991; 98(5):639-649.
11. 11. Ozdemir M, Bakaris S, Ozdemir G, Buyukbese MA, Cetinkaya A. Ocular surface disorders and tear function changes in patients with chronic renal failure. Can J Ophthalmol 2004; 39(5):526-532.
12. 12. Hori Y, Maeda N, Sakamoto M, Koh S, Inoue T, Tano Y. Bacteriologic profile of the conjunctiva in the patients with dry eye. Am J Ophthalmol 2008; 146:729-734.
13. 13. Balbaba M, Ulas F, Toplu SA. Effect of hemodialysis duration on conjunctival bacterial flora and susceptibility of conjunctival bacterial isolates to fluoroquinolones. Ocul Immunol Inflamm 2013; 21(3):197-200.
14. 14. Cockerill FR, Wikler MA, Alder J, Dudley MN, Eliopoulos GM, Ferraro MJ, et al. National Committee for Clinical Laboratory Standards.2012. Performance standards for antimicrobial disk susceptibility tests. Approved Standard 2H-2.
15. 15. Bakaris S, Ozdemir M, Isik IO, Buyukbese MA, Ozdemir G. Impression cytology changes and corneoconjunctival calcification in patients with chronic renal failure. Acta Cytol 2005;49(1):1-6.
16. 16. Graham JE, Moore JE, Jiru X, et al. Ocular pathogen or commensal: a PCR-based study of surface bacterial flora in normal and dry eyes. Invest Ophthalmol Vis Sci 2007;48(12):5616-5623.
17. 17. Martins EN, Alvarenga LS, Hofling-Lima AL, et al. Aerobic bacterial conjunctival flora in diabetic patients. Cornea 2004;23(2):136-142.
18. 18. Yang C, Fei Y, Qin Y, et al. Bacterial Flora Changes in Conjunctiva of Rats with Streptozotocin-Induced Type I Diabetes. Zhou D, ed. PLoS ONE 2015; 10(7):e0133021.
19. 19. Gunduz G, Gunduz A, Polat N, Cumurcu BE, Yakupogulları Y. The Effect of Chronic Alcoholism on the Conjunctival Flora. Curr Eye Res 2015; 4:1-6.
20. 20. Ermis SS, Aktepe OC, Inan UU, Ozturk F, Altindis M. Effect of topical dexamethasone and ciprofloxacin on bacterial flora of healthy conjunctiva. Eye (Lond. 2004;18(3):249-52.
21. 21. Chen SY, Kuo MC, Wang PN, Lin TL, Ma DH. Study of conjunctival flora in patients after peripheral blood stem cell transplantation and its correlation with tear secretion. Biomed J 2012;35(6):493-499.
22. 22. Gritz DC, Scott TJ, Sedo SF, Cevallos AV, Margolis TP, Whitcher JP. Ocular flora of patients with AIDS compared with those of HIV-negative patients. Cornea1997;16(4):400-005.
23. 23. Basaglia G.,et al. Catheter-Related Bacteremia Due to Kocuria kristinae in a Patient with Ovarian Cancer. J Clin Microbiol 2002; 40(1): 311–313.
24. 24. Savini V,et al. Drug sensitivity and clinical impact of members of the genus Kocuria Journal of Medical Microbiology 2010; 59:1395–1402.
25. 25. Kaya KE, Kurtoglu Y, Cesur S, et al. [Peritonitis due to Kocuria rosea in a continuous ambulatory peritoneal dialysis case.] Mikrobiyol Bul 2009; 43: 335-337. Turkish
26. 26. Altuntas F, Yildiz O, Eser B, Gundogan K, Sumerkan B, Cetin M. Catheter-related bacteremia due to Kocuria rosea in a patient undergoing peripheral blood stem cell transplantation. BMC Infect Dis 2004; 4: 62.
27. 27. Purty S, Saranathan R, Prashanth K, et al.The expanding spectrum of human infections caused by Kocuria species:a case report and literature review. Emerg Microbes Infect 2013; 2(10):e71.
28. 28. Boudewijns M, Vandeven J, Verhaegen J, Ben-Ami R, Carmeli Y. Vitek 2 automated identification system and Kocuria kristinae. J Clin Microbiol 2005; 43: 5832.
29. 29. Capriotti JA, Pelletier JS, Shah M, Caivano DM, Ritterband DC. Normal ocular flora in healthy eyes from a rural population in Sierra Leone. Int Ophthalmol 2009; 29(2):81-84.
30. 30. Aslan L. Prevention and Treatment of Bacterial Endophthalmitis After Cataract Surgery. Clin Anal Med 2014; 5(4): 353-357.