Bacterial profiles and antibiotic susceptibility pattern in patients with chronic dacryocystitis

Abstract

Aim: Dacryocystitis is an infection of the lacrimal apparatus, and without appropriate treatment, it can lead to serious complications such as orbital cellulitis and meningitis. In this study, we aimed to determine the frequency and antibiotic susceptibility of the bacterial pathogens in chronic dacryocystitis.
Methods: This cross-sectional study included 60 patients diagnosed with chronic dacryocystitis in the Ophthalmology department of Karabuk Training and Research Hospital between December 2019 and February 2020. Aerobic culture tests were performed using swab samples obtained from the lacrimal punctum of the patients. Identification and antibiotic susceptibility of isolates were determined using Phoenix-100TM (Becton Dickinson, Sparks, MD, USA) fully automated system.
Results: In total, 43 of 60 (71.7%) of patients were females, and the mean age was 56.78 (12.67) years. Aerobic bacteria were isolated from 51 (85%) of 60 samples. The most common pathogens were Pseudomonas aeruginosa (45%), Staphylococcus epidermidis (15.7%), and Staphylococcus aureus (11.8%) respectively. The most effective antibiotics against Gram-negative bacteria were aminoglycosides with a susceptibility of >90%. Gentamicin was also active against 85.7% of Gram-positive bacteria. Although in-vitro efficacy of ciprofloxacin was 81.5% against Gram-negative bacteria, it was mildly active against Gram-positive bacteria (52.5%). Methicillin resistance was detected in 33% of Staphylococcus species.
Conclusion: In our region, aminoglycosides may be preferred instead of fluoroquinolones for the empirical treatment of chronic dacryocystitis. However, since our study is single-centered and small-sized, these findings should be supported by large-scale studies in the future.

Keywords

• Dacryocystitis,Corynebacterium striatum,Pseudomonas aeruginosa,Antibiotic,Ciprofloxacin,Gentamicin

Kronik dakriyosistitli hastalarda bakteri profili ve antibiyotik duyarlılık paterni

Öz

Amaç: Dakriyosistit lakrimal aparatusun enfeksiyonu olup, uygun şekilde tedavi edilmezse orbital sellülit, menenjit gibi ciddi komplikasyonlara yol açabilir. Bu çalışmada kronik dakriyosistitte, bakteriyel patojenlerin sıklığını ve antibiyotik duyarlılık profilini saptamayı amaçladık.
Yöntemler: Bu kesitsel çalışmaya Aralık 2019- Şubat 2020 tarihleri arasında Karabük Eğitim ve Araştırma Hastanesi Göz hastalıkları bölümünde kronik dakriyosistit tanısı almış 60 hasta dahil edilmiştir. Hastaların punktumundan alınan sürüntü örneklerinden aerop kültür yapılmıştır. İzolatların identifikasyonu ve antibiyotik duyarlılığı Phoenix-100 (Becton Dickinson,MD, PA,USA) tam otomatize sistemle saptanmıştır.
Bulgular: Kronik dakriyosistitli toplam 60 hastanın 43’ü (%71,7) kadın olup yaş ortalaması 56,78 (12,67) idi. Altmış örneğin 51 inde aerop bakteri üredi (%85). En sık izole edilen patojenler Pseudomonas aeruginosa (%45), Staphylococcus epidermidis (15,7) ve Staphylococcus aureus (%11,8) idi. Gram negatif bakterilere en etkili antibiyotikler aminoglikozidler olup, duyarlılık %90’ın üzerinde idi. Gentamisin, Gram-pozitif bakterilere de %85,7 oranında etkili idi. Siprofloksasinin etkinliği Gram- negatiflerde %81,5 iken, Gram-pozitif bakterilere düşük etkili idi (%52,5). Stafilokok türlerinin %33’ ünde ise metisilin direnci saptandı.
Sonuç: Yöremizde kronik dakriyosistitin ampirik tedavisinde florokinolonlar yerine aminoglikozidler tercih edilebilir. Bununla birlikte, çalışmamız tek merkezli ve küçük boyutlu olduğundan, bu bulgular gelecekte büyük ölçekli çalışmalarla desteklenmelidir. 

Anahtar Kelimeler

• Dakriyosistit,Corynebacterium striatum,Pseudomonas aeruginosa,Antibiyotik,Gentamisin,Siprofloksasin

Kaynakça

1. 1. Mills DM, Bodman MG, Meyer DR, Morton AD III; ASOPRS Dacryocystitis Study Group. The microbiologic spectrum of dacryocystitis: a national study of acute versus chronic infection. Ophthal Plast Reconstr Surg. 2007;23(4):302–6.
2. 2. Chung SY, Rafailov L, Turbin RE, Langer PD.The microbiologic profile of dacryocystitis. Orbit. 2018; 38(1):72-8.
3. 3. Dantas RR. Lacrimal Drainage System Obstruction. Semin Ophthalmol. 2010;25(3):98-103.
4. 4. Bharathi MJ, Ramakrishnan R, Maneksha V, Shivakumar C, Nithya V, Mittal S. Comparative bacteriology of acute and chronic dacryocystitis. Eye. 2008; 22(7):953–60.
5. 5. Negm S, Aboelnour A, Saleh T, Yasser M, Hassanin O. Clinicobacteriological study of chronic dacryocystitis in Egypt. Bull Natl Res Cent. 2019;43:35.
6. 6. Teweldemedhin M, Gebreyesus H, Atsbaha AH, Asgedom SW,Saravanan M. Bacterial profile of ocular infections: a systematic review. BMC Ophthalmol. 2017;17(1):212.
7. 7. Chaudhary M, Bhattarai A, Adhikari SK, Bhatta DR. Bacteriology and antimicrobial susceptibility of adult chronic dacryocystitis. Nepal J Ophthalmol. 2010; 2(2):105–13.
8. 8. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 9.0, 2019. (Accessed 10 December 2019) Available online: http://www.eucast.org.

9. 9. Chen L, Fu T, Gu H, Jie Y, Sun Z, Jiang D et al. Trends in dacryocystitis in China: a STROBE-compliant article. Medicine (Baltimore). 2018; 97(26): e11318.
10. 10. Pinar-Sueiro S, Fernández-Hermida RV, Gibelalde A, Gibelalde, Martínez-Indart L. Study on the effectiveness of antibiotic prophylaxis in external dacryocystorhinostomy: a review of 697 cases. Ophthal Plast Reconstr Surg. 2010;26(6):467–72.
11. 11. Shigeta K, Takegoshi H, Kikuchi S. Sex and age differences in the bony nasolacrimal canal. Arch Ophthalmol. 2007;125(12):1677–81.
12. 12. Gumussoy M, Çukurova I, Ece G, Çetinkaya EA. Clinical and microbiological evaluation of the culture results of the patients with chronic dacryocystitis at a tertiary care hospital. ENT Updates. 2016;6(1):34–42.
13. 13. Hartikainen J, Lehtonen OP, Saari KM. Bacteriology of lacrimal duct obstruction in adults. Br J Ophthalmol. 1997;81(1):37–40.
14. 14. Briscoe D, Rubowitz A, Assia EI. Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis. Orbit. 2005;24(2):95–8.
15. 15. Pornpanich K, Luemsamran P, Leelaporn A, Santisuk J, Tesavibul N, Lertsuwanroj B, et al. Microbiology of primary acquired nasolacrimal duct obstruction: simple epiphora, acute dacryocystitis, and chronic dacryocystitis. Clin Ophthalmol. 2016;22(10):337–342.
16. 16. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, et al. Bad Bugs, No Drugs: No ESKAPE! An Update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(1):1–12.
17. 17. Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines or the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):103-20.
18. 18. Çakmaklıogullari EK, Kuru C. Pseudomonas aeruginosa Suşlarının Antibiyotik Duyarlılıkları: Farklı Örnek Türlerinde Değerlendirme. ANKEM Derg 2019;33(2):37-42.
19. 19. Özyurt M, Haznedaroğlu T, Baylan O, Hoşbul T, Ardıç N, Bektöre B. Yatan hastalardan izole edilen Pseudomonas izolatlarında antibiyotik direnci. ANKEM Derg. 2010;24(3):124-9.
20. 20. Eyigör M, Telli M, Tiryaki Y, Okulu Y, Aydın N. Yatan hastalardan izole edilen Pseudomonas aeruginosa suşlarının antibiyotik duyarlılıkları. ANKEM Derg. 2009;23(3):101-5.
21. 21. Asbell PA, Sanfilippo CM, Pillar CM, De Cory HH, Sahm DF, Morris TW. Antibiotic resistance among ocular pathogens in the United States: Five-year results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study. JAMA Ophthalmol. 2015;133(12):1445–54.
22. 22. Arabacı Ç, Kutlu O. Evaluation of microorganisms isolated from blood cultures and their susceptibility profiles to antibiotics in five years period. J Surg Med. 2019;3(10):729-33.
23. 23. Çakmaklıoğulları M, Çakmaklıoğulları EK. Bakteriyel Konjonktivit Etkenlerinin Rutinde Kullanılan Antibiyotiklere İnvitro Duyarlılıkları. Konuralp Tıp Derg. 2018;10(3):369-72.
24. 24. Razavi ME, Ansari-Astaneh MR, Farzadnia M, Rahmaniyan H, Moghiman T. Bacteriological evaluation of adult dacryocystitis in Iran. Orbit. 2010;29(5):286–90.
25. 25. Delia AC, Uuri GC, Das D, Gogol U. Bacteriology of Chronic Dacryocystitis in Adult Population of Northeast India. Orbit. 2008;27(4):243-7.
26. 26. Reddy AK, Garg P, Alam MR, Gopinathan U, Sharma S, Krishnaiah S. Comparison of in vitro susceptibilities of Gram-positive cocci isolated from ocular infections against the second and fourth generation quinolones at a tertiary eye care centre in South India. Eye. 2010;24(1):170-4.
27. 27. Aşgın N. ESKAPE Patojenler. In: Dalkılıç M,editor. Academic Studies on Natural and Health Sciences. Ankara (Turkey): Gece Publishing; 2019; p. 423-37.
28. 28. Fynn-Thompson N, Pineda R. Antibiotic advances in Ophthalmology. Int Ophthalmol Clin. 2004;44(3):91–102.
29. 29. Kebede A, Adamu Y, Bejiga A. Bacteriological Study of Dacryocystitis among Patients Attending in Menelik II Hospital, Addis Ababa. Ethiop Med Journal. 2010;48(1):29–33.
30. 30. Miller D. Update on the epidemiology and antibiotic resistance of ocular infections. Middle East Afri J Ophthalmol. 2017;24(1):30–42.
31. 31. Neemuchwala A, Soares D, Ravirajan V, Marchand-Austin A, Kus JV, Patel SN. In Vitro Antibiotic Susceptibility Pattern of Non-diphtheriae Corynebacterium Isolates in Ontario, Canada, from 2011 to 2016. Antimicrob Agents Chemother. 2018;62(4):1–9.
32. 32. Mumcuoğlu İ, Hazırolan G, Kurşun Ş, Aksu N. Bir eğitim ve araştırma hastanesinde artan sıklıkta izole edilen Corynebacterium striatum izolatlarının değerlendirilmesi. Turk Hij Den Biyol Derg. 2015;72(4):281-8.
33. 33. Aşgın N. Klinik örneklerden izole edilen Corynebacterium striatum suşlarının in-vitro antibiyotik direnç profili. ANKEM Derg. 2019;33(3):102–7.
34. 34. Çaycı Y, Korkmaz F, Birinci A. Hastanemizde 2014- 2017 yıllarında üreyen Corynebacterium izolatlarının değerlendirilmesi. KOU Sag Bil Derg. 2017;3(2):6-8.
35. 35. Asgin N, Otlu B. Antimicrobial Resistance and Molecular Epidemiology of Corynebacterium striatum Isolated in a Tertiary Hospital in Turkey. Pathogens. 2020;9(2):136.
36. 36. Deguchi H, Kitazawa K, Kayukawa K, Kondoh E, Fukumoto A, Yamasaki T, et al. The trend of resistance to antibiotics for ocular infection of Staphylococcus aureus, coagulase -negative staphylococci, and Corynebacterium compared with 10-years previous: A retrospective observational study. PLoS ONE. 2018;13(9):e0203705
37. 37. Alibi S, Ferjani A, Boukadida J, Cano ME, Fernández-Martínez M, Martínez-Martínez L, et al. Occurrence of Corynebacterium striatum as an emerging antibiotic-resistant nosocomial pathogen in a Tunisian hospital. Sci Rep. 2017;7(1):1–8.