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Journal Normal Bacteria Conjunctiva and Their Antibiotics PDF
Journal Normal Bacteria Conjunctiva and Their Antibiotics PDF
Journal Normal Bacteria Conjunctiva and Their Antibiotics PDF
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Original Article
Purpose: To evaluate the normal conjunctival flora and included both operated and control eyes.
and to ascertain their sensitivity to antibiotics. Coagulasenegative staphylococcus was isolated in
44eyes (81.5%). Maximum sensitivity was found
Materials and Methods: Prospective study was with vancomycin, gentamycin, chloramphenicol, and
undertaken with 56patients scheduled for cataract ciprofloxacin and maximum resistance with fusidic
surgery. In each of these patients, conjunctival acid, penicillin, and oxacillin.
swab was taken from both eyes before instilling any
antibiotic drops or local anesthetics and were sent for Conclusion: We conclude that coagulasenegative
culture sensitivity by inoculating the samples in blood staphylococcus are the most common bacteria isolated
agar plates. The unoperated eyes served as controls from the conjunctival sac, and vancomycin followed by
for the study. The results were tabulated and analyzed gentamycin and ciprofloxacin are most effective against
by applying confidence intervals at 95% confidence normal conjunctiva l flora, and fusidic acid the most
limits. ineffective of all the antibiotics tested.
Results: Of the 112eyes studied, positive cultures Keywords: Antibiotics, cataract surgery, conjunctival
were obtained from 54eyes (48.3%) preoperatively, flora, sensitivity
Copyright: 2012 Keshav BR and Basu S. 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.
Correspondence:
Dr. Belur R. Keshav, P.O.Box823, pc411, Sur, Oman. Email: keshavraj2000@gmail.com
Keshav and Basu: Normal conjunctival flora and their antibiotic sensitivity
must be done regularly due to the dynamic nature of bacterial staphylococcus, 4eyes (7.4%) grew Streptococcus pneumoniae, and
resistance to antibiotics.[5] 2(3.7%) eyes grew Staphyloccus viridans, Staphylococcus aureus,
S.corynebacterium, S.proteus, and S.enterococci were grown in one
In Oman with a wide prevalence of trachoma in the past, resulting eye (1.8%) each [Table2]. When preoperative and postoperative
in alteration of ocular surface subtly in many individuals and cultures were analyzed and compared, it was found that 11eyes
markedly in some, the conjunctival flora may be different. And as (20.3%) were showing the same growth preand postoperatively,
is wellknown going by the various studies,[38] every region may 44.4% (95% CI: 30.76%57.24%) of eyes operated for cataract
have a different sensitivity pattern. showed growth preoperatively and no growth postoperatively,
and 33.3% (95% CI: 20.46%45.54%) of the unoperated eyes with
This study was undertaken to ascertain the normal conjflora growth preoperatively showed no growth [Table3]. As regards to
in the region and its sensitivity pattern and change following susceptibility pattern in case of all isolates, the organisms showed
preoperative prophylactic antibiotic use. high sensitivity to choramphenicol, 63% (95% CI: 50.125%
88%), gentamycin 74% (95% CI: 62.3%85.7%), ciprofloxacin
72% (95% CI: 60.2%83.98%), and vancomycin 83% (95% CI:
Materials and Methods
72.98%93.02%) and high resistance to penicillin, ampicillin,
fusidic acid, and oxacillin [Table4]. As regards to the sensitivity
A prospective study was conducted with patients who underwent
pattern in case of coagulasenegative staphylococci, the organisms
cataract surgery between February and August 2010. Hundred
were most susceptible to vancomycin, 97.72% (95% CI: 91.96%
and twelve eyes of 56patients admitted for cataract surgery in
102.04%), gentamycin, 86.36% (95% CI: 75.75%96.25%), and
Sur regional hospital, a secondary care center with state of the art
ciprofloxacin 84% (95% CI: 73.17%94.83%) and moderately
laboratory facilities, were enrolled in this study. The fellow eye
susceptible to chloramphenicol 68.1% (95% CI: 54.2%81.78%),
of these patients served as controls. Patients with ocular surface
augmentin 52.27% (95% CI: 37.24%66.76%), oxacillin 50% (95%
disease such as meibomitis, dry eye, and chronic dacryocystitis
CI: 35.23%64.77%), and methicillin 61.36% (95% CI: 49.59%
were excluded from the study. After obtaining consent, conjunctival
75.41%) and least susceptible to fusidic acid (29.5%; Table5).
swab was taken 1day before cataract surgery from both eyes before
Thus, coagulasenegative staphylococci showed maximum
applying any antibiotic or anesthetic drops. Specimen was taken
sensitivity to vancomycin followed closely by gentamycin and
from the inferior conjunctival fornix with sterilized loop without
maximum resistance to fusidic acid.
touching the eyelids. The sample was inoculated aseptically by
Cshaped streaking onto blood agar medium at the bedside. The
plates were then incubated at 37C for 48hours under standard
Discussion
aerobic conditions.[7] Any positive bacterial growth was further
Postoperative endophthalmitis is the most dreaded complication
identified and susceptibility testing done according to Kirby
of cataract surgery and conjunctival flora has been blamed to be
Bauers method using standard CLSI guidelines.[8] Conjunctival
swab was taken from both eyes and processed similarly on the
Table1: The number of eyes with growth and no
first postoperative day. Chloramphenicol eye drops four times a
growth (n=112)
day were instilled into the eyes of patients undergoing surgery
Growth status Number of eyes %
1day preoperatively, and iodine (5050dilution of 10% povidone
No bacterial growth 58 51.7
iodine) wash preoperatively was performed. No medications were
Bacterial growth 54 48.3
applied to the control eyes of these patients either preoperatively
or postoperatively.
Table2: Ocular flora in patients undergoing
Data obtained were subjected to statistical analysis by applying cataract surgery
confidence intervals (CIs) at 95% confidence limits. This study Organism Frequency (n=54) %
was evaluated and approved by the ethics review committee Coagulasenegative staphylococcus 44 81.5
Streptococcus pneumoniae 4 7.4
members of the Ministry of Health in South Sharqiya region
Staphylococcus viridans 2 3.7
Staphylococcus aureus 1 1.8
Results Cornybacterium sp. 1 1.8
Proteus sp 1 1.8
A total of 112eyes of 56patients from whom the conjunctival swabs Enterococci 1 1.8
were taken were analyzed. In this study, 19(33.9%) were males
and 37(66.1%) were females. The age group was 4080years. Table3: Postoperative growth status (n=54)
No bacterial growth was seen 51.7% eyes preoperatively (95%
Eye Same growth, n (%) Negative growth, n (%)
CI: 41.75%61.25%), while 48.3% (95% CI: 38.75%57.25%) Test 4(7.4) 24(44.4)
showed bacterial growth [Table1]. This included both control Control 7(13) 18(33.3)
and operated eyes. Of the 54eyes showing bacterial growth, Total 11(20%) 32(78)
81.5% (95% CI: 71.12%81.84%) grew coagulasenegative *1eye showed a different growth from the preoperative growth
Keshav and Basu: Normal conjunctival flora and their antibiotic sensitivity
the primary and most frequent source of bacteria. So evaluation of bacteria were shown to be isolated in insignificant numbers.
the conjunctival bacterial flora and their sensitivity pattern is of Perioperative conjunctival irrigation with iodine is an effective
utmost importance. In our study, we were able to isolate bacteria in way of reducing bacterial flora. This study may act as a guide to
54eyes (48.3%). In a study by Reza etal.,[5] the percentage isolation choosing antibiotics for preoperative prophylaxis or postoperative
was found to be 52.4%. Another study by Terence etal.[6] showed prophylaxis and treatment.
the isolation was of the order of 80%. In both cases, the inoculation
was in blood agar and in the latter case the lid margin samples were Acknowledgements
also taken which could be the reason for such a high positivity.
We wish to thank the doctors and paramedical staff of ophthalmology
In our study, it is shown that 44% of eyes having growth and microbiology departments of Sur Hospital. We also wish to thank
preoperatively and treated with perioperative iodine Dr.PuneetJainHead, Department of Pathology, for his cooperation.
and chloramphenicol preoperatively showed no growth Last but not the least we are grateful to our executive director for his
cooperation. Finally, we wish to state that the study would not have been
postoperatively, and 33% of the control eyes showing growth
possible without the help of the patients and relatives involved in the
preoperatively and not treated with iodine perioperatively showed
study.
no growth postoperatively. The negative growth postoperatively
in control eyes is difficult to explain. More number of cases
treated with iodine showed negative growth postoperatively.
References
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In conclusion, our study is the first of its kind in Oman showing Cite this article as: Keshav BR, Basu S. Normal conjunctival flora and
nearly 50% positive growth with coagulasepositive staphylococci their antibiotic sensitivity in Omanis undergoing cataract surgery. Oman J
Ophthalmol 2012;5:16-8.
predominating, which was most sensitive to vancomycin followed
Source of Support: Nil, Conflict of Interest: No.
by ciprofloxacin, gentamycin, and chloramphenicol. The other