Chronic bilateral bacterial conjunctivitis caused by multi-resistant Staphyloccocus species in a Mexican province treated with compounded iodine drops
Authors (233 & 238): Miguel Angel Hernandez-Delgado1, Yuridia Garcia-Espindola2, Mélanie Hébert3. 1Instituto Tecnologico y de Estudios Superiores de Monterrey, 2 Universidad Michoacana de San Nicolas de Hidalgo, 3Department of Ophthalmology, Hôpital Saint-Sacrement, CHU de Québec - Université Laval.
Author Disclosures (233 & 238): M.A. Hernandez-Delgado: None. Y. Garcia-Espindola: None. M. Hébert: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Bayer = Research funding Fighting Blindness Canada = Research funding Vision Health Research Network = Research funding.
Abstract Body (233):
Purpose: To report 29 cases of Multiple Drug-Resistant Organisms (MDRO) causing chronic bacterial conjunctivitis in a suburban Mexican province treated with compounded iodine drops.
Study Design: Retrospective cohort study.
Methods: All cases of MDRO that presented to a single clinic from February 2018 to September 2022 were included. MDRO was defined as per the definition of the CDC in which a microorganism is resistant to one or more classes of antimicrobial agents confirmed on an antibiogram. Cases without antibiogram testing were therefore excluded. Statistical analysis was performed for the variables of age, sex, previous use and number of topical antibiotics employed, duration of conjunctivitis in months, patient systemic diseases, BCVA before and after treatment measured in LogMAR, and antibiogram results including species and resistances. Variables with non-normal distribution are presented in medianIQR [Q1, Q3].
Results: A total 29 patients were reported as having MDRO from 2018 to 2022 of which 17 patients (58.6%) were female. Age at presentation was 58 [47, 73] years old. Duration of conjunctivitis was 25 [20, 40] months and at least 1 previous topical antibiotic was used by 18 patients (62%). Among all patients, 7 (24%) had used 2 previous topical antibiotics and 2 (7%) reported using 3 topical antibiotics beforehand. There was an uncontrolled systemic illness at presentation in 12 patients (41%): 9 patients (31%) had uncontrolled type 2 diabetes mellitus, 1 (3.4%) had Sjögren’s syndrome, 1 (3%) had SARS-CoV-2, and 1 (3%) had chronic bronchitis. BCVA at presentation was 0.1 [0, 0.3] and BCVA after treatment was 0.0 [0.0, 0.2]. All cases were identified with a Gram-positive beta-hemolytic Staphylococcus spp. The number of resistances per case was 4 [2, 5] antibiotics. No oral antibiotics were required. All cases were treated with povidone-iodine drops. These cases were successfully treated with compounded iodine 10% drops in a sodium hyaluronate 4% eye drops bottle instilled four times daily over 9 days. In 8 cases (27.5%), additional treatment days were required. All cases resolved in less than 14 days and were confirmed by post-treatment culture.
Conclusions: MDRO is a serious cause of chronic conjunctivitis seen in developing countries. Proper identification and treatment requires cultures with antibiograms and targeted antibiotic therapy if available. In treatment-resistant cases, compounded 10% povidone-iodine drops can be used successfully.
Abstract Body (238):
Purpose: To report the resistance profiles of Multidrug-Resistant Staphylococcus spp. (MDRS) isolates in cases of chronic bacterial conjunctivitis in a Mexican population.
Study Design: Retrospective cohort study.
Methods: All cases of MDRS presenting to a single clinic from February 2018 to September 2022 were included. MDRS was defined as per the definition of the CDC in which a microorganism is resistant to one or more classes of antimicrobial agents confirmed by antibiogram. The following antibiotics were tested: Amikacin, Amoxicillin, Amoxicillin-Clavulanic Acid, Ampicillin, Ampicillin - Sulbactam, Azithromycin, Aztreonam, Cefalotin, Cefepime, Cefotaxime, Ceftazidime, Ceftriaxone, Cefuroxime, Ciprofloxacin, Clindamycin, Chloramphenicol, Dicloxacillin, Doxycycline, Eritromicin, Gentamicin, Imipenem, Levofloxacin, Meticillin, Nalidixic Acid, Oxacillin, Penicillin, Tetracycline, Tobramycin, Trimethoprim-Sulfamethoxazole and Vancomycin. Proportion of resistances by antimicrobial class are presented.
Results: All 29 cases were identified with a Gram-positive beta-hemolytic bacterial MDRS. Further identification by species found 11 (37.9%) cultures with S. epidermidis; 3 (10.3%) with methicillin-resistant S. aureus (MRSA); 3 (10.3%) with S. saprophyticus, and 2 (6.8%) as S. haemolyticus. The remaining 10 cases (34.4%) could only be identified as coagulase negative Staphylococcus spp. There were resistances reported against antibiotic classes as follows: Aminoglycosides in 22 of 40 (55%) (amikacin n=2/8, erythromycin n=5/10, gentamicin n=14/21, tobramycin n=1/1); Beta-lactam antibiotics in 65/128 (51%) (amoxicillin n=1/2, amoxicillin-clavulanic acid n=3/10, ampicillin n=13/15, ampicillin-sulbactam n=4/14, aztreonam n=7/8, cefalotin n=3/5, cefepime n=1/3, cefotaxime n=7/23, ceftazidime n=10/18, cefuroxime n=3/13, dicloxacillin 2/2, methicillin n=3/3, oxacillin n=3/3 and penicillin n=5/9); Carbapenems once (imipenem n=1/19, 5%); Chloramphenicol in 2 of 4 cases (50%); Fluoroquinolones in 11 of 29 (38%) (ciprofloxacin n=8/18, levofloxacin n=3/11); Glycopeptides in 5 of 16 (31%) (vancomycin n=5/16); Lincosamides in 3 of 4 (75%) (clindamycin n=3/4); Macrolides in 2 of 4 (50%) (azithromycin 2/4); Sulfonamides in 9 of 15 (60%) (trimethoprim-sulfamethoxazole n=9/15); Tetracyclines in 2 of 8 (25%) (doxycycline n=1/3 and tetracycline n=1/5).
Conclusions: High number of antibiotic resistances can be found in bacteria causing chronic bilateral conjunctivitis in developing countries. Systematic cultures with antibiogram profiling should be employed to identify the causative agent and direct antibiotic therapy.
