English

Abstract

BACKGROUND: Dacryocystitis acute or chronic poses a constant threat to cornea and orbital soft tissue if neglected revealing the importance of the condition. Infection with microbes in these patients can cause severe morbidity. Hence it is important to know the pathogen wise in management of the condition. Our study was determined to know the bacterial and fungal etiology of both acute and chronic dacryocystitis and their invitro antibacterial susceptibility and resistance to commonly used antibacterial agents. METHODS: This hospital based study was conducted during March 2011 to March 2013. Patients with suffering with acute and chronic dacrocystitis were included in the study. Specimens were collected from these patients, processing, isolation, identification and antibiogram of the isolates were done as per standard procedures. RESULTS: A total of 298 patients were included in the study based upon the inclusion criteria. Out of 298 patients 126(42.29%) presented with acute dacryocystitis and 172(57.71%) were with chronic dacryocystitis. Single eye involvement was noticed in 184 (61.75%) cases and 114 (38.25%) presented with involvement of both eyes. Out of 298 cases pure growth was seen in 255(85.57%) and 43(14.43%) yielded no growth on culture. On observation more percentage of culture positivity was noticed in chronic cases (164 of 172, 95.34%) and less in acute cases (91 of 126, 72.23%) and the difference was also statistically significant. Single isolate was found in 218 cases, two/three isolates were recovered from 37 cases. All cases of polymicrobial growth were observed in chronic dacryocystitis. Staphylococcus aureus as the most common gram positive pathogen (43/77, 55.84% in acute, 34/77, 44.16% in chronic dacryocystitis) followed by Staphylococcus epidermidis (38/64, 59.37% in acute, 26/64, 40.63% in chronic dacryocystitis), Streptococcus pneumoniae(10/12, 83.34% in acute, 2/12, 16.67% in chronic dacryocystitis) and least Micrococcus sp (6/6,100% in acute dacryocystitis). Pseudomonas aeruginosa was the common pathogen (14/67, 20.9% in acute, 53/67, 79.1% in chronic dacryocystitis) followed by Escherichia coli (11/53, 20.75% in acute, 42/53, 79.24% in chronic dacryocystitis), Klebsiella pneumonia (4/22,18.18% in acute, 18/22, 81.82% in chronic dacryocystitis) and last Haemophilus influenza (2/11, 18.18% in acute, 9/11, 81.82% in chronic dacryocystitis). Candida albicans was isolated from two cases of chronic Dacryocystitis. Analysis of the antibiotic sensitivity clearly indicated amikacin as choice of drug against all common pathogens except Streptococcus pneumoniae. In case of Streptococcus pneumoniae Cloxacillin still remains as a good choice. CONCLUSION: We highlighted the spectrum of pathogens in acute and chronic dacrocystitis. Our study indicates that Staphylococcus spp as the most common pathogen followed by Pseudomonas aeruginosa in dacryocystitis. Tobramycin, Amikacin, Bacitracin as suitable therapeutic options in both acute and chronic dacryocystitis. Bacterial species isolated from chronic dacryocystitis shows more resistance than one from acute cases. The present study may help the