Conjunctival Cultures Research Articles

Prospective Randomized Comparison of 2 Different Methods of 5% Povidone-Iodine Applications for Anterior Segment Intraocular Surgery

To determine the efficacy of reducing conjunctival bacteria flora with 2 different regimens of 5% povidone-iodine application: 2 drops on the conjunctiva cul-de-sac vs a 10-mL conjunctival irrigation of the fornices. In this prospective controlled trial, 200 eyes undergoing anterior segment intraocular surgery were randomized to control and study groups. All patients from both groups received topical ofloxacin and a povidone-iodine scrub of the periorbital area before the surgical procedure. The eyes in the control group received 2 drops of povidone-iodine on the conjunctiva preoperatively, whereas eyes in the study group had irrigation of the fornices with 10 mL of povidone-iodine. Conjunctival cultures were obtained at 4 separate time points before and after surgery. Twenty (26%) of 78 eyes in the study group had positive conjunctival cultures immediately prior to surgery compared with 40 (43%) of 94 eyes in the control group (P = .02). At the conclusion of the surgery, 14 (18%) of 78 eyes and 30 (32%) of 94 eyes had positive cultures in the study and control groups, respectively (P = .05). Irrigation of the fornices with 5% povidone-iodine was associated with significantly fewer positive conjunctival cultures at the time of surgery compared with the application of 2 drops on the conjunctiva.

Plasminogen activator inhibitor type 2 (PAI-2) is present in normal human conjunctiva

The purpose was to characterize plasminogen activator inhibitor type 2 (PAI-2) expression in normal human conjunctiva in vivo and in vitro. PAI-2 antigen was assayed by immunostaining and immunoblotting of extracts from normal human conjunctival epithelial lysates and conditioned media (CM) of cultured human conjunctival keratinocytes. Immunostaining of normal human conjunctival epithelia revealed that PAI-2 was found consistently in the superficial keratinocytes and, in some biopsies, also in the lower keratinocyte layers. In all cases, PAI-2 was concentrated around the cell periphery. In extracts of conjunctival epithelia and cultured conjunctival keratinocytes, PAI-2 had an apparent molecular weight of 45 kDa, consistent with the non-glycosylated form. The majority of PAI-2, approximately 90%, was cell associated, however, a small percentage of PAI-2 was released into the CM in a linear manner with time. PAI-2 in the conditioned medium had a higher molecular weight, consistent with a glycosylated form. Conjunctival PAI-2 was active, as shown by its ability to complex with a target enzyme, urokinase plasminogen activator (uPA). Although PAI-2 was detectable both in monolayer (i.e., relatively undifferentiated) conjunctival keratinocyte cultures as well as in stratified (i.e., more differentiated) cultures, steady state levels of PAI-2 were greater in the latter. PAI-2 is constitutively expressed by normal human conjunctival epithelial cells. The expression of PAI-2 throughout all epithelial layers in some biopsies of conjunctiva in vivo contrasts with the previously established distribution of PAI-2 in corneal epithelia, where it is present exclusively in the most superficial (i.e. most highly differentiated) cells. The role of PAI-2 in either tissue is unclear. However, we speculate that its distinct distribution in conjunctival versus corneal epithelia underscores inherent differences between these tissues, and may reflect specific functions of this proteinase inhibitor in both conjunctival and corneal epithelial cells.

Conjunctival Flora in Patients with Human Immunodeficiency Virus Infection

Purpose: To compare the conjunctival flora of human immunodeficiency virus (HIV)-positive and HIV-negative patients. Also, to assess the prophylactic effect of oral clarithromycin against Mycobacterium avium complex on the conjunctival flora of HIV-positive patients. Methods: Ninety-four eyes of 47 HIV-positive patients and 122 eyes of 61 control patients were examined. All participants had a detailed anterior segment examination, including conjunctival cultures and laboratory blood tests. Culture results for different organisms were evaluated by chi-square analysis between the groups. The effect of systemic antibiotic treatment on the conjunctival flora of patients with HIV infection was evaluated by chi-square analysis. Results: Bacterial organisms in the conjunctival sac were detected in four out of 28 (14.3%) eyes of HIV-positive patients treated with systemic clarithromycin and in 32 out of 66 (48.5%) eyes of HIV-positive patients without systemic clarithromycin treatment (p < 0.01). The CD4-positive T-cell counts in these groups were 158/μl and 416/μl, respectively (p < 0.01). Bacterial organisms were also detected in 46 of 122 (37.7%) control eyes. No difference was observed in the types and proportions of organisms isolated from the conjunctiva between HIV-positive patients without systemic clarithromycin treatment and controls. Conclusion: There was no difference between the conjunctival flora of HIV-negative and HIV-positive patients. Systemic clarithromycin treatment decreased the conjunctival flora of HIV patients, including those who had a CD4 count that was less than 50/μl.

Comparison of Preoperative Conjunctival Bacterial Flora in Patients Undergoing Glaucoma or Cataract Surgery

To assess differences in conjunctival bacterial flora between patients undergoing glaucoma and cataract surgery. A prospective study comparing conjunctival bacterial cultures obtained from 339 patients undergoing either cataract (n = 258) or glaucoma (n = 81) surgery. All cultures were acquired during the preoperative visit, approximately three to seven days prior to surgery. The culture samples were inoculated onto blood and chocolate agar, as well as blood culture broth media. All bacterial isolates were identified and statistical analyses were performed to determine if there were differences in flora between the eyes undergoing cataract versus glaucoma surgery. Two hundred fifteen of 258 eyes (83%) undergoing cataract surgery were found to have positive bacterial growth, compared with 62 of 81 eyes (77%) of those undergoing glaucoma surgery (P = 0.2246). Coagulase-negative Staphylococci, the most common bacterial isolate, was cultured from 167 eyes (65%) in the cataract group and 42 (52%) in the glaucoma group (P = 0.0514). Among all bacterial isolates, only Corynebacterium species was found to be statistically different between the two patient groups with 92 (36%) and 11 (14%) eyes testing positive in the cataract and glaucoma groups, respectively (P = 0.0003). There was no statistically significant difference in the proportion of conjunctival culture samples testing positive for bacterial growth in eyes undergoing glaucoma surgery compared with those undergoing cataract surgery. Glaucoma medications, or their preservatives, do not appear to significantly alter conjunctival flora. Techniques used for endophthalmitis prophylaxis prior to cataract surgery are likely appropriate for glaucoma surgery as well.

Microbiota bacteriana da conjuntiva de doadores de córnea

PURPOSE: To identify and qualify bacterial organisms in conjunctival tissue of donor corneas. To correlate the frequency of positive cultures with donor age, cause of death, and time from death to collection of conjunctival samples. To investigate bacterial susceptibility to specific antibiotics. METHODS: Conjunctival samples obtained from the inferior conjunctival fornix of 242 eyes of cornea donors were collected between January and March, 1994. The samples were transferred to Stuart´s medium and then inoculated into blood, acid blood, chocolate, McConkey agars, and thioglycolate broth. Donor age, time and cause of death were recorded. Bacterial susceptibility to antibiotics was tested using the diffusion method on agar modified by Kirby and Bauer. Statistical analysis was done using the chi-square, Fisher's exact and Mann-Whitney tests. RESULTS: Microorganisms were identified in 91.7% of the samples. The most frequently isolated microorganism was coagulase-negative Staphylococcus (27.3%). Time from death to collection of the conjunctival sample was on the average 4.2 hours. The most frequent cause of death was cardiovascular disease (26.4%). The median donor age was 62 years. No significant correlation between positive cultures and the investigated variables was found. Vancomycin inhibited bacterial growth in 100% of Gram-positive microorganisms. The sensitivity of Gram-negative bacteria to gentamicin ranged from 36.7 to 92.3%. CONCLUSION: The frequency of positive conjunctival cultures of donor corneas was 91.7%. No significant statistical difference was found between positive cultures and the investigated parameters. Vancomycin inhibited the growth of Gram-positive bacteria in 100% of the cases and the sensitivity of Gram-negative bacteria to gentamicin varied.

Características laboratoriais das ceratites e conjuntivites causadas por Streptococcus sp

OBJETIVOS: Analisar os resultados laboratoriais de conjuntivites e ceratites com cultura positiva para Streptococcus sp, avaliando a incidencia das diferentes especies e os dados dos antibiogramas. METODOS: Estudo retrospectivo de revisao de prontuarios de pacientes encaminhados ao laboratorio de Doencas Externas do Departamento de Oftalmologia da UNIFESP com resultado de cultivo bacteriano positivo de cornea ou conjuntiva e com identificacao de alguma cepa do genero Streptococcus sp, no periodo de janeiro de 1995 a dezembro de 2001. Analisou-se idade do paciente, especie de Streptococcus e os testes de sensibilidade aos seguintes antibioticos: cefalotina, amicacina, gentamicina, tobramicina, ciprofloxacina, lomefloxacina, ofloxacina, norfloxacina e vancomicina. RESULTADOS: As especies mais encontradas foram Streptococcus pneumoniae e Streptococcus viridans. Com relacao aos antibioticos, a sensibilidade foi maior a cefalotina, as quinolonas e a vancomicina. CONCLUSOES: Considerando-se os antibioticos topicos comercialmente disponiveis, as quinolonas apresentam melhor espectro de acao quando comparadas aos aminoglicosidios.

Chitosan nanoparticles as new ocular drug delivery systems: in vitro stability, in vivo fate, and cellular toxicity.

To assess the potential of chitosan (CS) nanoparticles for ocular drug delivery by investigating their interaction with the ocular mucosa in vivo and also their toxicity in conjunctival cell cultures. Fluorescent (CS-fl) nanoparticles were prepared by ionotropic gelation. The stability of the particles in the presence of lysozyme was investigated by determining the size and their interaction with mucin, by measuring the viscosity of the mucin dispersion. The in vivo interaction of CS-fl nanoparticles with the rabbit cornea and conjunctiva was analyzed by spectrofluorimetry and confocal microscopy. Their potential toxicity was assessed in a human conjunctival cell line by determining cell survival and viability. CS-fl nanoparticles were stable upon incubation with lysozyme and did not affect the viscosity of a mucin dispersion. In vivo studies showed that the amounts of CS-fl in cornea and conjunctiva were significantly higher for CS-fl nanoparticles than for a control CS-fl solution, these amounts being fairly constant for up to 24 h. Confocal studies suggest that nanoparticles penetrate into the corneal and conjunctival epithelia. Cell survival at 24 h after incubation with CS nanoparticles was high and the viability of the recovered cells was near 100%. CS nanoparticles are promising vehicles for ocular drug delivery.

Efficacy and safety of 0.5% levofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis in pediatric patients*1

A randomized, double-masked, multicenter, parallel study was conducted to compare the efficacy and safety of 0.5% levofloxacin ophthalmic solution (Quixin; Santen, Napa, CA) with 0.3% ofloxacin (Ocuflox; Allergan Inc, Irvine, CA) and placebo for the treatment of pediatric bacterial conjunctivitis. One hundred and sixty seven patients between the age of 1 and 16 years with a clinical diagnosis of bacterial conjunctivitis were randomized for treatment with 0.5% levofloxacin, ofloxacin, or placebo. Eyedrops were instilled every 2 hours on days 1 and 2 and every 4 hours on days 3 through 5. Conjunctival cultures were obtained on day 1 (baseline), days 3 to 5 (interim), and days 6 to 10 (final). Ocular cardinal signs (conjunctival discharge, bulbar conjunctival injection, palpebral conjunctival injection) and symptoms (burning and stinging, tearing, itching, foreign body sensation, photophobia, and discomfort) were graded using a four-point scale. Ocular safety was determined by evaluating the incidence and severity of adverse events and significant changes from baseline in biomicroscopy, ocular symptoms, visual acuity, and ophthalmoscopy. At endpoint, 0.5% levofloxacin treatment demonstrated greater microbial eradication rates compared with 0.3% ofloxacin or placebo. In children age 2 to 11 years this finding was statistically significant in favor of 0.5% levofloxacin versus ofloxacin (P < .032) and placebo (P < .001). In the same age range, the clinical cure rate of 0.5% levofloxacin was statistically superior to placebo (P < .034), and similar to that of 0.3% ofloxacin. Resolution of ocular signs and symptoms was consistently higher with 0.5% levofloxacin compared to placebo and similar to that achieved with 0.3% ofloxacin. All three treatments were safe and well tolerated. The conclusion is that 0.5% levofloxacin is safe and effective in the treatment of pediatric bacterial conjunctivitis.—Michael D. Wagoner

Efficacy and safety of 0.5% levofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis in pediatric patients

A randomized, double-masked, multicenter, parallel study was conducted to compare the efficacy and safety of 0.5% levofloxacin ophthalmic solution (Quixin; Santen, Napa, CA) with 0.3% ofloxacin (Ocuflox; Allergan Inc, Irvine, CA) and placebo for the treatment of pediatric bacterial conjunctivitis. One hundred and sixty seven patients between the age of 1 and 16 years with a clinical diagnosis of bacterial conjunctivitis were randomized for treatment with 0.5% levofloxacin, ofloxacin, or placebo. Eyedrops were instilled every 2 hours on days 1 and 2 and every 4 hours on days 3 through 5. Conjunctival cultures were obtained on day 1 (baseline), days 3 to 5 (interim), and days 6 to 10 (final). Ocular cardinal signs (conjunctival discharge, bulbar conjunctival injection, palpebral conjunctival injection) and symptoms (burning and stinging, tearing, itching, foreign body sensation, photophobia, and discomfort) were graded using a four-point scale. Ocular safety was determined by evaluating the incidence and severity of adverse events and significant changes from baseline in biomicroscopy, ocular symptoms, visual acuity, and ophthalmoscopy. At endpoint, 0.5% levofloxacin treatment demonstrated greater microbial eradication rates compared with 0.3% ofloxacin or placebo. In children age 2 to 11 years this finding was statistically significant in favor of 0.5% levofloxacin versus ofloxacin (P < .032) and placebo (P < .001). In the same age range, the clinical cure rate of 0.5% levofloxacin was statistically superior to placebo (P < .034), and similar to that of 0.3% ofloxacin. Resolution of ocular signs and symptoms was consistently higher with 0.5% levofloxacin compared to placebo and similar to that achieved with 0.3% ofloxacin. All three treatments were safe and well tolerated. The conclusion is that 0.5% levofloxacin is safe and effective in the treatment of pediatric bacterial conjunctivitis.—Michael D. Wagoner

Conjunctival colonization of infants hospitalized in a neonatal intensive care unit: a longitudinal analysis.

To determine the frequency of conjunctival colonization, identify the colonizing flora, and correlate culture results with physical findings in infants in a NICU. Surveillance study. Level III NICU of a large university teaching hospital. All infants admitted for longer than 24 hours during a 26-week period. Weekly bacterial conjunctival cultures were performed for all infants. The conjunctival appearance at the time of culture was recorded. The frequency, identity, and correlation of culture results with physical findings were determined. One thousand ninety-one cultures were performed for 319 infants: 133 (42%) had no positive cultures and 186 (58%) had at least one positive culture. Culture analysis revealed that 411 (38%) were positive and yielded 494 isolates comprising more than 18 bacterial species. Bacteria most commonly isolated included coagulase-negative Staphylococcus (CoNS) (75%), viridans group streptococci (8.7%), Staphylococcus aureus (3.8%), Enterococcus species (2.6%), and Serratia marcescens (2.4%). The frequency of non-CoNS isolates increased significantly during the first 6 weeks of patient hospital stay (6% [1 to 3 weeks] to 12% [4 to 6 weeks]; P = .01), with an increasing trend to 15 weeks (18%). Correlation of bacteriologic results with physical findings demonstrated that infants with non-CoNS isolates exhibited conjunctival edema, erythema, or exudates more frequently than did infants with CoNS alone (30% vs 13%; P = .0001). Conjunctival colonization was common among infants in a NICU. Prolonged hospitalization predisposes to colonization with potentially pathogenic organisms. Physical findings were more likely in patients with non-CoNS conjunctival isolates.

Ocular permeability screening of dexamethasone esters through combined cellular and tissue systems.

Dexamethasone transport across ocular epithelium was evaluated by means of permeability studies on a series of ester prodrugs with the aim of identifying the most promising candidates for the treatment of the ocular surface. Organotypic conjunctival bovine epithelial cell cultures were assumed representative of an average ocular epithelium and used to describe the mechanism of permeation. Permeability coefficients were also determined in excised rabbit corneas set up and in vivo pharmacokinetic experiments. All dexamethasone esters permeated through the transcellular route and their permeability coefficient rose with the increase of the molecules lipophilicity until a maximum was reached in correspondence of dexamethasone butyrate (Log P = 3.95). It was found that esters hydrolysis occurring in various extent along the transport process, affected the overall permeability rate. There was evidence that the permeation process can be confined at the ocular epithelium layer if the ester is highly hydrophobic and not susceptible of fast hydrolysis.

Feasibility of an antiviral clinical trial requiring cross-country shipment of conjunctival adenovirus cultures and recovery of infectious virus

Purpose. Accurate and timely laboratory diagnosis of adenovirus from conjunctival cultures is essential to ensure appropriate enrollment, and detection of residual infectious virus is essential to evaluate antiviral efficacy in any multicenter national clinical trial. As part of a feasibility study, we investigated those variables that might affect the successful recovery of infectious adenovirus from patient conjunctival cultures after cross-country shipment.Materials and methods. Simulated adenovirus conjunctival cultures were prepared in viral transport media to evaluate the effect of four variables (adenovirus serotype, initial concentration, initial storage temperature [−20°C, 0°C, 20°C], and preshipment storage times [1–5 days]) on the recovery of infectious adenovirus by a central laboratory in St. Paul, MN, following air shipment from Pittsburgh, PA. Upon arrival, the internal temperatures of the containers were recorded, and the samples were cultured on A549 cells using standard tube and/or shell vial culture.Results. Overall, adenovirus was recovered in 352/354 (99.4%) of the samples when the initial titer was greater than 1.0 PFU/ml. Adenovirus serotype, initial storage temperature, and preshipment storage times had no adverse effect on virus recovery.Conclusions. Simulated conjunctival samples could successfully be shipped cross-country at ambient temperatures to a commercial laboratory for adenovirus isolation by culture. Having demonstrated feasibility, a clinical trial was subsequently carried out that confirmed the ease of shipment and recovery of infectious adenovirus from conjunctival cultures.

Efficacy and safety of 0.5% levofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis in pediatric patients

Purpose To compare the efficacy and safety of 0.5% levofloxacin ophthalmic solution (Quixin; Santen, Napa, CA) with 0.3% ofloxacin (Ocuflox; Allergan Inc., Irvine, CA) and placebo for the treatment of pediatric bacterial conjunctivitis. Methods This study was a subset analysis of 167 pediatric patients (age range, 1 to 16 years) from two randomized, double-masked, multicenter, parallel group studies. Eye drops were instilled every 2 hours on days 1 and 2 and every 4 hours on days 3 through 5. Ocular signs and symptoms were noted, and conjunctival cultures were obtained on day 1 (baseline), days 3 to 5 (interim), and days 6 to 10 (final). Endpoint was defined as the last evaluable observation. Microbial and clinical outcomes were based on culture results and cardinal signs, respectively. Results At endpoint (mean of 6.5 days for 118 evaluable patients), 0.5% levofloxacin treatment demonstrated greater microbial eradication rates (percentage of patients with absence of causative organisms cultured at baseline) compared with 0.3% ofloxacin or placebo. In children age 2 to 11 years, this finding was statistically significant in favor of 0.5% levofloxacin (87% vs 62% with 0.3% ofloxacin [ P ≤ .032] and 88% vs 24% with placebo [ P < .001]). No significant differences between treatment groups in microbial eradication rates were noted in other age subgroups. Conclusions After 5 days of therapy, 0.5% levofloxacin ophthalmic solution was found to be safe and effective in treating pediatric bacterial conjunctivitis. Treatment with 0.5% levofloxacin achieved microbial eradication rates in children that were statistically superior to those attained with 0.3% ofloxacin or placebo.

Antibiotic resistance patterns of ocular bacterial flora: A prospective study of patients undergoing anterior segment surgery

Purpose To determine the antibiotic susceptibility patterns of conjunctival bacterial flora isolated preoperatively from patients undergoing anterior segment surgery. Design Prospective observational study. Participants One hundred fifty-six eyes from 139 patients scheduled for anterior segment surgery were enrolled over a 6-month period from August 2001 to February 2002. Methods Conjunctival cultures were obtained on the day of surgery before povidone-iodine or antibiotic application. Main outcome measures Bacterial isolates were identified and tested for antibiotic susceptibility using the Kirby-Bauer disc-diffusion technique. Results Among the 156 eyes studied, 36 were from patients who had undergone either bilateral surgery or more than one surgery in the same eye. Only the first eyes of the 120 patients that underwent initial ocular surgery were included in our analysis. Of these 120 eyes, 21 (18%) showed no bacterial growth. Of the 143 bacterial strains isolated from the remaining 99 eyes, 112 (78%) were coagulase-negative staphylococci (CNS). Among the CNS, greater than 90% were susceptible to cefotaxime, levofloxacin, imipenem, meropenem, vancomycin, and each of the aminoglycosides except neomycin. Between 70% and 90% of the CNS were susceptible to cefazolin, neomycin, ciprofloxacin, ofloxacin, norfloxacin, and chloramphenicol. Less than 70% of the isolated CNS were sensitive to the penicillin analogues, ceftazidime, erythromycin, and tetracycline. Conclusions Preoperative conjunctival isolates of CNS seem to be most sensitive to vancomycin, the aminoglycosides (except neomycin), and levofloxacin.

The immunomodulatory role of human conjunctival epithelial cells.

To characterize phenotypically the primary epithelial cells obtained from normal bulbar conjunctival biopsy specimens and a human conjunctival epithelial cell line (Wong-Kilbourne derivative of Chang conjunctiva; ChWK) with regard to their immunostimulatory function. The effects on expression of HLA-DR and costimulatory molecules (CD80, CD86, ICAM-1, and CD40) on normal conjunctival epithelial cells and ChWK treated with various cytokines (IFN-gamma, TNF-alpha, IL-4, and IL-13) were determined using flow cytometry and confocal microscopy. Epithelial cells were successfully grown from conjunctival explants and cultures passaged three times, while retaining their cell surface markers. At least 97% of primary epithelial cells (n = 10) and more than 96% of ChWK cells (n = 10) were cytokeratin positive by flow cytometry and immunocytochemistry and demonstrated epithelial cell morphology. Both primary conjunctival epithelial cells and ChWK had a low basal expression of HLA-DR and ICAM-1, and both were upregulated by IFN-gamma. For ChWK cells, CD80 and CD86 were constitutively expressed at low levels. CD80 was significantly upregulated after IFN-gamma treatment (P = 0.043), whereas IL-4 induced a significant upregulation of CD86 (P = 0.039). Treatment with IL-13 and TNF-alpha did not induce significant effects. The ability of conjunctival epithelial cells to express costimulatory molecules suggests a proinflammatory role for conjunctival epithelial cells.

Risk factors for antibiotic-resistant conjunctival bacterial flora in patients undergoing intraocular surgery.

The purpose of this study was to determine if patients with certain risk factors are more likely to harbor conjunctival bacterial flora resistant to multiple antibiotics. In this prospective study, detailed medical history and slit-lamp examination were performed on all patients prior to intraocular surgery. Patients with local risk factors were defined as those with chronic blepharitis, conjunctivitis or discharge. Those with systemic risk factors were patients with diabetes, autoimmune, immunodeficient or skin disorders, asthma and those taking immunosuppressant medications. Conjunctival cultures were obtained prior to preoperative antibiotics and povidone-iodine. Bacteria isolated were identified and antibiotic susceptibility was determined. Bacteria resistant to five or more antibiotics were defined as multi-resistant (MR). Among the 207 patients enrolled in the study, 73 patients had local risk factors. Of these patients, 32 patients (44%) carried MR organisms, compared to 32 of the 134 patients (24%) without local risk factors (P=0.0049). Thirty-two of 71 patients (45%) with systemic risk factors harbored MR organisms, compared to 32 of 136 patients (24%) without systemic risk factors (P=0.0025). Seventeen of 93 patients (18%) who had neither local nor systemic risk factors had MR organisms on their conjunctiva. In contrast, 17 of the 30 patients (57%) with both local and systemic risk factors (57%) carried MR bacteria (P=0.0001). Patients with local and/or systemic risk factors are more likely to harbor MR organisms. This may be one mechanism for the reported increased risk of postoperative endophthalmitis in this group of patients.

An outbreak of conjunctivitis caused by multiresistant Pseudomonas aeruginosa in a Brazilian newborn intensive care unit.

We report an outbreak of conjunctivitis due to Pseudomonas aeruginosa involving seven infants admitted in the Neonatal Intensive Care Unit (NICU) of the Uberlândial Federal University Hospital between March and September 2001. Three infants developed systemic complications (01 sepsis and 02 pneumonias). Ten isolates were obtained from conjunctival cultures and all were resistant to ceftazidime and aminoglycosides. Fast identification of the organism and treatment with imipenem were important in containing the outbreak of P. aeruginosa.

Pneumococcal Conjunctivitis at an Elementary School—Maine, September 20–December 6, 2002

On October 18, 2002, the nurse at an elementary school in Westbrook, Maine, notified the Maine Bureau of Health (MBOH) of an increase in the number of students with conjunctivitis. During September 23-October 18, a total of 31 students in kindergarten and in first and second grades either were reported by parents to the nurse as having conjunctivitis or had conjunctivitis diagnosed by the nurse at school. Conjunctival swab cultures from five (38%) of the 13 students who were tested initially grew Streptococcus pneumoniae. This report documents additional cases in the community and summarizes preliminary results of the investigation of this outbreak, which indicated that the outbreak was caused by the same nontypeable strain of pneumococcus that caused an outbreak of conjunctivitis among college students in New Hampshire during January-March 2002. This is the first time that this strain has been reported as the cause of a conjunctivitis outbreak among schoolchildren. Health-care providers and public health officials should be aware that nontypeable S. pneumoniae can cause outbreaks of conjunctivitis in school-age children and college students; outbreaks should be reported to state health departments and CDC.

A phase III clinical trial of 0.5% levofloxacin ophthalmic solution versus 0.3% ofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis

Objective To compare the efficacy and safety of 0.5% levofloxacin ophthalmic solution (QUIXIN) with 0.3% ofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis. Design Prospective, randomized, active-controlled, double-masked, multicenter study. Participants Four hundred twenty-three patients with a clinical diagnosis of bacterial conjunctivitis were enrolled. Methods Patients were randomly assigned to receive either 0.5% levofloxacin (n = 211) or 0.3% ofloxacin (n = 212) for 5 days (every 2 hours on days 1 and 2 and every 4 hours on days 3–5). Conjunctival cultures were obtained, and ocular signs and symptoms were evaluated on day 1 (baseline), days 3 to 5 (interim), and days 6 to 10 (final). End point was defined as the last evaluable observation. Main outcome measures Primary microbial and clinical outcomes were based on culture results and resolution of cardinal signs, respectively. Secondary efficacy assessments included evaluations of ocular signs and symptoms. Results Two hundred eight patients (levofloxacin, n = 109; ofloxacin, n = 99) were evaluated for efficacy. Microbial eradication rates were significantly greater in the 0.5% levofloxacin treatment group compared with the 0.3% ofloxacin group at both the final visit (89% vs. 80%, P = 0.034) and at end point (90% vs. 81%; P = 0.038). Treatment with 0.5% levofloxacin was significantly more effective in resolving photophobia than was 0.3% ofloxacin treatment (94% vs. 73%, P = 0.006). Both study medications were well tolerated, with a low incidence of adverse events. Conclusions Although clinical cure rates in the 0.5% levofloxacin and 0.3% ofloxacin treatment groups were similar, a 5-day treatment regimen with 0.5% levofloxacin achieved microbial eradication rates that were statistically superior to those attained with 0.3% ofloxacin. Despite the higher concentration of active drug in 0.5% levofloxacin versus 0.3% ofloxacin, there was no difference between treatment groups in the incidence of treatment-related adverse events.

Tear and mucus eotaxin-1 and eotaxin-2 in allergic keratoconjunctivitis

Objective Eotaxin-1 and eotaxin-2 are potent eosinophil chemotactic and activating peptides that may be implicated in the pathogenesis of the chronic allergic eye diseases vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC). The purpose of this study was to measure these chemokines in tear and mucus samples of active-disease patients and in vitro cultured conjunctival epithelial cells and fibroblasts. Design Comparative, observational case series and in vitro study. Participants Sixteen patients with clinically active and untreated VKC or AKC, six age-matched control patients, and five nonactive seasonal allergic conjunctivitis patients. Methods Tears were collected from the active VKC and AKC patients, and from the normal patients. Mucus was collected from six of these VKC patients. Tears were also collected from an additional five allergic patients after obtaining a positive reaction to conjunctival allergen challenge. Conjunctival epithelial cell and conjunctival fibroblast cultures were exposed to interleukin (IL)-4, IL-13, and tumor necrosis factor-α (TNF-α), or to combinations of these cytokines. Main outcome measures Levels of eotaxin-1 and eotaxin-2 in tears, mucus, and culture medium. Results High levels of eotaxin-1 and eotaxin-2 were found in mucus of VKC patients, whereas only eotaxin-2 was found to have increased significantly in tears of VKC and AKC patients compared with those of normal patients. Mucus contained higher levels of chemokines than did tears. Both tear eotaxin-1 and eotaxin-2 were correlated significantly with the percent of eosinophils in tear fluid. Eotaxin-1 also was correlated significantly with the sum clinical score and corneal involvement in VKC patients. Conjunctival epithelial cells in culture did not produce eotaxin-1 or eotaxin-2, either at baseline or after cytokine exposure. Conjunctival fibroblasts produced eotaxin-1 only after exposure to IL-4, TNF-α, and the combination of IL-4 plus TNF-α or IL-13 plus TNF-α. Conclusions Eotaxin-1 and eotaxin-2 are implicated in eosinophil recruitment and in the pathogenesis of VKC and AKC. Cytokine-stimulated conjunctival fibroblasts may be one source of eotaxin-1 in severely allergic tissues.