Original article
Bacteriologic Profile of the Conjunctiva in the Patients with Dry Eye

https://doi.org/10.1016/j.ajo.2008.06.003Get rights and content

Purpose

To assess the conjunctival bacterial profiles in dry eye and their fluoroquinolone susceptibility patterns.

Design

Prospective, observational study.

Methods

Sixty-seven female patients with dry eye (29 with Sjögren syndrome and 38 without Sjögren syndrome) who received artificial tears were enrolled at Osaka University Hospital in Japan. Twenty-three patients received additional topical steroids. Twenty-six puncta were occluded with plugs. Cultures were obtained with conjunctival swabs at the right eye of the subjects. The minimum inhibitory concentrations of isolated strains were determined for the fluoroquinolones (levofloxacin and gatifloxacin). The profiles of conjunctival bacteria of patients with dry eye were compared with those obtained before surgery from 56 female control patients.

Results

Eighty-eight strains were isolated (48 strains of Propionibacterium acnes, 26 coagulase-negative Staphylococcus [CNS] species, six Staphylococcus aureus strains, and eight others). Of the 26 CNS strains, 17 (65.4%) were fluoroquinolone resistant, including four (33.3%) of 12 methicillin-sensitive CNS and 13 (92.9%) of 14 methicillin-resistant CNS. All methicillin-sensitive S. aureus strains and P. acnes strains were sensitive to fluoroquinolones; one methicillin-resistant S. aureus strain was resistant. There was no significant difference in the conjunctival isolation rates between patients with dry eye and controls. However, the dry eye group had a significantly higher incidence of fluoroquinolone-resistant methicillin-sensitive CNS and of fluoroquinolone-resistant methicillin-resistant CNS than controls (P = .018 and P = .024, respectively). There were no significant differences in bacteria isolated between subgroups with or without punctal plugs and with or without topical steroids.

Conclusions

Patients with dry eye are more likely to have fluoroquinolone-resistant conjunctival bacteria than controls. These results may help prevent infectious keratoconjunctivitis in patients with dry eye.

Section snippets

Patients

Sixty-seven eyes of 67 female patients with dry eye (age range, 26 to 80 years; mean age, 60.3 years) whose dry eye treatments, for example, eye drops and punctual occlusion, had not changed within the previous three months were enrolled from September 1, 2005 through February 25, 2006 at the Department of Ophthalmology of Osaka University Hospital. Of 67 patients, 29 were patients with Sjögren syndrome and 38 were without Sjögren syndrome. Dry eye was diagnosed by both positive tear test

Results

Of the 67 eyes, 63 eyes (94.0%) had positive bacterial growth. A total of 88 bacterial strains were isolated from the 63 eyes. Of the 88 bacterial strains, 48 (54.5%) strains of Propionibacterium acnes, 26 (29.5%) with coagulase-negative Staphylococcus (CNS) species, including 12 methicillin-sensitive (MS) CNS and 14 methicillin-resistant (MR) CNS, six (6.8%) Staphylococcus aureus, including five MS S. aureus and one MR S. aureus, and eight (9.1%) others (three streptococci, two enterococci,

Discussion

In the current study, CNS was the major aerobic conjunctival bacteria isolated from patients with dry eye, and more than half of CNS strains isolated (14/26; 53.8%) were MR, which was similar to data from preoperative conjunctiva samples previously reported.24 Interestingly, we also observed that the dry eye group had a significantly higher incidence of fluoroquinolone-resistant MS CNS and MR CNS strains than control subjects. There were no significant differences in the incidences of these

Yuichi Hori, MD, is an Assistant Professor at the Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan. He received his medical degree from Osaka University Medial School in 1995. Dr Hori completed a postdoctoral research fellowship at The Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, from 2001 to 2004. His major scientific interests include molecular biology of the ocular surface, dry eye, and corneal transplantation.

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Yuichi Hori, MD, is an Assistant Professor at the Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan. He received his medical degree from Osaka University Medial School in 1995. Dr Hori completed a postdoctoral research fellowship at The Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, from 2001 to 2004. His major scientific interests include molecular biology of the ocular surface, dry eye, and corneal transplantation.

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