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Stella Chung, Leon Rafailov, Roger Turbin, Paul D Langer; The Microbiologic Profile of Dacryocystitis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3881.
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© ARVO (1962-2015); The Authors (2016-present)
While the pathogens that cause dacryocystitis are similar to those found on the skin and in the respiratory tract, recent studies suggest an increasing incidence of Gram-negative bacteria and methicillin-resistant Staphylococcus aureus in this disease. Since patients with dacryocystitis are often treated empirically without culture data, a changing microbiologic profile will markedly affect the success of oral treatment. To provide current guidelines for the treatment of this common condition, we investigated the microbiology and antibiogram of dacryocystitis seen at our institution.
The charts of all patients presenting with acute and/or chronic dacryocystitis in the inpatient and outpatient settings of University Hospital, Newark, from 2008-2015 were reviewed. Patients who underwent cultures of purulent lacrimal sac contents were included in the study. Patient demographics, culture isolates, and in vitro antimicrobial susceptibility data were collected. Additional sensitivity data were obtained from the Sanford Guide to Antimicrobial Therapy.
A total of 137 patients were included in the study. Of those, 16 (12%) were younger than 18 years old and 121 (88%) were adults. There were 91 females (66%) and 46 males (34%). The age range was 0 to 101 years old, with a mean age of 55.4 years. Many patients suffered more than one episode of dacryocystitis or experienced bilateral disease, yielding more cultures than patients studied. Of 205 samples collected, 49 samples grew no bacteria or only contaminants; the 156 remaining cultures were used for analysis. Staphylococcus aureus was the most commonly isolated organism (46 of 156, 30%) followed by Pseudomonas species (19 of 156, 12%), and P. acnes (15 of 156, 10%). Based on sensitivity data, the two oral antibiotics that would have been most effective in this population, levofloxacin and amoxicillin/clavulanate, would have encountered at least one resistant organism in 31% and 40% of patients, respectively.
The microbiologic spectrum of dacryocystitis is complex and includes many organisms that are resistant to common oral antibiotics. Given the broad range of causative organisms, routine treatment of dacryocystitis with any specific antibiotic may fail in up to one third of patients. Obtaining a culture at the time empiric antibiotic treatment is initiated is strongly recommended when treating patients with dacryocystitis.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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