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Peter Belin, Darlene Miller, Ajay Kuriyan, Harry Flynn; The Effects of Using Steroid or Combination Antibiotic/Steroid Drops on Ocular Culture Results. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2888.
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To report the results of ocular cultures from patients using steroid or combination antibiotic/steroid drops.
This study is a non-comparative consecutive case series. Microbiology laboratory data was analyzed to identify all positive ocular cultures from patients using steroid and combination antibiotic/steroid drops from 11/30/11 to 11/30/12.
50 patients on either steroid or combination antibiotic/steroid drops had ocular cultures. Positive external or intraocular cultures were identified in 36 of the 50 patients. The culture sites included corneal scrapping (58%), conjunctiva (18%), vitreous (8%), anterior chamber (6%), lid (6%), socket (2%), and contact lens (2%). Overall, 38 individual organisms were identified comprising 20 different species. The following gram-positive organisms comprised 20 of 38 (53%) isolates: coagulase negative Staphylococcus (CNS, 28.9%), S. aureus (10.5%), Streptococcus pneumonia (5.3%), S. sanguinis (2.6%), Diphtheroids (2.6%), and Bacillus cereus (2.6%). S. epidermidis accounted for four of the 11 CNS organisms. The following gram-negative organisms comprised 13 of 38 (34%) isolates: Pseudomonas aeruginosa (18.4%), Enterobacter aerogenes (5.3%), Serratia marcescens (5.3%), Klebsiella oxytoca (2.6%), and Moraxella osloensis (2.6%). Five of 38 (13%) isolates were non-bacterial, each identified once, representing 2.6% of isolates: Acanthamoeba, Candida parapsilosis, Fusarium, Nocardia, and one non-speciated fungus. Two cultures (5.5%) were polymicrobial. The most common organisms cultured in patients using steroid drops were CNS (33.3%) and P. aeruginosa (19.4%). The most common organisms identified in patients using combination steroid/antibiotic drops were CNS (25%), S. aureus (25%), and P. aeruginosa (18.8%). In the current study, methicillin-resistance was found in 2 of 4 S. epidermidis and 1 of 4 S. aureus isolates.
The most common organisms identified in the current study were CNS and P. aeruginosa. Corneal scrapping in patients with keratitis was the most common site of positive cultures. Broad spectrum antimicrobial coverage is necessary until laboratory data are available. The use of steroid and combination steroid/antibiotic drops may predispose to the occurrence of more virulent and non-bacterial organisms.
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