Lacrimal sac bacteriology and susceptibility pattern in infants with congenital nasolacrimal duct obstruction in the 1st year of life: a cross-sectional study

Abstract

Background Congenital nasolacrimal duct obstruction (CNLDO) is one of the main causes of epiphora in infants, and antibiotics are usually used as a conservative therapy in the first year. Yet, little is known about the bacteriology of the occluded lacrimal drainage system in this group of patients. The aim of this study was to evaluate the microbiology of lacrimal sac (LS) in Chinese children with CNLDO in their first year of life. Methods Patients with CNLDO between May 1, 2017 and August 31, 2018 at a tertiary care children’s hospital were enrolled. The study recruited infants who received lacrimal probing under 1 year old, and refluxed discharge from LS was collected. Samples were cultured and susceptibility test was performed for positive culture. Results Thirty-two patients with CNLDO were included. The ratio of male to female was 23:9. The mean age was 6.7 ± 2.4 (1.7–12) months. Positive cultures was identified in 87.5% of the sample, and presented 38 strains of bacteria. Mixed infection was identified in 10 (31.3%) children. Gram-positive bacteria accounted for 60.5% of all the strains, with Streptococcus (50%) being the most frequent species, whereas Haemophilus (21.1%) and Neisseriae (13.2%) were most common isolates for Gram-negative organisms. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 2 infants whose symptoms resolved by a routine probing. No difference of bacteriology pattern was detected between patients under 6 months old and those beyond. The pathogens were highly sensitive to chloramphenicol (88%) and levofloxacin (84%), but resistant to erythromycin (40%) and sulfamethoxazole (32%). Conclusions Infants with CNLDO under 1 year of age presented predominance of Streptococcus as Gram-positive organism, and Haemophilus as Gram-negative organism. Levofloxacin was an active topical antibiotic agent with few chance of resistance especially for Chinese children. These findings could help clinicians choose optimal medicine for CNLDO as the conservative treatments.

Assessment of Perinatal Clinical Characteristics, Perinatal Risk Factors, and Microbial Profile in Congenital Nasolacrimal Duct Obstruction in a Tertiary Care Center: A Descriptive Study

“…Gram-positive organisms showed high rates of sensitivity to ciprofloxacin, and a majority of them were resistant to erythromycin. This correlates with a study that mentioned a 40% resistance to erythromycin and thus ineffective in CNLDO [ 4 ]. While gram-negative organisms were moderately susceptible to ciprofloxacin.…”

“…The predominant organism identified as S. pneumoniae, followed by Haemophilus influenzae, and the most drugs with high sensitivity for microbes were identified to be ofloxacin and tetracycline. Another study conducted in Wardha by Madan et al [1] on CNLDO showed similar results with Haemophilus influenzae and S. pneumonia to be the most common microbial isolates followed by Moraxella catarrhalis similar to other studies, which also showed ciprofloxacin, chloramphenicol, bacitracin, and neomycin to be the most effective local antibiotics for these microorganisms [4,20,21]. The most common gram-negative organisms identified as P. aeruginosa and E. coli have been predominant organisms in dacryo-cystitis in acquired or adults than in CNLDO [21,22].…”

“…Studies have shown that microbiological testing in CNLDO may have a value in predicting the obstruction [ 3 ]. Also, analyzing the lacrimal sac microorganisms and their antibiotic susceptibility in infants can prevent the complications and inappropriate use of antibiotics leading to antibiotic resistance [ 4 ].…”

Is surgical intervention avoidable in congenital nasolacrimal duct obstruction (CNLDO)

“…Stasis of lacrimal fluid in the lacrimal sac promoted bacterial growth with formation of purulent discharge. In a study by Xiao et al, 20 the bacterial species most frequently cultured from the lacrimal fluid samples obtained at probing were Streptococcus (50%), Haemophilus (21.1%) and Neisseriae (13.2%). We used Tobramycin eyedrops which has a broad spectrum and was considered safe for our cases which needed it as they were mostly 3-5 months old.…”

Patologías Oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital de referencia

“…Sin embargo, se debe realizar un seguimiento oftalmológico hasta la resolución completa . Es una (16) causa frecuente de infección del saco lagrimal con gérmenes gram positivos entre los que se encuentra el y también el Steptococcus pneumonia Stafilococo aureus y los gérmenes gram negativos de las especies de (17) Hemophilus En el presente estudio la patología congénita más frecuente fue la catarata. Esta se caracterizada por una opacidad del cristalino que se origina durante el desarrollo embrionario y debe ser diagnosticada en el recién nacido o a edades tempranas, para realizar el tratamiento adecuado para evitar la ceguera .…”