Increasing Bacterial Resistance in Pediatric Acute Conjunctivitis (1997–1998)

Abstract

We sought to determine the current level of resistance in Haemophilus influenzae and Streptococcus pneumoniae, the primary pathogens of pediatric conjunctivitis. Between January 1997 and March 1998, we prospectively cultured acute conjunctivitis in 250 ambulatory pediatric patients from rural Kentucky whose average age was 24.3 months. In those 250 cases, 106 H. influenzae (42% of the total) and 75 S. pneumoniae (30% of the total) pathogens were isolated, with no growth or no pathogen resulting in 79 cases (32% of the total). Beta-lactamase was detected in 60 (69%) of 87 tested strains of H. influenzae. Among 65 isolates of S. pneumoniae tested for penicillin susceptibility, 44 (68%) were susceptible, 17 (26%) were resistant, and 4 (6%) were intermediate. Conjunctivitis with acute otitis media was observed in 97 patients (39%), and H. influenzae was recovered in 57% of these 97 cases. As for in vitro activity, ciprofloxacin, ofloxacin, and tetracycline were the most active; and gentamicin, tobramycin, polymyxin B-trimethoprim, and polymyxin B-neomycin were intermediately active. Sulfamethoxazole possessed no activity against either pathogen. Beta-lactamase production was detected in 69% of H. influenzae strains, which still remains the primary causative pathogen of both conjunctivitis and conjunctivitis-otitis syndrome. Penicillin-nonsusceptible S. pneumoniae was observed in 32% of 65 patients with S. pneumoniae conjunctivitis, with most strains being penicillin resistant.Acute conjunctivitis is the most common ocular infection in childhood, usually affecting children younger than 6 years old with a peak incidence between 12 and 36 months (3). Pediatric acute conjunctivitis is diagnosed by clinical signs of ocular purulent discharge or hyperemia of bulbar conjunctiva. The etiology of this infection has been documented as bacterial in 54 to 73% of pediatric cases (3,20). The pathogens predominantly recovered include nontypeable Haemophilus influenzae (44 to 68% of cases) and Streptococcus pneumoniae (7 to 21% of cases). Concomitant infection with acute otitis media (AOM) has been coined the conjunctivitis-otitis syndrome by Bodor (4) and is associated with H. influenzae in 20 to 73% of cases and with S. pneumoniae in 12 to 20% of cases (4, 10). Other rare bacterial pathogens of conjunctivitis include Moraxella catarrhalis, Streptococcus mitis, and Streptococcus pyogenes (10,22).Clinicians nearly always empirically treat acute conjunctivitis with topical antimicrobial therapy. The disease is mild, cultures are rarely obtained because of expense, and culture results are reported days later (13). Compared with placebo, topical therapy with polymyxin-bacitracin ointment has been shown to reduce by half the duration of symptoms and to achieve a 2.5-fold increase in rate of bacteriologic eradication at days 8 to 10 (31 versus 79%, respectively) (6). Furthermore, selecting among the multitude of available topical antimicrobials to treat conjunctivitis has been based on either sparse in vitro data or on earlier limited c...

Genome-wide fitness profiling reveals adaptations required by Haemophilus in coinfection with influenza A virus in the murine lung

“…represent the most common isolates (1). β-Lactam antibiotics are commonly used for treatment, and yet ∼30% of H. influenzae isolates are β-lactamasepositive (4)(5)(6). Because of increasing levels of bacterial antibiotic resistance, and the continued threat of global pandemics with potential emergence of new IAV subtypes, combined IAV and bacterial infection remains a significant public health concern.…”

Non Chlamydial Acute Bacterial Conjunctivitis in Sudanese Children

“…Another important diagnostic clue is the concomitant infection with acute otitis media [19] and the most common bacterium causing this syndrome is Haemophilus influenzae [20]. The same result was obtained by Block [10] who recommended that when practitioners encounter children with conjunctivitis-otitis media syndrome they should more than ever select an antimicrobials that possess good in vitro coverage for Haemophilus influenzae. Rietveld study stated that glued eye, itch and history of conjunctivitis provided optimal discrimination between patients with bacterial and viral aetiology, a history of both infectious conjunctivitis and itch make the probability of bacterial aetiology less likely, while glued eye is strong hint for bacterial aetiology [18].…”

“…gonococcal infection [3]. Acute infectious conjunctivitis is a common disorder with annual incidence of 1.5-2% in primary care centres [10,11]. In children incidence of acute infectious conjunctivitis is higher than in adults and the spectrum of causative microorganisms may differ from that in adults [12].…”

“Oldie But Goodie”: Pediatric Clinical Concepts

“…12,13 What is unique about the otitis-conjunctivitis syndrome is the temporal association of the two infections and the infectious agent which is most commonly nontypable strains of Hemophilus influenzae. [12][13][14][15][16][17] Typically, the same strain of H.influenzae is found in both the eyes and the ears. 15 In our experience sinusitis is also part of this association but does not seem to be widely discussed.…”