Outbreak of Gram-positive bacterial keratitis associated with epidemic keratoconjunctivitis in neonates and infants

Abstract

Objectives To report the clinical characteristics of bacterial keratitis associated with epidemic keratoconjunctivitis (EKC) and to evaluate the risk factors for bacterial keratitis development in eyes with EKC. Methods After 108 patients diagnosed as EKC were retrospectively reviewed, clinical characteristics and incidence of bacterial keratitis-associated EKC were described. To analyse the effect of steroid use and the methicillin-resistant Staphylococcus aureus (MRSA) colonization in conjunctiva on developing bacterial keratitis, HCU-stayed children (n ¼ 43) were divided into two groups: those with and those without bacterial keratitis. Other risk factors such as gestational age, duration of hospitalization, MRSA colonization rate of other sites, and interval between follow-ups were evaluated in neonates who stayed in a neonatal intensive care unit (NICU; n ¼ 29). Results Eight out of nine bacterial keratitis developed in HCU-stayed children. All the eight cases of bacterial keratitis occurred in neonates and infants. MRSA keratitis was found in seven hospitalized infants. The incidence of bacterial keratitis was significantly higher in HCU-stayed children than in outpatients (P ¼ 0.03), although it never occurred in HCU-stayed adults. The culture-positive rate of MRSA in conjunctiva (P ¼ 0.047) and topical use of steroid (P ¼ 0.01) were significantly higher in HCU-stayed children who carried bacterial keratitis. The incidence of bacterial keratitis was significantly related with the longer interval of follow-up in early EKC period in NICU in patients (P ¼ 0.009). Conclusions Infants and neonates show high tendency of MRSA keratitis accompanied with EKC, especially if they were in HCU, applied topical steroid or followed with long interval.

Study of Conjunctival Flora in Patients after Peripheral Blood Stem Cell Transplantation and its Correlation with Tear Secretion

“…[28,[34][35][36] mentioned earlier, there is a large variation of culture-positive rate in the studies of healthy eyes (47-95%) as well as diseased eyes. [6,14,28,34,35,37] In this study, the positive culture rate in patients with PBSCT-related dry eye and in nonhematopoietic transplantation-related dry eye patients were even lower than that of healthy eyes in the previous study. The difference in the culture methodology and different culture locations may explain the variation.…”

“…Among diabetic patients, a significantly higher frequency of positive culture rate is detected in those with diabetic retinopathy than in those without. [14] The study by Miller and Ellis revealed a positive correlation between increasing doses of prednisone and the number of bacterial organisms in the patients' conjunctiva. [16] Therefore, the of ocular surface flora.…”

“…The majority of bacterial floras on the ocular surface were aerobic as noted in previous studies. [6,7,[14][15][16] For that reason, we used aerobic culture only in this study.…”

Antibodies to Conserved Surface Polysaccharides Protect Mice Against Bacterial Conjunctivitis

“… 1 – 5 These bacteria are also common causes of ocular infections including keratitis and conjunctivitis. 6 – 9 Streptococcus pneumoniae is reported to be the most common bacterial pathogen of acute conjunctivitis in children. 7 Staphylococcus aureus , including methicillin-resistant S. aureus (MRSA), along with Pseudomonas aeruginosa , are increasingly isolated in elderly patients with conjunctivitis.…”

Focal Bacterial Infections

“…Conjunctivitis owing to MRSA was reported as the first case in an epidemic that eventually involved 14 neonates in an NICU including multiple invasive infections and two deaths [677]. MRSA has also caused dacrocystitis [678] and keratitis [679] in neonates.…”