title: Changing bacterial isolates and antibiotic sensitivities of purulent dacryocystitis.
abstract: OBJECTIVE
  To examine the current spectrum of bacterial isolates in cases of chronic dacryocystitis and dacryoabcess and to determine their antibiotic sensitivities.
  
  
  METHODS
  We carried out a prospective study in which 39 patients who presented to the outpatient clinic with chronic purulent dacryocystitis or acute dacryoabscess had cultures taken. All patients were antibiotic-free for at least one week prior to culturing.
  
  
  RESULTS
  The 39 positive cultures grew 41 bacterial isolates, as two patients grew two species of bacteria; 16 isolates (39%) were Gram-positive and 25 (61%) were Gram-negative. The most common isolates were Pseudomonas (22%), Staphylococcus aureus (13%), Enterobacter (10%), Citrobacter (10%), Streptococcus pneumoniae, E. coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in two cases (5%), and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciproxin in 86%, and cefuroxime in 50% of cases, with sensitivity of less than 30% to cephalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidine, 86% were sensitive to ciprofloxacin, with only 20% being sensitive to ampicillin and 14% to cephalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidine.
  
  
  CONCLUSIONS
  This study demonstrates a significant change in bacterial flora and antibiotic treatment requirements of purulent dacryocystitis from previously published data. A higher incidence of Gram-negative organisms, particularly Pseudomonas, with resistance to commonly used antibiotics was found. The emergence of rarer highly resistant Gram-negative microorganisms may also indicate a trend in lacrimal sac infections. These findings suggest that the antibiotic treatment protocol before and after lacrimal surgery should be reconsidered in this subgroup of patients.
authors.affiliation: Department of Ophthalmology, Sapir Medical Center, Kfar Saba, Israel. briscoe@barak-online.net
authors.forename: Daniel
authors.initials: D
authors.lastname: Briscoe
authors.forename: Alexander
authors.initials: A
authors.lastname: Rubowitz
authors.forename: Ehud
authors.initials: E
authors.lastname: Assia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015331:Cohort Studies; D003607:Dacryocystitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents