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. Sixteen 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, Escherichia coli, and Enterococcus (7%). Uncommon Gram-negative bacteria were also cultured: Alcaligenes in 2 cases (5%) and one case of Stenotrophomonas maltophilia (2.5%). No anaerobic bacteria were isolated. Gram-negative isolates were sensitive to ceftazidime in 95%, ciprofloxacin in 86% and cefuroxime in 50%, with a sensitivity of less than 30% to cefalexin and ampicillin in those tested. All Pseudomonas isolates (100%) were sensitive to ceftazidime, 86% were sensitive to ciprofloxacin, while only 20% were sensitive to ampicillin and 14% to cefalexin. Alcaligenes was resistant to all antibiotics tested with the exception of ceftazidime.
  
  
  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 I
authors.initials: EI
authors.lastname: Assia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003607:Dacryocystitis / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000382:microbiology*; D006801:Humans; D007557:Israel; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013492:Suppuration / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents