Background
Methods
Study design, data and specimens collection
Specimen transportation
Cultivation and identification of isolates
Antimicrobial susceptibility testing
Quality assurance
Statistical analysis
Results
Sociodemographic characteristics
Characteristic | Number N = 270 | Percentage (%) |
---|---|---|
Gender | ||
Male | 119 | 44.1 |
Female | 151 | 55.9 |
Age (years) (mean (SD) = 37.8 22.9) | ||
Less than 16 | ||
16–30 | 58 | 21.5 |
31–45 | 49 | 18.1 |
46–60 | 64 | 23.7 |
Greater than 60 | 51 | 18.9 |
48 | 17.8 | |
Residence | ||
Rural | 158 | 58.5 |
Urban | 112 | 41.5 |
Occupation | ||
Preschool | 30 | 11.1 |
Student | 40 | 14.8 |
Housewife | 43 | 15.9 |
Farmer | 91 | 33.7 |
Governmental employee | 34 | 12.6 |
Self-employed | 32 | 11.9 |
Total | 270 | 100 |
Educational level | ||
Preschool | 30 | 11.1 |
1–8 grades | 66 | 24.1 |
9–12 grades | 34 | 12.6 |
College and above | 18 | 6.7 |
No formal education | 122 | 45.2 |
Total | 270 | 100 |
Bacterial profile and clinical features
Clinical diagnosis | Bacterial Culture positive | Total, N (%) | |
---|---|---|---|
No (%) | Yes (%) | ||
Periorbital cellulitis | 1 (12.5) | 7 (87.5) | 8 (100) |
Dacryocystitis | 1 (7.7) | 12 (92.3) | 13 (100) |
Blepharitis | 12 (46.2) | 14 (53.8) | 26 (100) |
Blepharoconjunctivitis | 10 (62.5) | 6 (37.5) | 16 (100) |
Conjunctivitis | 48 (39) | 75 (61) | 123 (100) |
Keratitis | 11 (19.3) | 46 (80.7) | 57 (100) |
Endophthalmitis | 7 (25.9) | 20 (74.1) | 27 (100) |
Identification of bacterial isolates
Type of bacterial isolate, N (%) | Clinical diagnosis | Total N (%) | ||||||
---|---|---|---|---|---|---|---|---|
P’orbital cellulitisa
| Dacryocystitis | Blepharitis | Blepharoconjunctivitis | Conjunctivitisb
| Keratitisc
| Endophthalmitisd
| ||
S. aureus
| 4 (50) | 3 (25) | 5 (38.5) | 2 (33.3) | 17 (21.5) | 7 (14.9) | 2 (9.5) | 40 (21.5) |
CoNSe
| 0 | 0 | 3 (23.1) | 1 (16.7) | 13 (16.5) | 8 (17) | 6 (28.6) | 31 (16.7) |
S. pyogenes
| 1 (12.5) | 3 (25) | 0 | 0 | 1 (1.3) | 0 | 0 | 5 (2.7) |
S. pneumoniae
| 2 (25) | 2 (16.7) | 0 | 1 (16.7) | 3 (3.8) | 0 | 0 | 8 (4.3) |
Viridans streptococci | 0 | 0 | 0 | 0 | 6 (7.6) | 1 (2.1) | 0 | 7 (3.8) |
Enterococcus spp.
| 0 | 0 | 0 | 0 | 6 (7.6) | 2 (4.3) | 0 | 8 (4.3) |
Moraxella spp.
| 1 (12.5) | 0 | 0 | 0 | 0 | 1 (2.1) | 0 | 2 (1.1) |
N. gonorrhoeae
| 0 | 0 | 0 | 0 | 1 (1.3) | 0 | 0 | 1 (0.5) |
H. influenzae
| 0 | 0 | 0 | 0 | 2 (2.5) | 0 | 0 | 2 (1.1) |
P. aeruginosa
| 0 | 0 | 1 (7.7) | 0 | 2 (2.5) | 11 (23.4) | 7 (33.3) | 21 (11.3) |
K. pneumoniae
| 0 | 1 (8.3) | 1 (7.7) | 0 | 2 (2.5) | 1 (2.1) | 2 (9.5) | 7 (3.8) |
Klebsiella spp.
| 0 | 1 (8.3) | 0 | 0 | 2 (2.5) | 2 (4.3) | 0 | 5 (2.7) |
E. coli
| 0 | 1 (8.3) | 1 (7.7) | 1 (16.7) | 7 (8.9) | 4 (8.5) | 1 (4.8) | 15 (8.1) |
Enterobacter spp.
| 0 | 1 (8.3) | 1 (7.7) | 0 | 5 (6.3) | 3 (6.4) | 0 | 10 (5.4) |
Citrobacter freundii
| 0 | 0 | 0 | 0 | 2 (2.5) | 2 (4.3) | 0 | 4 (2.2) |
S. marcescens
| 0 | 0 | 0 | 1 (16.7) | 3 (3.8) | 1 (2.1) | 0 | 5 (2.7) |
Aeromonas spp.
| 0 | 0 | 0 | 0 | 1 (1.3) | 1 (2.1) | 0 | 2 (1.1) |
P. shigelloides
| 0 | 0 | 0 | 0 | 1 (1.3) | 0 | 0 | 1 (0.5) |
Proteus spp.
| 0 | 0 | 0 | 0 | 2 (2.5) | 1 (2.1) | 0 | 3 (1.6) |
Acinetobacter spp.
| 0 | 0 | 1 (7.7) | 0 | 1 (1.3) | 2 (4.3) | 1 (4.8) | 5 (2.7) |
GPBf
| 0 | 0 | 0 | 0 | 2 (2.5) | 0 | 2 (9.5) | 4 (2.2) |
Total | 8 (100) | 12 (100) | 13 (100) | 6 (100) | 79 (100) | 47 (100) | 21 (100) | 186 (100) |
Risk factors for bacterial occurrence in ocular infections
Variable | Bacterial occurrence, N (%) | Total, N (%) | CORa (95% CIb), P-value | AORc (95% CI), P-value | |
---|---|---|---|---|---|
No | Yes | ||||
History of ocular surface disease | |||||
Yes | 10 (11.0) | 81 (89.0) | 91 (100) | 6.5 (3.2–13.4), <0.01 | 13.6 (3.8–49), <0.01 |
No | 80 (44.7) | 99 (53.3) | 179 (100) | 1 | 1 |
History of ocular trauma | |||||
Yes | 14 (16.7) | 70 (83.3) | 84 (100) | 3.4 (1.8–6.5), <0.01 | 4.2 (1.4–13), 0.012 |
No | 76 (40.9) | 110 (59.1) | 186 (100) | 1 | 1 |
History of hospitalization | |||||
Yes | 9 (13.4) | 58 (86.6) | 67 (100) | 4.3 (2–9), <0.01 | 3.3 (1.03–12.5), 0.04 |
No | 81 (39.9) | 122 (60.1) | 203 (100) | 1 | 1 |
Cosmetic application practices | |||||
Yes | 7 (12.1) | 51 (87.9) | 58 (100) | 5.3 (2.2–12.8), <0.01 | 4.7 (1.6–13.9), <0.01 |
No | 39 (41.9) | 54 (58.1) | 93 (100) | 1 | 1 |
Variable | Bacterial occurrence N (%) | Total N (%) | CORa
| 95% CIb
|
P-value | |
---|---|---|---|---|---|---|
No | Yes | |||||
Gender | ||||||
Male | 41 (34.5) | 78 (65.5) | 119 (100) | 0.9 | 0.5–1.5 | 0.7 |
Female | 49 (32.5) | 102 (67.5) | 151 (100) | 1 | ||
Age | ||||||
15 | 28 (48.3) | 30 (51.7) | 58 (100) | 1 | ||
16–30 | 15 (30.6) | 34 (69.4) | 49 (100) | 2.1 | 0.9–4.6 | 0.06 |
31–45 | 17 (26.6) | 47 (73.4) | 64 (100) | 2.6 | 1.2–5.5 | 0.01 |
46–60 | 14 (27.5) | 37 (72.5) | 51 (100) | 2.5 | 1.1–5.5 | 0.02 |
61 | 16 (33.3) | 32 (66.7) | 48 (100) | 1.8 | 0.8–4.1 | 0.1 |
Residence | ||||||
Rural | 48 (30.4) | 110 (69.6) | 158 (100) | 0.7 | 0.4–1.2 | 0.22 |
Urban | 42 (37.5) | 70 (39.1) | 112 (100) | 1 | ||
Occupation | ||||||
Preschool | 13 (43.3) | 17 (56.7) | 30 (100) | 1.0 | 0.4–2.7 | 0.8 |
Student | 18 (45.0) | 22 (55.0) | 40 (100) | 1 | ||
Housewife | 11 (25.6) | 32 (74.4) | 43 (100) | 2.3 | 0.9–6.0 | 0.06 |
Farmer | 25 (27.5) | 66 (72.5) | 91 (100) | 2.1 | 0.9–4.6 | 0.051 |
Government employee | 13 (38.2) | 21 (61.8) | 34 (100) | 1.3 | 0.5–3.3 | 0.2 |
Self-employed | 10 (31.3) | 22 (68.8) | 32 (100) | 1.8 | 0.6–4.7 | 0.2 |
Educational level | ||||||
Preschool | 13 (43.3) | 17 (56.7) | 30 (100) | 0.8 | 0.25–2.7 | 0.7 |
1–8 | 28 (42.4) | 38 (57.6) | 66 (100) | 0.9 | 0.3–2.5 | 0.8 |
9–12 | 10 (29.4) | 24 (70.6) | 34 (100) | 1.5 | 0.7–4.2 | 0.2 |
College and above | 7 (38.9) | 11 (61.1) | 18 (100) | 1 | ||
No formal education | 32 (26.2) | 90 (73.8) | 122 (100) | 1.8 | 0.6–5.0 | 0.2 |
History of ocular surface disease | ||||||
Yes | 10 (11.0) | 81 (89.0) | 91 (100) | 6.5 | 3.2–13.4 |
<0.01
|
No | 80 (44.7) | 99 (53.3) | 179 (100) | 1 | ||
History of Ocular surgery | ||||||
Yes | 14 (24.6) | 43 (75.4) | 57 (100) | 1.7 | 0.8–3.3 | 0.11 |
No | 76 (35.7) | 137 (64.3) | 213 (100) | 1 | ||
History of Ocular trauma | ||||||
Yes | 14 (16.7) | 70 (83.3) | 84 (100) | 3.4 | 1.8–6.5 |
<0.01
|
No | 76 (40.9) | 110 (59.1) | 186 (100) | 1 | ||
History of Hospitalization | ||||||
Yes | 9 (13.4) | 58 (86.6) | 67 (100) | 4.3 | 2–9 |
<0.01
|
No | 81 (39.9) | 122 (60.1) | 203 (100) | 1 | ||
Contact lens use | ||||||
Yes | 4 (30.8) | 9 (69.2) | 13 (100) | 1.1 | 0.3–3.7 | 0.8 |
No | 86 (33.5) | 171 (66.5) | 257 (100) | 1 | ||
Cosmetic application practices | ||||||
Yes | 7 (12.1) | 51 (87.9) | 58 (100) | 5.3 | 2.2–12.8 |
<0.01
|
No | 39 (41.9) | 54 (58.1) | 93 (100) | 1 |
Antimicrobial susceptibility pattern of bacterial isolates
Bacterial isolate (N) | S/R N (%) | Antibiotics tested | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CN | AK | C | CIP | TC | DOX | SXT | CRO | DA | E | CH | MET | ||
S. aureus (40) | R S | 5 (12.5) 35 (87.5) | 1 (2.5) 39 (97.5) | 11 (27.5) 29 (72.5) | 5 (12.5) 35 (87.5) | 18 (45) 22 (55) | 11 (27.5) 29 (72.5) | 17 (42.5) 23 (57.5) | NT | 9 (22.5) 31 (77.5) | 8 (20) 32 (80) | NT | 7 (17.5) 33 (82.5) |
CoNSa (31) | R S | 2 (6.5) 29 (93.5) | 1 (3.2) 30 (96.8) | 9 (29) 22 (71) | 3 (9.7) 28 (90.3) | 18 (58.1) 13 (41.9) | 7 (22.6) 24 (77.4) | 21 (67.7) 10 (32.3) | NT | 12 (38.7) 19 (61.3) | 9 (29) 22 (71) | NT | 14 (45.2) 17 (54.8) |
S. pyogenes (5) | R S | NT | NT | 2 (40) 3 (60) | NT | 1 (20) 4 (80) | NT | NT | NT | 0 5 (100) | 0 5 (100) | 0 5 (100) | NT |
S. pneumoniae (8) | R S | NT | NT | 2 (25) 6 (75) | NT | 4 (50) 4 (50) | 2 (25) 6 (75) | 3 (37.5) 5 (62.5) | NT | 1 (12.5) 7 (87.5) | 1 (12.5) 7 (87.5) | 0 8 (100) | NT |
Viridans streptococci (7) | R S | NT | NT | 3 (42.9) 4 (57.1) | NT | 2 (28.6) 5 (71.4) | NT | NT | 0 7 (100) | NT | 1 (14.3) 6 (85.7) | 0 7 (100) | NT |
Enterococcus spp. (8) | R S | NT | NT | 4 (50) 4 (50) | 1 (12.5) 7 (87.5) | 4 (50) 4 (50) | 2 (25) 6 (75) | NT | NT | NT | 1 (12.5) 7 (87.5) | NT | NT |
N. gonorrhoeae (1) | R S | NT | NT | NT | 0 1 (100) | 0 1 (100) | NT | NT | 0 1 (100) | NT | NT | NT | NT |
H. influenzae (2) | R S | NT | NT | 0 2 (100) | 0 2 (100) | 0 2 (100) | NT | 1 (50) 1 (50) | NT | NT | NT | 0 2 (100) | NT |
P. aeruginosa (21) | R S | 1 (4.8) 20 (95.2) | 1 (4.8) 20 (95.2) | NT | 4 (19) 17 (81) | NT | NT | NT | NT | NT | NT | NT | NT |
K. pneumoniae (7) | R S | 2 (28.6) 5 (71.4) | 1 (14.3) 6 (85.7) | 3 (42.9) 4 (57.1) | 1 (14.3) 6 (85.7) | 5 (71.4) 2 (28.6) | 2 (28.6) 5 (71.4) | 4 (57.1) 3 (42.9) | 3 (42.9) 4 (57.1) | NT | NT | NT | NT |
Other Klebsiella spp. (5) | R S | 0 5 (100) | 1 (20) 4 (80) | 2 (40) 3 (60) | 1 (20) 4 (80) | 2 (40) 3 (60) | 1 (20) 4 (80) | 4 (80) 1 (20) | 0 5 (100) | NT | NT | NT | NT |
E. coli (15) | R S | 3 (20) 12 (80) | 2 (13.3) 13 (86.7) | 4 (26.7) 11 (73.3) | 1 (6.7) 14 (93.3) | 8 (53.3) 7 (46.7) | 3 (20) 12 (80) | 8 (53.3) 7 (46.7) | 3 (20) 12 (80) | NT | NT | NT | NT |
Enterobacter spp. (10) | R S | 1 (10) 9 (90) | 1 (10) 9 (90) | 1 (10) 9 (90) | 0 10 (100) | 6 (60) 4 (40) | 5 (50) 5 (50) | 4 (40) 6 (60) | 2 (20) 8 (80) | NT | NT | NT | NT |
Citrobacter freundii (4) | R S | 0 4 (100) | 0 4 (100) | 2 (50) 2 (50) | 1 (25) 3 (75) | 3 (75) 1 (25) | 2 (50) 2 (50) | 1 (25) 3 (75) | 0 4 (100) | NT | NT | NT | NT |
Acinetobacter spp. (5) | R S | 1 (20) 4 (80) | 1 (20) 4 (80) | NT | 0 5 (100) | 3 (60) 2 (40) | 3 (60) 2 (40) | 4 (80) 1 (20) | 0 5 (100) | NT | NT | NT | NT |
S. marcescens (5) | R S | 1 (20) 4 (80) | 1 (20) 4 (80) | 2 (40) 3 (60) | 0 5 (100) | 1 (20) 4 (80) | 1 (20) 4 (80) | 2 (40) 3 (60) | 1 (20) 4 (80) | NT | NT | NT | NT |
Proteus spp. (3) | R S | 0 3 (100) | 0 3 (100) | 0 3 (100) | 0 3 (100) | NT | NT | 1 (33.3) 2 (66.7) | 0 3 (100) | NT | NT | NT | NT |
P. shigelloides (1) | R S | 0 1 (100) | 0 1 (100) | 0 1 (100) | 0 1 (100) | 0 1 (100) | 0 1 (100) | 0 1 (100) | 0 1 (100) | NT | NT | NT | NT |
Total, N (%) | R S | 16 (10.9) 131 (89.1) | 10 (6.8) 137 (93.2) | 45 (29.8) 106 (70.2) | 17 (10.8) 141 (89.2) | 75 (48.7) 79 (51.3) | 39 (28.1) 100 (71.9) | 70 (51.3) 66 (48.7) | 9 (14.3) 54 (85.7) | 22 (26.2) 62 (73.8) | 20 (20.2) 79 (79.8) | 0 22 (100) | 21 (29.6) 50 (70.4) |
Type of bacterial isolate | Level of resistance N (%) | Total | |||||
---|---|---|---|---|---|---|---|
R0 | R1 | R2 | R3 | R4 | |||
Gram-positive |
S. aureus
| 7 (17.5) | 8 (20) | 6 (15) | 7 (17.5) | 12 (30) | 40 (100) |
CoNSa
| 4 (12.9) | 6 (19.4) | 5 (16.1) | 0 | 16 (51.6) | 31 (100) | |
S. pyogenes
| 3 (60) | 2 (40) | 0 | 0 | 0 | 5 (100) | |
S. pneumoniae
| 1 (12.5) | 2 (25) | 4 (50) | 0 | 1 (12.5) | 8 (100) | |
Viridans streptococci | 2 (28.6) | 2 (28.6) | 2 (28.6) | 1 (14.3) | 0 | 7 (100) | |
Enterococcus spp. | 2 (25) | 1 (12.5) | 4 (50) | 1 (12.5) | 0 | 8 (100) | |
Total | 19 (19.2) | 21 (21.2) | 21 (21.2) | 9 (9) | 29 (29.3) | 99 (100) | |
Gram-negative |
N. gonorrhoeae
| 1 (100) | 0 | 0 | 0 | 0 | 1 (100) |
H. influenzae
| 1 (50) | 1 (50) | 0 | 0 | 0 | 2 (100) | |
P. aeruginosa
| 10 (47.6) | 9 (42.9) | 2 (9.5) | 0 | 0 | 21 (100) | |
K. pneumoniae
| 0 | 0 | 1 (14.3) | 5 (71.4) | 1 (14.3) | 7 (100) | |
Other Klebsiella spp. | 0 | 2 (40) | 1 (20) | 1 (20) | 1 (20) | 5 (100) | |
E. coli
| 5 (33.3) | 2 (13.3) | 1 (6.7) | 1 (6.7) | 6 (40) | 15 (100) | |
Enterobacter spp. | 2 (20) | 2 (20) | 3 (30) | 1 (10) | 2 (20) | 10 (100) | |
Citrobacter freundii
| 1 (25) | 0 | 1 (25) | 1 (25) | 1 (25) | 4 (100) | |
S. marcescens
| 2 (40) | 1 (20) | 0 | 1 (20) | 1 (20) | 5 (100) | |
P. shigelloides
| 1 (100) | 0 | 0 | 0 | 0 | 1 (100) | |
Proteus spp. | 0 | 0 | 2 (66.7) | 1 (33.3) | 0 | 3 (100) | |
Acinetobacter spp. | 0 | 2 (40) | 1 (20) | 1 (20) | 1 (20) | 5 (100) | |
Total | 23 (29.1) | 19 (24) | 13 (16.5) | 11 (13.9) | 13 (16.5) | 79 (100) | |
Grand Total | 42 (23.6) | 40 (22.5) | 34 (19.1) | 20 (11) | 42 (23.5) | 178 (100) |
Type of bacterial isolate | Total number of isolates | MDRa isolates, N (%) |
---|---|---|
S. aureus
| 40 | 18 (45) |
K. pneumoniae
| 7 | 4 (57.1) |
Other Klebsiella spp. | 5 | 2 (40) |
E. coli
| 15 | 7 (46.7) |
Enterobacter spp. | 10 | 2 (20) |
Citrobacter freundii
| 4 | 1 (25) |
Serratia marcescens
| 5 | 1 (20) |
P. shigelloides
| 1 | 0 |
Proteus spp. | 3 | 0 |
Acinetobacter spp.
| 5 | 1 (20) |
Total | 95 | 36 (37.9) |