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Ocular Surface Infections in Northeastern State of Malaysia: A 10-Year Review of Bacterial Isolates and Antimicrobial Susceptibility

Rahman, Zaidah A. M.Path.; Harun, Azian M.Path., Ph.D.; Hasan, Habsah M.Path.; Mohamed, Zeehaida M.Path.; Noor, Siti S. Md. M.Path., Ph.D.; Deris, Zakuan Z. M.Path., Ph.D.; Ismail, Nabilah M.Path.; Hassan, Asma S. M.Path.; Ahmad, Fadzhilah Dip; Yaakub, Azhany M.Med.

doi: 10.1097/ICL.0b013e3182a3026b

Objective: Ocular surface infections that include infections of conjunctiva, adnexa, and cornea have the potential risk of causing blindness within a given population. Empirical antibiotic therapy is usually initiated based on epidemiological data of common causative agents. Thus, the aims of this study were to determine the bacterial agents and their susceptibility patterns of isolates from ocular surface specimens in our hospital.

Methods: This is a retrospective analysis and records of bacterial isolates from ocular surface specimens in Hospital Universiti Sains Malaysia from January 2001 to December 2010 were examined. Specimens were processed according to standard laboratory procedures. Antimicrobial susceptibility testing was conducted based on Clinical and Laboratory Standards Institute recommendations. Only single, nonrepetitive isolates were included in the analysis.

Results: A total of 1,267 isolates were obtained during the study period, which comprised Staphylococcus aureus (n = 299, 23.6%), Pseudomonas aeruginosa (n = 194, 15.3%), Streptococcus pneumoniae (n = 108, 8.5%), Haemophilus influenzae (n = 100, 7.9%), Haemophilus parainfluenzae (n = 84, 6.6%), and Enterobacter spp. (n = 81, 6.4%). Fungi contributed to 4.4% of the total isolates. The antimicrobial susceptibility testing demonstrated that gram-positive bacteria were generally resistant to gentamicin (19%–57%), whereas gram-negative bacteria were resistant to chloramphenicol (27%–58%).

Conclusions: Based on the above results, knowledge of the initial Gram stain findings is imperative before the commencement of empirical antibiotic therapy. Therefore, a simple Gram staining for all eye specimens is highly recommended.

Departments of Medical Microbiology and Parasitology (Z.A.R., A.H., H.H., Z.M., S.S.M.N., Z.Z.D., N.I., A.S.H., F.A.), and Ophthalmology (A.Y.), School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Address correspondence to Zaidah Abdul Rahman, M.Path., Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Kelantan, Malaysia; e-mail:

Presented in part at 16th National Conference on Medical and Health Sciences 2011, Malaysia.

The authors have no funding or conflicts of interest to disclose.

Accepted June 30, 2013

© 2013 Contact Lens Association of Ophthalmologists, Inc.