Penicillin resistance among ocular pneumococcal isolates. Specimens

E. M. Perez, L. A. Palma, Darlene Miller, Eduardo C Alfonso

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Purpose. Streptococcus pneumoniae is a significant reemerging ocular isolate. Expanding spectrum of disease is increasingly seen in the elderly and or otherwise immunocompromised patients and includes endophthalmitis and keratitis. Penicillin remains the drug of choice. Methods. Pneumococcal isolates recovered from patients seen at BPEI (Jan. 1988-1995), blepharoconjunctivitis (81); keratitis (44),intraocular fluids (20), lacrimal and soft tissues (17) were evaluated via disc diffusion for drug resistance against several antimicrobial including penicillin. The "E" test was used to confirm and differentiate between low and high level penicillin resistant isolates. Results. Sixty-seven percent of the ocular pneumococcal isolates had MICs greater than 4 (high level pencilling resistance). Overall penicillin resistance was 14%. Highest levels were found in intraocular fluids (20%) and blepharoconjunctivitis (15%). Nine percent of the keratitis isolates were resistant to penicillin. Pediatric isolates (33%) were most frequently recovered from acute, surface infections (39%), of short duration and characterized by low level penicillin resistance. Adult infections tend to involve intraocular tissues, be chronic and recalcitrant to treatment. Drug resistance to two or more antibiotics were recovered in 17% of the patients. Conclusions. Drug resistant pneumococcal isolates may constitute an emerging management dilemma for patients with keratitis and endophthalmitis.

Original languageEnglish
JournalInvestigative Ophthalmology and Visual Science
Issue number3
StatePublished - Feb 15 1996


ASJC Scopus subject areas

  • Ophthalmology

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