NEONATAL BACTERIAL CONJUNCTIVITIS IN TERTIARY HOSPITALS IN SANA'A CITY, YEMEN

Background: Ophthalmia neonatorum (ON) is the most widespread eye infection occurring in the first 28 days of life. Although most of these cases are benign, some may progress to systemic complications or blindness if left untreated. Objectives: The current study was conducted with the aim of revealing the bacteriological causes of conjunctivitis in neonates and the antibiotic sensitivity pattern of these bacteria. Subjects and methods: The study included all neonates at the age of 1 to 28 days presenting at the neonatal nurseries with Neonatal Intensive Care Unit (NICU) and level II care beds in three hospitals; Authority of Al-Thawra General Hospital, Al-Kuwait University Hospital and Al-Sabeen Maternity and Child Hospital in Sana’a city, Yemen. A full history was taken from each nurse and mothers of the neonates included in the study in which the findings were recorded in a predesigned questionnaire including socio demographic, maternal clinical information and therapeutic interventions. To isolate the causative agent, the conjunctival swabs were inoculated on proper media and bacteria were identified by standard microbiological methods and antibiotic resistance was done for the isolates. Results: 203 swabs were collected from newborns with eye discharge over a nine-month period. Positive growth rate was 51.7%, males were more affected (57.1%), 80% of affected neonates had low birth weight, 71.4% of preterm infants were most affected (p <0.01). There was a significant relationship between invasive and non-invasive mechanical ventilation with neonatal conjunctivitis (p<0.05). Gentamicin showed good in vitro sensitivity to all bacteria isolated, Staphylococcus aureus (83%), Escherichia coli 84.6%, with P. aeruginosa it was 60%. Conclusion: The vast majority of cases of neonatal conjunctivitis were mild with a high level of occurrence, Staphylococcus aureus and Klebsiella pneumoniae were the major bacterial agents, neonatal conjunctivitis most likely to be a hospital-acquired infection. There was a significant association between phototherapy, non-invasive ventilation and incidence of neonatal conjunctivitis . Gentamicin had high activity against the bacteria isolated in this study. Peer Review History: Received: 9 November 2021; Revised: 11 December; Accepted: 27 December, Available online: 15 January 2022 Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, [email protected] Dr. Jucimary Vieira dos Santos, Hemonorte Dalton Barbosa Cunha, Brazil, [email protected] Similar Articles: BACTERIAL CONJUNCTIVITIS OF ADULTS: CAUSES AND OPHTHALMIC ANTIBIOTIC RESISTANCE PATTERNS FOR THE COMMON BACTERIAL ISOLATES BACTERIAL CAUSES AND ANTIMICROBIAL SENSITIVITY PATTERN OF EXTERNAL OCULAR INFECTIONS IN SELECTED OPHTHALMOLOGY CLINICS IN SANA’A CITY

Conjunctivities of newborns

The article is focused on the peculiarities of the clinical course of separate forms of neonatal conjunctivitis, depending on the etiological factor. It was found that more often the disease refers to nosocomial eye infection and bacterial nature. We performed the bacteriological analysis of the contents of the conjunctival cavity of 50 newborn patients being treated in the neonatal department. Our analysis indicated the leading role of gram-positive bacteria Staph. epidermidis (59.7%) and Staph. aureus (21.7%) in the development of the inflammatory process. The share of other types of pathogens, including gram-negative minor and various pathogens, is from 0.54% to 3.2%. The cause of nosocomial infection is considered to be the pathogen that circulates in the department and acquires the features of a hospital strain. These are consistent with the results of similar studies conducted by both domestic and foreign clinicians, which are also presented in the article. Particular attention is paid to the causative agents of intrauterine infections that are dangerous for the anterior section: gonococcus, chlamydia, herpes simplex, etc. These agents often cause serious diseases in newborns (gonoblenorrhea, ophthalmic chlamydiosis, and ophthalmic herpes), in which the cornea and vision are often affected. The article highlights the measures of primary prevention of intrapartum infection of the ocular surface in newborns, adopted in Russia. The paper presents modern approaches to selecting drugs for local antibacterial therapy of neonatal conjunctivitis, considering age restrictions for their use. Methods of laboratory diagnostics and their validity for the etiology of conjunctivitis have been described in detail. For example, the bacteriological method (inoculations in various culture media) is considered a reference (specificity 100%). The culture medium can be used to isolate bacteria, chlamydia, and mycoplasma, which allows getting clear results even with a minimal amount of microflora

Proportion of ophthalmia neonatorum following prophylaxis with azithromycin eye ointment in newborns at a tertiary care centre in Central Kerala

Background: The objective was to evaluate the proportion of ophthalmia neonatorum among 425 hospital born newborns who had received antibiotic eye prophylaxis within one hour of birth at a tertiary care centre in Central Kerala and to detect their causative organisms.Methods: The study design was an observational study done for a period of 10 months. A total of 425 term well newborn babies were included in the study. At delivery after the normal routine newborn care, babies were received azithromycin 1% eye ointment as prophylaxis for neonatal conjunctivitis in both eyes within one hour of birth. Babies were observed routinely during every vital monitoring for developing signs of neonatal conjunctivitis for the first 72 hours of life at hospital. During outpatient follow ups, 7 to 14 days and 14 to 28 days, these babies were examined for the presence of neonatal conjunctivitis. Babies having neonatal conjunctivitis were treated empirically with the same topical 1% azithromycin eye ointment after taking eye swab for culture and sensitivity in both eyes. The treatment has been modified based on the culture reports. Proportions were compared using Chi-square test with significance at p<0.05.Results: A total 15 (3.5%) of the 425 babies developed ophthalmia neonatorum. The most common isolate was Staphylococcus aureus which was 4 (26.7%) of all positive cultures followed by Escherichia coli 13.3%, Klebsiella pneumoniae 6.7%, Serracia marcescens 6.7%. None of the risk factors were found to be having association with conjunctivitis.Conclusions: This study concludes that a high proportion of neonatal conjunctivitis present despite eye antibiotic prophylaxis, though a greater reduction in cases has been shown when compared with no prophylaxis at our centre during the previous year. S. aureus was the most common causative organism isolated.

Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns

Background Neonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due to Chlamydia trachomatis. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established. Objective To examine published literature to determine whether antibiotic containing preparation are efficacious for prevention of NCC and C. trachomatis in the nasopharynx. Methods A literature search of MEDLINE and EMBASE. Articles were selected for review if their content included 4 key criteria: (1) Prospective/comparative study. (2) Prenatal screening of mothers for C. trachomatis with results reported. (3) Follow-up of infants born to chlamydia-positive women. (4) Infants prospectively followed at regular intervals and tested for C. trachomatis in the eye/ nasopharynx (NP). Results The search yielded 159 studies; 11 were selected for full reviews, eight were excluded; three addressed the four criteria. Rates of C. trachomatis conjunctivitis in infants in included studies who received silver nitrate was 20–33%; positive NP, 1–28% and pneumonia, 3–8%. Rates of C. trachomatis conjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0–15 and 11%, respectively, who received erythromycin or tetracycline developed NCC. Similarly, 4–33 and 5% of infants who received erythromycin or tetracycline, respectively, had positive NP cultures; 0–4% developed chlamydial pneumonia. Conclusion Neonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers with C. trachomatis infection compared to silver nitrate.

Konjungtivitis pada Bayi (Oftalmia Neonatorum)

Conjunctivitis is a disease that can affect every age group including newborns. One of its complications is blindness. The vision of WHO in 2020 is ophthalmia neonatorum as the leading cause of blindness in low income country in African and other third world countries. This study was aimed to obtain an overview of ophthalmia neonatorum in general. This was a literature review study using three database Clinical Key, Pub Med, and Google Scholar, using the key words ophthalmia neonatorum OR neonatal conjunctivitis. The result showed that the most common pathogens were S. aureus, C. trachomatis, and N. gonorrhoeae. Transmission through normal labour had the highest incidence of conjunctivitis in newborns. Internal factors of mothers such as infected by pathogens had a tendency to transmit the infection to the babies meanwhile external factors of mothers were skipping the initial antenatal care (ANC) for screening of pathogens infecting the mothers supported by the high prevalence of conjunctivitis in developing countries associated with lower educational and socioeconomic status. In conclusion, ophthalmia neonatorum was affected by the mother conditiom (antenatal infection) and external factors including ANC, developed countries, and low educational and socioeconomic status.Keywords: conjunctivitis, newborns, ophthalmia neonatorum Abstrak: Konjungtivitis merupakan penyakit mata yang dapat menyerang semua kalangan termasuk bayi. Salah satu komplikasi konjungtivitis pada bayi ialah kebutaan. World Health Organization tahun 2020 mencanangkan bahwa oftalmia neonatorum termasuk salah satu penyebab utama terjadinya kebutaan di negara-negara yang berpenghasilan rendah di benua Afrika dan negara lainnya. Penelitian ini bertujuan untuk mendapatkan gambaran umum dari konjungtivitis pada bayi. Jenis penelitian ialah literature review. Pencarian data menggunakan tiga database, yaitu: ClinicalKey, PubMed, dan Google Scholar. Kata kunci yang digunakan yaitu ophthalmia neonatorum OR neonatal conjunctivitis. Hasil penelitian mendapatkan bahwa organisme patogen penyebab tersering ialah S. aureus, C. trachomatis, dan N. gonorrhoeae dengan penularan melalui jalan lahir ibu yang terinfeksi. Persalinan pervaginam menunjukkan angka kejadian terjadinya konjungtivitis pada bayi yang tinggi. Faktor internal ibu yang terinfeksi organisme patogen berisiko menularkan infeksi kepada bayinya. Faktor eksternal ibu yang tidak rutin melakukan antenatal care (ANC) akan melewatkan skrining awal adanya organisme yang menginfeksi ibu, didukung juga oleh prevalensi konjungtivitis yang terjadi di negara berkembang dengan status pendidikan dan sosioekonomi yang masih rendah. Simpulan penelitian ini ialah konjungtivitis pada bayi dipengaruhi oleh faktor ibu (infeksi antenatal) dan faktor eksternal termasuk ANC, negara berkembang, serta status pendidikan dan sosioeknomi yang rendah.Kata kunci: konjungtivitis, bayi, oftalmia neonatorum

Ophthalmologic Emergencies

Despite sharing similar eye size and anatomy with adults, pediatric patients have unique patterns of ophthalmic infection and injury. Children, especially neonates, have a significantly less developed resistance to the systemic and central nervous system complications associated with ophthalmic infections and trauma. This chapter reviews pediatric eye conditions with a focus on practical approaches for diagnosis and treatment. Special considerations for neonatal conjunctivitis and dacryocystitis are addressed including indications for systemic treatment and criteria for admission. Guidelines are given for the treatment of household chemical exposure and for eye injuries from foreign bodies or blunt trauma. Common and atypical presentations are discussed. Treatment and selected procedures are detailed.

Congenital Chlamydia Infection – case presentation

There are several pathogens involved in the etiology of neonatal infections. Based on etiology, these can be classified into materno-fetal and nosocomial infections. Bacteria of the Chlamydia family behave like intracellular parasites. The most well-known member is Chlamydia trachomatis, which is the cause of the most common sexually transmitted disease in developed societies. In this case, we present a 27-days-old girl who presented at our clinic with conjunctivitis, dyspnea and coughing. Laboratory and imaging findings reported leucocytosis, eosinophilia, and bronchopneumonia. Her condition improved rapidly during antibiotic treatment, but her conjunctivitis recurred. Serological tests confirmed Chlamydia infection of the newborn. She became asymptomatic after the whole family has been cured. In case of neonatal conjunctivitis, pneumonia and eosinophilia, Chlamydia should be considered and the whole family treated to prevent re-infections.

Conjunctival bacterial infection among hospitalized neonates

Background: Conjunctivitis is a common infection among neonates and it is a known cause of preventable childhood blindness. There is geographical variation in the distribution of aetiological agents. Objective: To assess the prevalence of conjunctivitis among hospitalized neonates receiving care in a tertiary health care centre in South-west Nigeria, and describe its clinical and bacteriological correlates. Methods: The hospital records of neonates diagnosed with conjunctivitis at the Olabisi Onabanjo University Teaching Hospital, Sagamu between January 2015 and December 2019 were reviewed. Their bio-data, perinatal history, laboratory results and treatment received were extracted for analysis. Results: One hundred and twenty-two neonates had conjunctivitis out of a total number of 2,286 admissions, giving a prevalence rate of 5.3%. Male infants had almost double the risk of developing the disease compared to female infants (OR = 1.6; 95% CI: 1.09-2.35). Eighty-six (70.5%) babies were term, while 21 (17.2%) and 15 (12.3%) were preterm and small-for-gestational-age respectively. Most cases of neonatal conjunctivitis (82.0%) occurred in the first week of life while the mean ±SD age of onset was 5.3±4.5 days. Staphylococcus aureus and Klebsiella species were the commonest bacterial isolates affecting 57.1% and 23.0% neonates respectively. Moderately-high rates of resistance to erythromycin and gentamicin were observed among the bacterial isolates. Conclusion: Neonatal conjunctivitis is commonly due to Staphylococcus aureus and Klebsiella species in this setting. It is commoner among male infants. Most cases run a mild course with good response to topical antimicrobial therapy.