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Bacteriology and Antimicrobial Susceptibility Patterns of Childhood Acute Bacterial Conjunctivitis in Western Greece

Maria-Zoi Oikonomakou, Olga E. Makri, Eleni Panoutsou, Konstantinos Kagkelaris, Panagiotis Plotas, Dionysia Garatziotou, Constantinos D. Georgakopoulos, Maria I. Eliopoulou


Acute bacterial conjunctivitis is a common, highly contagious infection in children and is usually treated empirically with broad spectrum topical antibiotics. In the current study we investigated bacteriology and antibiotic susceptibility patterns in childhood acute bacterial conjunctivitis in Western Greece. We conducted a retrospective analysis of presumed acute bacterial conjunctivitis cases in ''Karamandaneio'' Pediatric General Hospital of Patras, Western Greece, between February 1, 2013 and January 31, 2018. Specimens from the lower conjunctiva fornix were isolated from 191 cases and outcomes were analyzed to identify the pathogenic bacteria of acute bacterial conjunctivitis and their corresponding antibiotic susceptibility patterns. Patients were divided into 3 groups; Group A included neonates under 28 days of life, Group B children from 1 month to 2 years and Group C from 2 years to 14 years. Results revealed that Staphylococcus spp., Haemophilus spp. and Streptococcus spp. were the most prevalent pathogens. No significant differences in isolated pathogens were found between the age groups. Antibiotic resistance rates were higher against ampicillin, ceftriaxone, ceftazidime and sulfamethoxazole. Resistance rates to Ciprofloxacin were low while none of the evaluated isolates were resistant to vancomycin. We concluded that predominant pathogens of childhood acute bacterial conjunctivitis in Western Greece were Staphylococcus spp., Haemophilus spp. and Streptococcus spp. Continuous surveillance, focused in distinct geographic areas, is encouraged to prepare more precise protocols of empirical treatment. Epub: October 1, 2019.


Sheikh A, Hurwitz B. Topical antibiotics for acute bacterial conjunctivitis: a systematic review. Br J Gen Pract. 2001;51(467):473-7. pmid: pubmed/11407054

Block SL, Hedrick J, Tyler R, Smith A, Findlay R, Keegan E, et al. Increasing bacterial resistance in pediatric acute conjunctivitis (1997-1998). Antimicrob Agents Chemother. 2000;44(6):1650-4. doi: 10.1128/aac.44.6.1650-1654.2000 pmid: pubmed/10817723

Patel PB, Diaz MC, Bennett JE, Attia MW. Clinical features of bacterial conjunctivitis in children. Acad Emerg Med. 2007;14(1):1-5. doi: 10.1197/j.aem.2006.08.006 pmid: pubmed/17119185

Mataftsi A, Kokkali S, Papagianni E, Tsonona V, Mavridou E, Ziakas N, et al. Management of Bacterial Conjunctivitis in Children-Preferred Practice Pattern in Northern Greece. Eye Contact Lens. 2018;44 Suppl 1:S373-S4. doi: 10.1097/ICL.0000000000000452 pmid: pubmed/30157160

Kagkelaris KA, Makri OE, Georgakopoulos CD, Panayiotakopoulos GD. An eye for azithromycin: review of the literature. Ther Adv Ophthalmol. 2018;10:2515841418783622. doi: 10.1177/2515841418783622 pmid: pubmed/30083656

Carreras B. Bacteriological analysis in the management of conjunctivitis. Comparison of antibiotic resistance between 1982 and 2008. Arch Soc Españ Oftalmol. 2012;87(4):107-11. doi: 10.1016/j.oftale.2012.06.004

CLSI. Microbiology Clinical Standards: Clinical and Laboratory Standards Institute; 2019 [cited 2019 12 February]. Available from:

EUCAST. Antimicrobial Susceptibility Testing of bacteria: European Comittee on Antimicrobial Susceptibility Testing; 2019 [cited 2019 12 February]. Available from:

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x pmid: pubmed/21793988

Pichichero ME. Bacterial conjunctivitis in children: antibacterial treatment options in an era of increasing drug resistance. Clin Pediatr (Phila). 2011;50(1):7-13. doi: 10.1177/0009922810379045 pmid: pubmed/20724317

Golde KT, Gardiner MF. Bacterial conjunctivitis in children: a current review of pathogens and treatment. Int Ophthalmol Clin. 2011;51(4):85-92. doi: 10.1097/IIO.0b013e31822d66a1 pmid: pubmed/21897142

Wald ER. Conjunctivitis in infants and children. Pediatr Infect Dis J. 1997;16(2 Suppl):S17-20. doi: 10.1097/00006454-199702001-00005 pmid: pubmed/9041623

Weiss A, Brinser JH, Nazar-Stewart V. Acute conjunctivitis in childhood. J Pediatr. 1993;122(1):10-4. doi: 10.1016/s0022-3476(05)83479-1 pmid: pubmed/8419593

Wadhwani M, D'Souza P, Jain R, Dutta R, Saili A, Singh A. Conjunctivitis in the newborn- a comparative study. Indian J Pathol Microbiol. 2011;54(2):254-7. doi: 10.4103/0377-4929.81584 pmid: pubmed/21623069

Azari AA, Barney NP. Conjunctivitis: a systematic review of diagnosis and treatment. JAMA. 2013;310(16):1721-9. doi: 10.1001/jama.2013.280318 pmid: pubmed/24150468

Agrawal A, Murphy TF. Haemophilus influenzae infections in the H. influenzae type b conjugate vaccine era. J Clin Microbiol. 2011;49(11):3728-32. doi: 10.1128/JCM.05476-11 pmid: pubmed/21900515

Buznach N, Dagan R, Greenberg D. Clinical and bacterial characteristics of acute bacterial conjunctivitis in children in the antibiotic resistance era. Pediatr Infect Dis J. 2005;24(9):823-8. pmid: pubmed/16148850

Thulukkanam K, Periyasamy S. Neonatal Conjunctivitis and Its Drug Sensitivity Pattern. J Evid Based Med Healthcare. 2017;4(39):2342-6. doi: 10.18410/jebmh/2017/460

Chawla R, Kellner JD, Astle WF. Acute infectious conjunctivitis in childhood. Paediatr Child Health. 2001;6(6):329-35. doi: 10.1093/pch/6.6.329 pmid: pubmed/20084257

DeLeon J, Silverstein BE, Allaire C, Gearinger LS, Bateman KM, Morris TW, et al. Besifloxacin ophthalmic suspension 0.6% administered twice daily for 3 days in the treatment of bacterial conjunctivitis in adults and children. Clin Drug Investig. 2012;32(5):303-17. doi: 10.2165/11632470-000000000-00000 pmid: pubmed/22420526

Mantadakis E, Maraki S, Michailidis L, Gitti Z, Pallikaris IG, Samonis G. Antimicrobial susceptibility of Gram-positive cocci isolated from patients with conjunctivitis and keratitis in Crete, Greece. J Microbiol Immunol Infect. 2013;46(1):41-7. doi: 10.1016/j.jmii.2011.12.025 pmid: pubmed/22209987

Asbell PA, Colby KA, Deng S, McDonnell P, Meisler DM, Raizman MB, et al. Ocular TRUST: nationwide antimicrobial susceptibility patterns in ocular isolates. Am J Ophthalmol. 2008;145(6):951-8. doi: 10.1016/j.ajo.2008.01.025 pmid: pubmed/18374299

Shrestha SP, Khadka J, Pokhrel AK, Sathian B. Acute bacterial conjunctivitis - antibiotic susceptibility and resistance to commercially available topical antibiotics in Nepal. Nepal J Ophthalmol. 2016;8(15):23-35. doi: 10.3126/nepjoph.v8i1.16153 pmid: pubmed/28242882

Neß T. Multiresistente Keime in der Augenheilkunde. Der Ophthalmol 2010;107(4):318-22. doi: 10.1007/s00347-009-2076-0

Gigliotti F, Williams WT, Hayden FG, Hendley JO, Benjamin J, Dickens M, et al. Etiology of acute conjunctivitis in children. J Pediatr. 1981;98(4):531-6. doi: 10.1016/s0022-3476(81)80754-8 pmid: pubmed/6970802

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