Neonatal Bacterial Conjunctivitis: Pathogenic Distribution

Seol Hee Ahn; Yeon Kyung Lee; Sun Young Ko; Son Moon Shin

doi:10.14734/kjp.2015.26.4.299

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Ahn, Lee, Ko, and Shin: Neonatal Bacterial Conjunctivitis: Pathogenic Distribution

Original Article

Korean J Perinatol 2015;26(4):299-304.

Published online: 20 December 2015

DOI: https://doi.org/10.14734/kjp.2015.26.4.299

Neonatal Bacterial Conjunctivitis: Pathogenic Distribution

Seol Hee Ahn, M.D., Yeon Kyung Lee, M.D., Sun Young Ko, M.D., Son Moon Shin, M.D.

Department of Pediatrics, Cheil General Hospital & Women's Health Care Center, Dankook University College of Medicine, Seoul, Korea

Correspondence to: Yeon Kyung Lee, M.D. Department of Pediatrics, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, 1-19 Mukjeong-dong, Jung-gu, Seoul 04619, Korea Tel: +82-2-2000-7771, Fax: +82-2-2000-7778 E-mail: ykleeped@hanmail.net

Received 18 September 2015 Revised 30 September 2015 Accepted 1 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To study the causative microorganism of neonatal bacterial conjunctivitis and its correlation with maternal factors.

Methods

We retrospectively reviewed the medical records of 55 neonates diagnosed with bacterial conjunctivitis and the records of mothers from January 2008 to July 2013. We investigated microbiologic culture of conjunctival discharge, time of occurrence, the mode of delivery, premature rupture of membrane (PROM), microbiologic culture of vaginal swab and the sensitivities to antibiotics.

Results

The most common organism was Staphylococcus epidermidis, isolated in 24 (36.4%) neonates, followed by other Coagulase-negative Staphylococcus (CNS) 10 (15.2%), E. cloacae 6 (9.1%), S. marsescens 6 (9.1%), and P. aeruginosa 5 (7.6%). Concerning the time of occurrence, 23 (41.8%) were founded with conjunctivitis within 1 week of life. By mode of delivery, 18 (32.7%) were delivered through vaginal route and 37 (67.3%) delivered by Cesarean section. The most common organism grown in conjunctival discharge of both group was S. epidermidis. Of these 55 neonates' mothers, 9 (16.4%) had history of PROM. Regardless of the presence of PROM, the most common organism was S. epidermidis. A total of 22 (40.0%) microbiologic culture of vaginal swab were examined and 6 (27.2%) of them had detected organisms. The results of vaginal swabs were in discord with results of conjunctival swabs of neonates.

Conclusion

S. epidermidis was the most common infectious organism of neonatal bacterial conjunctivitis. We could not identify the correlation between neonatal bacterial conjunctivitis and maternal factors. Further comprehensive studies are needed to investigate the risk factors related to bacterial conjunctivitis of neonates.

Keywords: Bacterial conjunctivitis, Staphylococcus epidermidis, Neonates

References

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Table 1.

Clinical Features of Neonatal Bacterial Conjunctivitis (N=55)

Variable	No. (%)
Sex
Male	28 (50.9)
Female	27 (49.1)
Gestational age
<37 weeks	30 (54.5)
≥37 weeks	25 (45.5)
Mode of delivery
Vaginal delivery	18 (32.7)
Cesarean section	37 (67.3)
PROM (>12hrs)
(+)	9 (16.4)
(−)	46 (83.6)
Time of diagnosis
1^st week	23 (41.8)
2^nd week	14 (25.5)
3^rd week	14 (25.5)
4^th week	4 (7.2)

Abbreviation: PROM, Premature rupture of membranes

Table 2.

Organisms grown in Conjunctival Swabs

Organism	Total No. of Isolates^∗ (%)
Staphylococcus epidermidis	24 (36.4)
Other CNS	10 (15.2)
Enterobacter cloacae	6 (9.1)
Serratia marcescens	6 (9.1)
Streptococcus species	6 (9.1)
Pseudomonas aeruginosa	5 (7.6)
Escherichia coli	2 (3.0)
Staphylococcus aureus	3 (4.5)
Corynebacterium pseudodiphtheriticum	1 (1.5)
Enterococcus faecalis	1 (1.5)
Klebsiella pnemoniae	1 (1.5)
Enterobacter aerogenes	1 (1.5)

^∗ Includes 10 cases with >1 organism isolated Abbreviation: CNS, Coagulase-negative Staphylococcus

Table 3.

Distribution of Organisms based on Timing of Diagnosis

Organism	Total No. of Isolates^∗ (%)
Organism	1^st week	2^nd week	3^rd week	4^th week
S. epidermidis	10 (38.5)	7 (41.1)	7 (38.9)	0
Other CNS	3 (11.5)	1 (5.9)	4 (22.2)	2 (40.0)
E. cloacae	0	4 (23.5)	1 (5.5)	1 (20.0)
S. marcesens	2 (7.7)	1 (5.9)	2 (11.2)	1 (20.0)
Streptococcus species	6 (23.1)	0	0	0
P. aerusinosa	2 (7.7)	1 (5.9)	2 (11.2)	0
E. Coli	0	2 (11.8)	0	0
S. aureus	2 (7.7)	1 (5.9)	0	0
C. pseudodiphtheriticum	1 (3.8)	0	0	0
E. faecalis	0	0	1 (5.5)	0
K. pnemoniae	0	0	0	1 (20.0)
E. aerogenes	0	0	1 (5.5)	0

^∗ Includes 10 cases with >1 organism isolated Abbreviation: CNS, Coagulase-negative Staphylococcus

Table 4.

Distribution of Organisms based on Mode of Delivery

Organism	Total No. of Isolates^∗ (%)
Organism	Cesarean section	Vaginal delivery
S. epidermidis	16 (37.2)	8 (34.8)
Other CNS	5 (11.6)	5 (21.7)
E. cloacae	5 (11.6)	1 (4.3)
S. marcesens	4 (9.3)	2 (8.7)
Streptococcus species	3 (7.0)	3 (13.0)
P. aerusinosa	4 (9.3)	1 (4.3)
E. Coli	1 (2.3)	1 (4.3)
S. aureus	2 (4.7)	1 (4.3)
C. pseudodiphtheriticum	1 (2.3)	0
E. faecalis	0	1 (4.3)
K. pnemoniae	1 (2.3)	0
E. aerogenes	1 (2.3)	0

^∗ Includes 10 cases with >1 organism isolated Abbreviation: CNS, Coagulase-negative Staphylococcus

Table 5.

Organisms grown in Vaginal Swabs of Mother (N=22)

Organism	No. (%)
No growth	16 (72.8)
Streptococcus agalactiae	3 (13.7)
Candida albicans	1 (4.5)
Staphylococcus auricularis	1 (4.5)
Lactobacillus	1 (4.5)

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