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      The eyes have it: An unusual case of Escherichia coli ophthalmia neonatorum or a shifting landscape?

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          Abstract

          Despite dramatic declines in the incidence of ophthalmia neonatorum with universal prophylaxis, it remains a clinically important cause of eye disease in newborns. While clear guidelines exist for the treatment of the historically primary agents of ophthalmia neonatorum ( Chlamydia trachomatis and Neisseria gonorrhoeae), it is less clear how to manage newborns with conjunctivitis secondary to other bacterial organisms, particularly those also frequently implicated in neonatal sepsis. We present the case of a 3-day-old well-appearing term infant with unilateral purulent conjunctivitis. The eye culture grew Escherichia coli, an unusual cause of ophthalmia neonatorum. After a limited sepsis evaluation proved negative, the infant was switched to moxifloxacin ophthalmic drops and made a full recovery. This case highlights the challenge of managing a rare presentation with minimal guideline support, as well as the need to consider other bacterial causes of neonatal conjunctivitis which are emerging in the era of routine prophylaxis in the United States.

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          Most cited references12

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          Comparative in-vitro activity of moxifloxacin, minocycline and azithromycin against Chlamydia spp.

          The in-vitro activity of moxifloxacin, a new 8-methoxyquinolone, was compared with minocycline and azithromycin against 40 strains of Chlamydia trachomatis, Chlamydia pneumoniae and Chlamydia psittaci. Both the MIC and the MBC of moxifloxacin ranged from 0.03 to 0.125 mg/L. MICs of minocycline ranged from 0.015 to 0.06 mg/L and MBCs between 0.03 and 0.25 mg/L. MICs of azithromycin ranged from 0.03 to 0.125 mg/L and the MBCs between 0.06 and 0.5 mg/L. MBC values of moxifloxacin were the same as MICs in 32 (80%) of 40 strains tested, whereas those of minocycline and azithromycin were two to four times higher than their MICs. These data confirm those previously obtained indicating that quinolones kill chlamydial strains at concentrations equivalent to their MICs.
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            Treatment and prevention of ophthalmia neonatorum.

            In my office I occasionally see neonates with conjunctivitis. What are the current recommendations for ocular prophylaxis at birth? Do topical antibiotics alone provide adequate treatment of neonatal conjunctivitis? When is systemic therapy indicated?
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              Epidemiology of gram-negative conjunctivitis in neonatal intensive care unit patients.

              To describe the epidemiologic features, risk factors, and antibiotic susceptibilities for gram-negative conjunctivitis among neonatal intensive care unit (NICU) patients. Retrospective, observational study. In a University Tertiary Care Hospital with a level III-IV NICU, 65 NICU infants (< eight weeks of age) with positive culture results for conjunctivitis between January 1, 2001 and June 1, 2007, were included. Patient demographics, clinical examination results, device usage, and antibiotic susceptibility data were compared between infants with gram-negative conjunctivitis and infants without gram-negative conjunctivitis. One or more episodes of gram-negative conjunctivitis occurred in 38% (n = 25/65) of NICU infants. Predominant pathogens included Klebsiella species (23%), Escherichia coli (17%), Serratia marcescens (17%), Pseudomonas aeruginosa (3%), and Enterobacter species (2%). Birth weight and gestational age were significantly less in infants with gram-negative conjunctivitis than in infants without gram-negative conjunctivitis (P = .008 and P = .008, respectively). With multivariate analysis, birth weight less than 1500 g (odds ratio [OR], 4.35; 95% confidence interval [CI], 1.42 to 13.36), and gestational age of 29 weeks or fewer (OR, 5.60; 95% CI, 1.88 to 16.66) were identified as risk factors for the development of gram-negative conjunctivitis. Antibiotic resistance of gram-negative organisms to ampicillin, cefazolin, gentamicin, and levofloxacin were 96%, 52%, 13%, and 7% respectively. Of the Klebsiella isolates, two (25%) of eight were resistant to gentamicin. Low birth weight and low gestational age in NICU infants with clinical signs of conjunctivitis should raise the suspicion for a gram-negative cause. Given the observed resistance patterns of Klebsiella isolates, gentamicin resistance should be considered when designing empiric treatment.
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                Author and article information

                Journal
                SAGE Open Med Case Rep
                SAGE Open Med Case Rep
                SCO
                spsco
                SAGE Open Medical Case Reports
                SAGE Publications (Sage UK: London, England )
                2050-313X
                11 December 2017
                2017
                : 5
                : 2050313X17745905
                Affiliations
                [1 ]Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA
                [2 ]University of Minnesota, Minneapolis, MN, USA
                Author notes
                [*]Walid Mounis Maalouli, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, 2450 Riverside Avenue, Minneapolis, MN 55454, USA. Email: maalo005@ 123456umn.edu
                Article
                10.1177_2050313X17745905
                10.1177/2050313X17745905
                5734447
                59275b54-6bf4-445c-ba3b-761732e8860b
                © The Author(s) 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 28 December 2016
                : 8 November 2017
                Categories
                Case Report
                Custom metadata
                January-December 2017

                neonate,ophthalmia neonatorum,escherichia coli
                neonate, ophthalmia neonatorum, escherichia coli

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