Ocular infections are a serious public health problem in Ethiopia with increased incidence of morbidity and blindness. Empirical therapy with topical ophthalmic broad spectrum antibiotic formulations is also a prevailing practice. The aim of this study was to determine the bacterial causes of external ocular infections (EOIs), antimicrobial resistance and its associated risk factors among patients at Felege Hiwot Referral Hospital, Northwest Ethiopia. A hospital based cross - sectional study was conducted from 1 February to 30 April 2019. Patients with EOIs were consecutively included from 1 February to 30 April, 2019. Data were collected using structured questionnaire by face-to-face interview and complemented with patient card review. Conjunctival, eyelid margin and lacrimal sac swabs were collected aseptically. Bacterial species were identified using standard bacteriological techniques. Antimicrobial susceptibility testing was done using Kirby-Bauer disk diffusion method. Binary logistic regression analysis was calculated to identify the factors associated with EOIs. P.value (p) < < 0.05 was considered as statistically significant. A total of 360 patients took part in the study and majority of them were males (64.7%). The median age of study participants was 59.5 years. Overall, 208(57.8%) (95%CI = 52.6– - 62.8%) of patients had culture confirmed bacterial EOIs. The proportion of culture confirmed EOIs was 60.4% among conjunctivitis cases and 55.8% among blepharitis. Ocular trauma (P < < 0.001), ocular disease (P < < 0.001) and having eye allergy (P = 0.027) were significantly associated with EOIs. The most frequent isolates were S. aureus (37%), K. pneumoniae (13.5%), Proteus(7.2%) spp., S. pneumoniae (4.3%), Citrobacter spp. (3.4%) and P. aeruginosa (2.9%). Gram positive isolates were resistant to penicillin in 87% and ampicillin in 86.2%. Gram negative isolates were resistant to ampicillin (87.5%). P.aeruginosa isolates (85.3%) were resistant to piperacillin and 50% were resistant to tobramycin. Overall, 45.2% of the isolates were multi-drug resistant. The percentage of multi-drug resistance was 80% among Enterobacter isolates and 64.3% among K. pneumoniae. Bacterial external ocular infections linked with multi-drug resistance and resistance to penicillin, ampicillin, tetracycline and piperacillin are high. Therefore, empirical treatment of eye infections in the study area needs to be monitored by regular antimicrobial-susceptibility testing of isolates.

中文翻译：

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埃塞俄比亚西北部Felege Hiwot转诊医院眼科病房患者外部眼部感染的常见细菌原因，相关的危险因素和抗生素耐药性：一项横断面研究

眼部感染是埃塞俄比亚的一个严重的公共卫生问题，发病率和失明率增加。用局部眼科广谱抗生素制剂进行的经验疗法也是一种普遍的做法。这项研究的目的是确定埃塞俄比亚西北部Felege Hiwot转诊医院患者的外部眼部感染（EOIs），抗菌素耐药性及其相关危险因素的细菌原因。从2019年2月1日至2019年4月30日进行了一项基于医院的横断面研究。从2019年2月1日至4月30日连续纳入了EOI患者。通过结构化问卷调查，通过面对面访谈收集数据并辅以患者证卡审查。无菌收集结膜，眼睑边缘和泪囊拭子。使用标准细菌学技术鉴定细菌种类。抗菌药敏试验采用Kirby-Bauer纸片扩散法进行。计算了二进制逻辑回归分析，以识别与EOI相关的因素。P.值（p）<<0.05被认为具有统计学意义。共有360名患者参加了研究，其中大多数是男性（64.7％）。研究参与者的中位年龄为59.5岁。总体而言，有208（57.8％）（95％CI = 52.6–-62.8％）的患者经培养证实为细菌EOI。在结膜炎病例中，经培养证实的EOIs比例为60.4％，在睑缘炎病例中为55.8％。眼外伤（P <<0.001），眼部疾病（P <<0.001）和对眼睛过敏（P = 0.027）与EOI显着相关。最常见的分离株是S。金黄色葡萄球菌（37％），肺炎克雷伯菌（13.5％），变形杆菌（7.2％）spp。，肺炎链球菌（4.3％），柠檬酸杆菌。（3.4％）和铜绿假单胞菌（2.9％）。革兰氏阳性菌株对青霉素的耐药率为87％，对氨苄西林的耐药率为86.2％。革兰氏阴性菌株对氨苄西林有抗药性（87.5％）。铜绿假单胞菌分离株（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。肺炎链球菌（13.5％），变形杆菌（7.2％）spp。，肺炎链球菌（4.3％），柠檬酸杆菌。（3.4％）和铜绿假单胞菌（2.9％）。革兰氏阳性菌株对青霉素的耐药率为87％，对氨苄青霉素的耐药率为86.2％。革兰氏阴性菌株对氨苄西林有抗药性（87.5％）。铜绿假单胞菌分离株（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。肺炎链球菌（13.5％），变形杆菌（7.2％）spp。，肺炎链球菌（4.3％），柠檬酸杆菌。（3.4％）和铜绿假单胞菌（2.9％）。革兰氏阳性菌株对青霉素的耐药率为87％，对氨苄西林的耐药率为86.2％。革兰氏阴性菌株对氨苄西林有抗药性（87.5％）。铜绿假单胞菌分离株（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。肺炎链球菌（4.3％），柠檬酸杆菌属。（3.4％）和铜绿假单胞菌（2.9％）。革兰氏阳性菌株对青霉素的耐药率为87％，对氨苄西林的耐药率为86.2％。革兰氏阴性菌株对氨苄西林有抗药性（87.5％）。铜绿假单胞菌分离株（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。肺炎链球菌（4.3％），柠檬酸杆菌属。（3.4％）和铜绿假单胞菌（2.9％）。革兰氏阳性菌株对青霉素的耐药率为87％，对氨苄西林的耐药率为86.2％。革兰氏阴性菌株对氨苄西林有抗药性（87.5％）。铜绿假单胞菌分离株（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。革兰氏阳性菌株对青霉素的耐药率为87％，对氨苄西林的耐药率为86.2％。革兰氏阴性菌株对氨苄西林有抗药性（87.5％）。铜绿假单胞菌分离株（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。革兰氏阳性菌株对青霉素的耐药率为87％，对氨苄青霉素的耐药率为86.2％。革兰氏阴性菌株对氨苄西林有抗药性（87.5％）。铜绿假单胞菌分离株（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。铜绿假单胞菌（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。铜绿假单胞菌（85.3％）对哌拉西林有抗药性，50％对妥布霉素有抗药性。总体而言，有45.2％的分离株具有多重耐药性。肠杆菌中多药耐药的百分比为80％，肺炎克雷伯菌中为64.3％。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过对分离株进行常规抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。细菌外眼感染与多药耐药性以及对青霉素，氨苄青霉素，四环素和哌拉西林的耐药性有关。因此，需要通过定期对分离株进行抗菌药敏试验来监测研究区域内眼部感染的经验性治疗。