Bacterial assay of contact lens wearers.

PURPOSE: The goal of the project was to determine the quantity of bacteria on the contact lens and adjacent areas of the eye. This paper is a quantitative study of the contact lens and ocular aerobic microbiota in a mixed group of daily and extended wear disposable contact lens users. METHODS: The contact lens, the lower fornix, tears collecting at the lower fornix, and edge of the lower lid at the Meibomian gland margin were assayed for the quantity of bacterial colony forming units (CFU). Eighteen patients wearing 49 disposable high water content hydrogel contact lenses were assayed and the mean lens age was 8.8 +/- 4.6 days. Three patients wore their lenses on a daily wear basis and 15 on an extended wear schedule. Tear samples were obtained with sterile microbial loops and the lens was macerated into small particles with a tissue grinder. The samples were poured onto the surface of chocolate agar plates and incubated at 35 degrees C for 48 h in 5% Co2. RESULTS: The lid margin revealed the greatest bacterial presence (mean = 9.7 CFU; median = 2 CFU; mode = 0 CFU). The lens showed the next greatest presence of CFU (mean = 4.5 CFU; median = 1 CFU; mode = 0). The fornix and tears revealed the least bacterial presence (fornix: mean = 2.6 CFU; median = 0 CFU; mode = 0 CFU). The bacteria were coagulase-negative staphylococci. CONCLUSIONS: The bacterial assay of disposable lens wearing contact lens subjects indicates that the lid margins are the greatest source of bacteria with the tears being the lowest. These studies support the concept that in the eye, the lens typically does not possess a large number of bacteria under normal conditions.

Tear lactoferrin levels and ocular bacterial flora in HIV positive patients.

Keratoconjunctivitis Sicca(4) has recently been reported to occur at a greater rate in HIV-positive symptomatic patients. We looked at HIV positive asymptomatic patients, compared to age matched HIV negative patients to study external ocular resistant factors, namely lactoferrin levels in tears, bacterial flora in lid margins, conjunctiva and tears, and evidence of dry eyes using a Schirmer test and tear osmolarity. Eighteen eyes of nine HIV positive patients and eighteen eyes of HIV negative controls were studied. Results showed markedly decreased lactoferrin levels in HIV positive asymptomatic patients with a mean of 85.8 mgs/dcl compared to HIV negative patients with a mean 156 mgs/dcl (P < 0.01). There were increased numbers of colonies of bacterial flora on the lids of HIV positive asymptomatic patients with an average colony count 4.1 colonies/patient compared to 1.5 colonies/patients in the control group (P < 0.025). Seventy eight percent of the study group had bacterial growth compared to 33% in the control group. The tear osmolarity in both groups had no significant difference; mean in HIV positive being 312 mosml/litre; mean in control 306 mosml/litre. The Schirmer test also showed no significant difference, with the mean in HIV positive patients being 11 mm wetting, and in control patients being 12.7 mm wetting. Therefore, despite no symptomatic or clinical evidence of dry eyes, asymptomatic HIV-positive patients had markedly decreased levels of lactoferrin in tears and increased colony counts of bacterial flora in the lids.

Rapid detection and identification of pathogenic mycobacteria by combining radiometric and nucleic acid probe methods.

The combination of radiometric methodology (BACTEC 12B) and probe technology for recovery and identification of mycobacteria was studied in two large hospital laboratories. The sediment from vials with positive growth indices was tested with DNA probes specific for Mycobacterium tuberculosis, Mycobacterium avium, and Mycobacterium intracellulare. The sensitivity of the radiometric method and the specificity of the probes resulted in a marked reduction in the time to the final report. Biochemical testing could be eliminated on isolates giving a positive reaction with one of the probes. Some 176 isolates of M. tuberculosis, 110 of M. avium, and 5 of M. intracellulare were recovered. Two-thirds of these isolates were detected and identified within 2 weeks of inoculation and the remainder was detected by 4 weeks, a reduction of 5 to 7 weeks to the final report.

Preliminary evaluation of a rapid colorimetric method for identification of pathogenic Neisseria.

A rapid colorimetric method for the identification of pathogenic Neisseria (Identicult-Neisseria; Scott Laboratories, Inc.) based on beta-galactosidase, gamma-glutamylaminopeptidase, and gamma-prolylaminopeptidase is described. All 82 clinical isolates of Neisseria gonorrhoeae, 9 clinical isolates of N. meningitidis, and 5 clinical isolates of N. lactamica were correctly determined to the species level, as were 4 isolates of Branhamella catarrhalis. Reactions were prompt and easily interpreted. The system should be extremely useful in clinical laboratories.

Preliminary evaluation of a rapid colorimetric method for the presumptive identification of group A streptococci and enterococci.

A rapid colorimetric method for the presumptive identification of group A streptococci and enterococci based upon pyroglutamyl aminopeptidase activity is described. Of 76 group A streptococcal isolates from primary plates, 83 gave positive reactions, and the remaining 7 were positive on retesting in pure culture. Of the 31 enterococcal isolates tested, all gave positive reactions. Despite occasional positive reactions with staphylococci and Klebsiella pneumoniae, the test could be useful and cost-effective in the clinical laboratory.

Haemophilus influenzae susceptibility testing within four hours by a modification of the Autobac I system.

By adding an XV strip to the eugonic broth or substituting Levinthal broth, the standard Autobac I susceptibility testing system may be used to determine susceptibility of Haemophilus influenzae to antimicrobial agents. Complete concordance was attained in testing 30 strains (5 resistant) by Autobac I, disk diffusion, and broth dilution methods. Autobac I results were available within 4 h after isolation of the organism.