Abstract:AIM: To summarize and analyze the pathogen distribution and treatment experience in infants and young children with acute dacryocystitis, so as to explore an effective treatment strategy for this clinical emergency.
METHODS: Retrospective study. Infants with acute dacryocystitis who were treated at Hebei Eye Hospital from January 2015 to October 2023 were enrolled.Post-diagnosis,dacryocystic pus specimens were collected for bacterial culture,and antibiotic eye drops were administered for dacryocystic instillation and irrigation. The selection of antibiotics was adjusted based on antimicrobial susceptibility testing results.For patients aged ≥3 mo after acute inflammation control,dacryocystorhinostomy was performed. For patients <3 mo, dacryocystorhinostomy was performed after reaching 3 mo of age.
RESULTS: Thirty-four infants(34 eyes)with acute dacryocystitis were included in the study, comprising 18 males and 16 females, with an average age of 38.1±4.4 d. The pathogen detection rate was 88%(30 cases), with gram-positive cocci being the primary pathogens in 23 cases(77%), including Staphylococcus aureus in 12 cases(40%), Streptococcus pneumoniae in 4 cases(13%), Group A Streptococcus in 3 cases(10%), Staphylococcus epidermidis in 2 cases(7%), and Staphylococcus haemolyticus in 2 cases(7%). Gram-negative bacilli were detected in 7 cases(23%), including Escherichiacoli in 4 cases(13%), Citrobacter freundii in 2 cases(7%), and Stenotrophomonas maltophilia in 1 case(3%). Gram-positive cocci were more sensitive to vancomycin, rifampin, levofloxacin, and amikacin; Gram-negative bacilli were more sensitive to levofloxacin, tobramycin, aztreonam, and amikacin. Among the 34 patients, an average of 1-4 drug irrigation treatments were administered, with acute inflammation well controlled. Subsequent dacryocystoplasty successfully treated 33 cases, while 1 patient failed to achieve patency.
CONCLUSION: Gram-positive cocci constitute the primary causative agents of acute dacryocystitis in infants and young children. Levofloxacin and amikacin ophthalmic preparations can be used as empirical treatment for early-stage acute dacryocystitis in infants and young children. Sensitivity antibiotic eye drops administered via dacryocyst instillation and irrigation can effectively control acute inflammation, preparing for subsequent lacrimal duct probing.
