Lacrimal Sac Bacteriology and Susceptibility Pattern in Infants with Congenital Nasolacrimal Duct Obstruction in the 1st Year of Life: A Cross-Sectional Study 

Lacrimal Sac Bacteriology and Susceptibility Pattern in Infants with Congenital Nasolacrimal Duct Obstruction in the 1st Year of Life: A Cross-Sectional Study  | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Lacrimal Sac Bacteriology and Susceptibility Pattern in Infants with Congenital Nasolacrimal Duct Obstruction in the 1st Year of Life: A Cross-Sectional Study Xiaoyu Zheng, Bonnie Nga Kwan Choy, Mingming Zhou, Caiping Shi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-42405/v3 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Oct, 2020 Read the published version in BMC Pediatrics → Version 3 posted 2 You are reading this latest preprint version Show more versions Abstract Background: Congenital nasolacrimal duct obstruction (CNLDO) is one of the main causes of epiphora in infants, and antibiotics are usually used as a conservative therapy in the first year. Yet, little is known about the bacteriology of the occluded lacrimal drainage system in this group of patients. The aim of this study was to evaluate the microbiology of lacrimal sac (LS) in Chinese children with CNLDO in their first year of life. Methods: Patients with CNLDO between May 1, 2017 and August 31, 2018 at a tertiary care children’s hospital were enrolled. The study recruited infants who received lacrimal probing under 1 year old, and refluxed discharge from LS was collected. Samples were cultured and susceptibility test was performed for positive culture. Results: Thirty-two patients with CNLDO were included. The ratio of male to female was 23:9. The mean age was 6.7 ± 2.4 (1.7-12) months. Positive cultures was identified in 87.5% of the sample, and presented 38 strains of bacteria. Mixed infection was identified in 10 (31.3%) children. Gram-positive bacteria accounted for 60.5% of all the strains, with Streptococcus (50%) being the most frequent species, whereas Haemophilus (21.1%) and Neisseriae (13.2%) were most common isolates for Gram-negative organisms. Methicillin-resistant Staphylococcus aureus ( MRSA ) was detected in 2 infants whose symptoms resolved by a routine probing. No difference of bacteriology pattern was detected between patients under 6 months old and those beyond. The pathogens were highly sensitive to chloramphenicol (88%) and levofloxacin (84%), but resistant to erythromycin (40%) and sulfamethoxazole (32%). Conclusions: Infants with CNLDO under 1 year of age presented predominance of Streptococcus as Gram-positive organism, and Haemophilus as Gram-negative organism. Levofloxacin was an active topical antibiotic agent with few chance of resistance especially for Chinese children. These findings could help clinicians choose optimal medicine for CNLDO as the conservative treatments. Pediatrics Congenital nasolacrimal duct obstruction Infant Microbiology Lacrimal sac Levofloxacin Figures Figure 1 Figure 2 Background Congenital nasolacrimal duct obstruction (CNLDO) is one of the most common causes of tearing in infants, and as many as 11-20% of newborns could be affected by CNLDO [ 1 , 2 ]. First-line treatment modalities include frequent lacrimal sac (LS) massage and topical antibiotics for the patients passing discharge. If conservative therapy is ineffective, lacrimal duct probing would be advocated. Though controversy exists for the best timing for lacrimal probing [ 3 , 4 ], conservative treatment in the first year of life was generally recommended due the high spontaneous recovery rate of CNLDO [ 2 , 5 , 6 ]. Thus, it is essential to analyze the microbiology in the microhabitat of LS during the observation period for the patients in their first year of life, because infants have compromised immune system, and misuse of antibiotics could lead to growth of resistant bacteria, a delayed or maltreated CNLDO would lead to severe complications such as acute dacryocystitis, orbital cellulitis, sepsis or meningitis [ 7 ]. The previous studies reporting the bacteria strains of CNLDO have a wider age range, or varied ways of sample collection, and some papers are old [ 8-18 ]. Few of the studies focused merely on infants under 1 year of age [ 14 , 16 ], and few looked into the Chinese population [ 18 ]. The objective of this study was to analyze the current microbiology spectrum of CNLDO in Chinese children under 1 year old, and to compile a bacterial resistogram which could guide antibiotic regimen. Methods Study setting, design and population This study conformed to the provisions of the Declaration of Helsinki and was approved by the Institutional Research Ethics Board of Children’s Hospital Zhejiang University School of Medicine (ethical approval numer: 2020-IRB-087). Children under 1 year old with unilateral CNLDO who received early lacrimal duct probing from May 1, 2017, through August 31, 2018 were included. Patients with punctal or canalicular abnormalities, previous lacrimal duct irrigation, epiphora caused by diseases other than CNLDO and previous usage of systemic antibiotics were excluded. The medical records of all the subjects were reviewed. Demographic data including the age, sex, residence, and clinical parameters including manifestation of CNLDO, success rates of probing, microbiology culture results, and susceptibility test were collected. Culture results, whether positive or negative, were reviewed and divided into groups according to the strains identified. Treatment methods and sample collection The diagnosis of CNLDO was made in infants with epiphora, increased tear lake and discharge, and confirmed by probing thereafter. All of them had been treated by conservative methods such as Crigler’s LS massage [ 19 ]. Levofloxacin, a broad-spectrum antibiotic eye drop, was used if they presented with purulent discharge or any symptoms of ophthalmic infection; if ineffective, tobramycin would be used. No systemic antimicrobial agents were given. Lacrimal duct probing was recommended for the patients who had refractory conjunctivitis that needed continuous use of antibiotics for more than 1 week, patients with severe canthal eczema caused by epiphora, and those whose parents had strong desire for early probing because of their severe anxiety about the babies’ symptoms, poor compliance to LS massage treatment, or inconvenience in follow-up visits. All the lacrimal probings were done by a single senior ophthalmologist (Dr. XYZ). After local anesthesia, an antiseptic with 5% povidone-iodine was applied to the conjunctival sac, lid margin and periocular skin. A syringe was passed through the upper punctum after punctal dilation, and normal saline was irrigated, aiming to open up the obstruction. A reflux of discharge was collected with cotton swab during syringing. If high-pressure irrigation could not open the nasolacrimal duct, probing was performed with a #6 stainless steel lacrimal probe in the same session. Microbiology investigation The clinical specimens were inoculated into Columbia blood agar and Haemophilus Chocolate agar (BioMérieux, France), and incubated in 5% CO2 for 18-24 hours. At the same time, the samples were incubated anaerobically into Columbia blood agar in GENbox anaer (BioMérieux, France). Sabouraud agar (Antu, China) was used for fungal culture. The colonies were identified using Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS, Bruker). Antimicrobial susceptibility test was performed with commercialized microdilution method (VITEK COMPACT, BioMérieux, France) or disk diffusion method, as appropriate, and the isolates were divided into susceptible or non-susceptible (intermediate and resistant) categories according to the breakpoints available from Clinical Laboratory Standards Institute (CLSI) guidelines M100-S28. Statistical methods Statistical analysis was performed using SPSS software, version 20 (SPSS Inc., Chicago, IL). Means and standard deviations were used for continuous variables, rates and percentages were used for categorical variables. Bacteria characteristics according to subjects’ age groups were analyzed with Fisher exact tests. Value of P < 0.05 was considered statistically significant. Subgroup analysis was performed for those under 6 months old vs those beyond 6 months old. The division was made on the basis that stagnant bacteria might reduce the success rate of probing after 6 months of age by inflammatory tissue remodling [ 20 , 21 ], and that the bacteria might be changed by intermittent use of local antibiotics. Results This study included 32 consecutive otherwise healthy infants with unilateral CNLDO consisting of 23 (71.9%) males and 9 (28.1%) females. Except for 6 patients who did not indicate their residence, 15 (57.7%) children lived in downtown and 11 (42.3%) in countryside. Tearing and purulent discharge were presented in all the patients, who recovered completely after lacrimal probings without developing severe infections such as acute dacryocystitis before or after the procedure. The patients’ age at probing ranged between 1.7 and 12 months, with a mean of 6.7 ± 2.4 months. Among the 32 collected samples, 28 (87.5%) positive cultures were identified, yielding a total of 38 strains of 19 different bacteria. None of the isolates was anaerobic bacterium or fungus. Sixteen (57.1%) samples yielded only Gram-positive bacteria, 7 (25%) only Gram-negative, and 5 (17.9%) both. Table 1 summarizes the details of bacterial strains isolated in CNLDO. In 23 (60.5%) Gram-positive strains, Streptococcus was the most frequent species (50%), among which Streptococcus pneumoniae ( S. pneumoniae ) (23.7%) was predominant, followed by Streptococcus mitis (10.5%). Methicillin-resistant Staphylococcus aureus ( MRSA ) was detected in 2 (6.3%) infants. In 15 (39.5%) Gram-negative organisms, Haemophilus species (21.1%) and Neisseriae species (13.2%) were commonly isolated. For the former type, Haemophilus influenzae ( H. influenza e) and Haemophilus haemolyticus were often identified, both accounting for 7.9%. There was no significant difference with respect to the bacteria spectrum between patients under 6 months old and those beyond (Table 2). Ten mixed cultures (31.3%) were identified with 2 bacterial isolates in a single sample. More patients beyond 6 months old had mixed cultures, but no difference of co-colonization rate was found compared to that of patients under 6 months old ( P = 0.226). Antibiotic susceptibility results were obtained in 22 patients (78.6%). In general, bacteria in CNLDO were most sensitive to chloramphenicol (88%), followed by levofloxacin (84%), ceftriaxone (80%) and vancomycin (76%). Streptococcus species exhibited high rates of sensitivity to chloramphenicol (100%), ceftriaxone (94.4%), cefotaxime (94.4%), and vancomycin (94.4%). Erythromycin and sulfamethoxazole were proven to be ineffective in 40% and 32% of the isolates, respectively. Furthermore, 55.6% of Streptococcus species showed resistance towards erythromycin. Levofloxacin, which is the most commonly used topical antibiotics in our practice, exhibited a non-susceptibility rate of 16% in all the bacteria. The sensitivity patterns of microorganisms to antibiotic agents routinely tested are presented in Figure 1 and 2. Four patients presented pathogens resistant to levofloxaxin and 3 were beyond 6 months of age. However, the non-susceptibility rate did not differ significantly between infants under and beyond 6 months old ( P = 0.616), though the older group of patients might use levofloxaxin eye drops intermittently for a longer time during the conservative treatment (Table 2). Discussion Our study was one of the larger studies targeted at children under 1 year old in China. It demonstrated a high positive culture rate in infantile CNLDO. Among all the colonization, S. pneumoniae was the major isolate. Haemophilus and Neisseriae species were also commonly detected colonies. Chloramphenicol and levofloxacin were active agents for most of the pathogens in CNLDO, while erythromycin and sulfamethoxazole were proven to be resisted in a relatively high proportion. There have been a few studies investigating the microbiology in CNLDO, and the bacterial spectrum varies among different age groups and changes over time (Table 3) [ 8-11 , 13-18 ]. Most of the previous literatures included both infants and young children. Only 2 studies focused on infants under 1 year old, which were published 2 to 3 decades ago. The latter revealed a prevalent growth of Staphylococcus aureus ( S. aureus ) with a positive culture rate of 8.9-25%, and few evidence of S. pneumoniae infection (0-2%) [ 14 , 16 ]. It was inconsistent with our observation, where S. pneumoniae constituted for a major proportion of 32.1% and MRSA only 7.1%. Though the details of topical antibiotics which the infants used before probing were not mentioned in these 2 literatures, we speculate that this could cause the differences of microorganisms detected in CNLDO [ 14 ]. Microbiota varies in different microhabitats of human eyes. The ocular surface, conjunctiva, lid margin and skin might show respective distinct bacterial spectra [ 22 ]. The sampling location is vital to the analysis of microbiome in CNLDO patients. In most of the previous studies, the samples were obtained from conjunctival discharge by compressing LS. The specimen could be contaminated by the conjunctiva or lid margin, or sometimes little discharge with insufficient bacterial load could be obtained. In our study, we first sterilized the conjunctival sac, palpebral margin and skin, then collected the refluxed secretion from the lacrimal puncta by irrigation. This procedure would ensure maximum amount of specimen from LS. Up till now, there have been 3 studies collecting irrigation samples of CNLDO, and they were investigated in Germany and Korea more than 10 years ago [ 9 , 14 , 15 ]. These literatures showed a high growth of S. aureus (13-25%), a low growth of Neisseriae (0.8-2%) and a variable clustering of S. pneumoniae (2-31%). The above were in contrast to our study which showed that Streptococcus and Neisseriae species were the most common, whereas S. aureus was a rare isolate. The difference could be attributed to microbiol changes with time, race or locality. Prokosch’s studies were 10 years later than Kim’s, and the former showed prevalence of S. pneumoniae which was similar to ours [ 9 , 14 , 15 ]. The Korean children Kim reported were closer to our patients with respect to race (both Asians) and locality compared to those in Prokosch’s studies conducted in Germany, which showed a much fewer isolation of S. pneumoniae . Prior antibiotic use might influence the result, and lead to a relatively low positive culture rate (64% vs 87.5% in our study, 97% in Prokosch’s studies) [ 14 ]. Non-gonococcal, non-meningococcal Neisseriae were rarely reported in CNLDO. Antibiotic sensitivity tests of Neisseriae were not routinely performed in our hospital. Whether the bacteria are not susceptible to levofloxacin or tobramycin, or Chinese are genetically more susceptible to Neisseriae infection needs further study to prove. S. aureus was one of the most common bacterial pathogens in neonatal conjunctivitis with a positive rate of 17-37.4% about 30 years ago [ 23 , 24 ]. However, a study from southern China revealed a declining trend of S. aureus from 2002 to 2016, which was assumed to be attributed to antibiotics abuse [ 25 ]. In our study, we advised patients with conjunctivitis to use levofloxacin every time they passed purulent discharge before probing could be performed, which might lead to no detection of S. aureus, and the result was consistent with that of A. Kuchar [ 8 ]. So far, MRSA has been rarely isolated from infants with CNLDO. Sylvia Kodsi reported a case of MRSA cultured from the regurgitated pus in an 8.5-month-old child [ 26 ], while the other 2 cases demonstrated its overgrowth in conjunctiva and blood, respectively [ 27 , 28 ]. MRSA could be related to chronic systemic antibiotics administration [ 24 ], recent hospitalization [ 25 ] or vertical transmission from the mother [ 26 ]. Our study identified 2 infants with MRSA colonization in a total of 32 patients. No prior systemic antibiotics were used, no special signs of infection were detected in the infants and their family members, and their ocular symptoms resolved completely after an uneventful probing without causing any other infectious diseases. H. influenza e and S. pneumoniae were reported to be prevalent bacteria in CNLDO patients with a wider range of age (Table 3), both pathogens can induce bacteremia after lacrimal probing [ 29 , 30 ], and S. pneumoniae can cause severe endophthalmitis following glaucoma or cataract surgeries [ 31 , 32 ]. Neisseriae species are part of the normal flora in respiratory system. Non-gonococcal, non-meningococcal Neisseriae are usually not pathogenic, but they can still lead to severe infections such as sepsis and endocarditis on occasion [ 33 ]. Since the high prevalences of Streptococcus, Haemophilus and Neisseriae were reported in our study, empirical use of antibiotics against these bacteria should be considered as the initial treatment if the infants with CNLDO develop sepsis. Furthermore, the need of investigating the bacteriology after lacrimal probing should be emphasized. By knowing the prevalent bacteria and susceptibility results in CNLDO, it which could help prepare the doctors in treating the potential severe infections especially in young children. Since bacterial conjunctivitis occurs intermittently in CNLDO, topical antibiotics should be given when a purulent discharge is present [ 34 ]. It’s crucial to make prudent choice of antibiotic eye drops for infants, because they might require long term use of eye drops until the infection is treated. Chloramphenicol and levofloxacin were reported to be the most active according to our susceptibility test, and are usually used as topical eye drops instead of systemic antibiotics. Though literatures of infants under 1 year old are uncommon, levofloxacin is still deemed as an effective and safe antibiotic for infants with bacterial conjunctivitis [ 35 , 36 ]. Despite the activity of chloramphenicol against most bacteria in CNLDO, its ineffectiveness has been reported in pediatric conjunctivitis [ 37 ]. Furthermore, it is contraindicated in children with G6PD deficiency, which is common in southern China [ 38 ], and some doctors have concern for its possible side effects of gray baby syndrome and aplastic anemia in newborn [ 39 , 40 ]. It is noteworthy that tobramycin, a commonly prescribed medicine in pediatric clinic [ 18 ], may sometimes be ineffective in CNLDO according to literature review (Table 3). Erythromycin, another frequently prescribed ophthalmic prescription [ 41 ], is proven to be ineffective for CNLDO, which is in accordance with most of the previous studies regardless of the year of study. Above all, topical administration of levofloxacin would be a better choice for Chinese infantile CNLDO with purulent discharge. Pollard reported that 2.9% of infants with CNLDO would develop acute dacryocystitis [ 42 ], among which, 22.7% were concurrent with bacteremia [ 43 ]. In such situation, antibiotics are usually given intravenously, including penicillins, cephalosporins, clindamycin, and vancomycin [ 7 ], which are consistent with our study. The limitations of the study lie in the following aspects: 1. the preceding usage of antibiotics could influence the bacteria profile; 2. our hospital is a tertiary referral institution of CNLDO in Zhejiang which is a well-developed province in southern China. The hospital-based study represent the local condition, but might not represent the other areas in China; 3. the bacteriology of asymptomatic CNLDO might not be included; 4. variation of the bacterial spectrum with age was not certain; 5. retrospective design of the study hindered absolute standardization of intervention and data collection, which in turn reduce the level of evidence. However, the strength of this study is a large sample size focusing only on infants under 1 year old, and the unified treatment strategy and a reasonable way of collecting LS specimen. For the further study, a prospective, multi-centered investigation involving more patients of broader age spectrum with both symptomatic and asymptomatic CNLDO should be conducted. Conclusions The current study shows that the presence of microorganisms is common in infantile CNLDO, and investigating the LS bacteriology after probing is essential. A high rate of isolation of Streptococcus, Haemophilus and Neisseriae species was found in infants with CNLDO. MRSA infection occurred occasionally. With early probing, we got the latest evidence of LS microbial profile in the first year of life. Most doctors would adopt a conservative approach during this period of time, and thus the choice of topical antibiotics for the relatively frequent occurrence of conjunctivitis would be of concern. The present study shows that topical levofloxacin would be a good choice as an empirical treatment during the expectant period, especially in China. Abbreviations CLSI: Clinical Laboratory Standards Institute; CNLDO: Congenital nasolacrimal duct obstruction; H. influenza e: Haemophilus influenzae ; LS: Lacrimal sac; MRSA: Methicillin-resistant Staphylococcus aureus ; S. aureus : Staphylococcus aureus ; S. pneumoniae: Streptococcus pneumoniae Declarations Acknowledgements We would like to thank all fund providers, participating parents and children who made this study possible. Authors’ contributions XYZ developed the project and wrote the manuscript; BNKC analyzed data, and revised the manuscript; MMZ and CPS collected data; ZYZ interpretated data. All authors read and approved the final manuscript. Funding This study was supported by the Zhejiang Provincial Natural Science Foundation (No. LSY19H180011) and the Health Department of Zhejiang Province, China (Grant 2016KYA130). The sponsor or funding organizations had no role in the design or conduct of this research. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The Ethics Committee of Children’s Hospital Zhejiang University School of Medicine approved this retrospective study and waived informed consent to participate who received medical treatment at Children’s Hospital Zhejiang University School of Medicine. (No. 2020-IRB-087) Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Author details 1, 4 Department of Ophthalmology, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China. 2 Department of Ophthalmology, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China. 3 Department of Clinical Lab, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China. 5 Department of Child Health Care, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China. References Sathiamoorthi S, Frank RD, Mohney BG. Incidence and clinical characteristics of congenital nasolacrimal duct obstruction. Br J Ophthalmol. 2019;103(4):527-9. MacEwen CJ, Young JD. Epiphora during the first year of life. Eye (Lond). 1991;5 (Pt 5):596-600. Petris C, Liu D. Probing for congenital nasolacrimal duct obstruction. Cochrane Database Syst Rev. 2017;7(7):CD011109. Pediatric Eye Disease Investigator G. A randomized trial comparing the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction. Arch Ophthalmol. 2012;130(12):1525-33. Kakizaki H, Takahashi Y, Kinoshita S, Shiraki K, Iwaki M. The rate of symptomatic improvement of congenital nasolacrimal duct obstruction in Japanese infants treated with conservative management during the 1st year of age. Clin Ophthalmol. 2008;2(2):291-4. Vagge A, Ferro Desideri L, Nucci P, Serafino M, Giannaccare G, Lembo A, Traverso CE. Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases. 2018;6(4):96. Ali MJ. Pediatric Acute Dacryocystitis. Ophthalmic Plast Reconstr Surg. 2015;31(5):341-7. Kuchar A, Lukas J, Steinkogler FJ. Bacteriology and antibiotic therapy in congenital nasolacrimal duct obstruction. Acta Ophthalmol Scand. 2000;78(6):694-8. Prokosch V, Prokosch JE, Promesberger J, Idelevich EA, Bohm MR, Thanos S, Stupp T. Bacterial spectrum and antimicrobial susceptibility patterns in acquired and connatal lacrimal duct stenosis. Curr Eye Res. 2014;39(11):1069-75. Al-Faky YH, Naeem T, Al-Sobaie N, Al-Huthail R, Al-Odan H, Osman EA, Mousa A. Value of microbiology study in congenital nasolacrimal duct obstruction. Saudi J Ophthalmol. 2012;26(2):223-8. Usha K, Smitha S, Shah N, Lalitha P, Kelkar R. Spectrum and the susceptibilities of microbial isolates in cases of congenital nasolacrimal duct obstruction. J AAPOS. 2006;10(5):469-72. Gerkowicz M, Koziol-Montewka M, Pietras-Trzpiel M, Kosior-Jarecka E, Szczepanik A, Latalska M. Identification of bacterial flora of conjunctival sac in congenital nasolacrimal duct obstruction in children. Klin Oczna. 2005;107(1-3):83-5. Bareja U, Ghose S. Clinicobacteriological correlates of congenital dacryocystitis. Indian J Ophthalmol. 1990;38(2):66-9. Kim YS, Moon SC, Yoo KW. Congenital nasolacrimal duct obstruction: irrigation or probing? Korean J Ophthalmol. 2000;14(2):90-6. Prokosch V, Prokosch JE, Promesberger J, Thanos S, Stupp T. [Bacteriology of occluded nasolacrimal ducts in infants]. Klin Monbl Augenheilkd. 2010;227(7):585-8. MacEwen CJ, Phillips MG, Young JD. Value of bacterial culturing in the course of congenital nasolacrimal duct (NLD) obstruction. J Pediatr Ophthalmol Strabismus. 1994;31(4):246-50. Bekmez S, Eris E, Altan EV, Dursun V. The Role of Bacterial Etiology in the Tear Duct Infections Secondary to Congenital Nasolacrimal Duct Obstructions. J Craniofac Surg. 2019;30(7):2214-6. Wong VW, Lai TY, Chi SC, Lam DS. Pediatric ocular surface infections: a 5-year review of demographics, clinical features, risk factors, microbiological results, and treatment. Cornea. 2011;30(9):995-1002. Crigler LW. The treatment of congenital dacryocystitis. JAMA. 1923;81(23-4. Katowitz JA, Welsh MG. Timing of initial probing and irrigation in congenital nasolacrimal duct obstruction. Ophthalmology. 1987;94(6):698-705. Kashkouli MB, Beigi B, Parvaresh MM, Kassaee A, Tabatabaee Z. Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure? Br J Ophthalmol. 2003;87(9):1151-3. Ozkan J, Willcox M, Wemheuer B, Wilcsek G, Coroneo M, Thomas T. Biogeography of the human ocular microbiota. Ocul Surf. 2019;17(1):111-8. Sandstrom KI, Bell TA, Chandler JW, Kuo CC, Wang SP, Grayston JT, Foy HM, Stamm WE, Cooney MK, Smith AL et al . Microbial causes of neonatal conjunctivitis. J Pediatr. 1984;105(5):706-11. Rao K, Ramji S, Thirupuram S, Prakash K. Clinical and bacteriological study of normal and inflamed neonatal conjunctivae. Indian Pediatr. 1992;29(2):161-5. Tang S, Li M, Chen H, Ping G, Zhang C, Wang S. A chronological study of the bacterial pathogen changes in acute neonatal bacterial conjunctivitis in southern China. BMC Ophthalmol. 2017;17(1):174. Kodsi S. Community-acquired methicillin-resistant Staphylococcus aureus in association with chronic dacryocystitis secondary to congenital nasolacrimal duct obstruction. J AAPOS. 2006;10(6):583-4. Siddiqui SN, Zafar SN. Congenital Cataract, Nasolacrimal Duct Obstruction, and Methicillin-Resistant Staphylococcus aureus Conjunctivitis: When to Operate? J Pediatr Ophthalmol Strabismus. 2016;53 Online(e29-31. Rutar T. Vertically acquired community methicillin-resistant Staphylococcus aureus dacryocystitis in a neonate. J AAPOS. 2009;13(1):79-81. Eippert GA, Burnstine RA, Bates JH. Lacrimal-duct-probing-induced bacteremia: should children with congenital heart defects receive antibiotic prophylaxis? J Pediatr Ophthalmol Strabismus. 1998;35(1):38-40. Ganguly A, Ali MJ, Padmaja K, Sharma S, Lakshmi V, Naik MN. Bacteremia Following Nasolacrimal Duct Probing: Is There a Role of Preoperative Antibiotic Prophylaxis? Ophthalmic Plast Reconstr Surg. 2016;32(2):90-2. Sidoti PA, Lopez PF, Michon J, Heuer DK. Delayed-onset pneumococcal endophthalmitis after mitomycin-C trabeculectomy: association with cryptic nasolacrimal obstruction. J Glaucoma. 1995;4(1):11-5. Good WV, Hing S, Irvine AR, Hoyt CS, Taylor DS. Postoperative endophthalmitis in children following cataract surgery. J Pediatr Ophthalmol Strabismus. 1990;27(6):283-5. Feder HM, Jr., Garibaldi RA. The significance of nongonococcal, nonmeningococcal Neisseria isolates from blood cultures. Rev Infect Dis. 1984;6(2):181-8. Schnall BM. Pediatric nasolacrimal duct obstruction. Curr Opin Ophthalmol. 2013;24(5):421-4. Lichtenstein SJ, Rinehart M, Levofloxacin Bacterial Conjunctivitis Study G. Efficacy and safety of 0.5% levofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis in pediatric patients. J AAPOS. 2003;7(5):317-24. Schwab IR, Friedlaender M, McCulley J, Lichtenstein SJ, Moran CT, Levofloxacin Bacterial Conjunctivitis Active Control Study G. A phase III clinical trial of 0.5% levofloxacin ophthalmic solution versus 0.3% ofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis. Ophthalmology. 2003;110(3):457-65. Rose PW, Harnden A, Brueggemann AB, Perera R, Sheikh A, Crook D, Mant D. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9479):37-43. Lin F, Lou ZY, Xing SY, Zhang L, Yang LY. The gene spectrum of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Guangdong province, China. Gene. 2018;678(312-7. Pineiro-Carrero VM, Pineiro EO. Liver. Pediatrics. 2004;113(4 Suppl):1097-106. Lepow ML. Aplastic anemia following chloramphenicol therapy still happens! Pediatrics. 1986;77(6):932-3. Ulanovsky I, Shnaider M, Geffen Y, Smolkin T, Mashiah T, Makhoul IR. Erythromycin Prophylaxis for Neonatal Conjunctivitis: Ointment Versus Drops. Isr Med Assoc J. 2016;18(7):404-6. Pollard ZF. Treatment of acute dacryocystitis in neonates. J Pediatr Ophthalmol Strabismus. 1991;28(6):341-3. Baskin DE, Reddy AK, Chu YI, Coats DK. The timing of antibiotic administration in the management of infant dacryocystitis. J AAPOS. 2008;12(5):456-9. Tables Table 1 Bacteriology of children with CNLDO under 1 year of age Bacteria isolated Number of isolates % of isolates (n=38) % of samples (n=32) Gram-positive bacteria 23 60.5 65.6 Streptococci species 19 50.0 59.4 Streptococcus pneumoniae 9 23.7 28.1 Streptococcus mitis 4 10.5 12.5 Streptococcus anginosus 2 5.3 6.3 Streptococcus oralis 1 2.6 3.1 Streptococcus contellatus 1 2.6 3.1 Streptococcus intermedius 2 5.3 6.3 Others Staphylococc us aureus (MRSA) 2 5.3 6.3 Gemella haemolysans 1 2.6 3.1 Corynebacterium macginleyi 1 2.6 3.1 Gram-negative bacteria 15 39.5 37.5 Haemophilus species 8 21.1 25.0 Haemophilus influenzae 3 7.9 9.4 Haemophilus parainfluenzae 1 2.6 3.1 Haemophilus haemolyticus 3 7.9 9.4 Haemophilus aphrophilus 1 2.6 3.1 Neisseriae species 5 13.2 15.6 Neisseriae flavescens 1 2.6 3.1 Neisseriae sicca 1 2.6 3.1 Neisseriae elongata 1 2.6 3.1 Neisseriae macacae 2 5.3 6.3 Others Stenotrophomonas maltophilia 1 2.6 3.1 Capnocytophaga sputigena 1 2.6 3.1 Anaerobic organisms 0 0 0 Fungas 0 0 0 Note: CNLDO = congenital nasolacrimal duct obstruction, MRSA = methicillin-resistant Staphylococcus aureus. Table 2 Comparison of bacteria profile of 2 subgroups demarcated by 6 months old Age (month) No. of cases Positive samples Mixed cultures Gram staining Dominant strains Resistance to levofloxacin Pos Neg Pos+Neg Streptococci Haemophilus Neisseria 6 20 17 8 9 4 4 12 6 3 3 P value 1.000 0.226 0.758 1.000 0.419 1.000 0.616 Note: Pos = positive, Neg = negative. P value for Fisher exact tests Table 3 Review of bacterial pathogen patterns in patients with CNLDO [ 8-11 , 13-18 ] Study Year of study Country No. of cases Age range (mean) Positive culture rate (%) Mixed infection rate (%) Sample collection method Dominant bacteria (%) Sensitivity test (%) Non-susceptibility (%) Zheng (our study) 2017-2018 China 32 1.7-12 mons (6.6 mons) 87.5 35.7 Irrigation Streptococcus pneumoniae (23.7) Streptococcus mitis (10.5) Haemophilus influenzae (7.9) Haemophilus haemolyticus (7.9) Neisseriae (13.2) Chloramphenicol (88) Levofloxacin (84) Ceftriaxone (80) Erythromycin (40) Sulfamethoxazole (32) Bekmez 2017-2018 Turkey 70 12-36 mons (25 mons) 28.6 NA Conjunctival swab Haemophilus haemolyticus (20) Haemophilus influenzae (20) Ciprofloxacine (85) Tetracycline (60) Gentamicin (40) Penicilin (40) NA Prokosch 2007-2012 Germany 132 0-60 mons (27 mons) 97 87 Pressure over LS or irrigation Streptococcus pneumoniae (28.5) Staphylococcus aureus (18.3) Haemophilus influenzae (8.7) Moraxella catarrhalis (8.5) Ciprofloxacin (99) Chloramphenicol (97) Tobramycin (95) Levofloxacin (95) Penicillin (65) Erythromycin (41) Gentamicin (22) Wong 2005-2010 China 16 0-84 mons (26.4mons) 43.7 12.5 Conjunctival scraping Streptococcus pneumoniae (18.8) Haemophilus influenzae (12.5) NA NA Kuchar NA (before 2000) Austria 47 8-36 mons (21 mons) 70 40 Pressure over LS Streptococcus pneumoniae (36.4) Haemophilus influenzae (19.2) Ofloxacin (84) Tetracycline (84) Chloramphenicol (84) Ciprofloxacin (62) Norfloxacin (60) Neomycin (63) Gentamycin (54.8) Tobramycin (57.5) AL-Faky 1998-2008 Saudi Arabia 141 1-108 mons (29.9 mons) 87.9 25.4 Pressure over LS Streptococcus pneumoniae (48.1) Haemophilus influenzae (39.2) Moraxella catarrhalis (12.7) Staphylococcus aureus (6.6) Bacitracin (NA) Polymyxin B (NA) NA Prokosch 2007 Germany 66 6-16 mons 97 87 Irrigation Gram-pos: Streptococcus pneumoniae (31) Staphylococcus aureus (13) Streptococcus epidermidis (13) Gram-neg: Branhamella (12) Haemophilus influenzae (11) Chloramphenicol (99) Fusidic acid (99) Ciprofloxacin (99) Levofloxacin (95) Tobramycin (95) Erythromycin (41) Gentamycin (22) Usha NA (before 2006) India 187 0-60 mons (14 mons) 83 11.7 Pressure over LS Streptococcus pneumoniae (32.7) Haemophilus influenzae (31.3) Streptococcus viridans (14.7) Gram-pos: Chloramphenicol (98) Vancomycin (82) Ofloxacin (75) Gram-neg: Ofloxacin (83) Ciprofloxacin (81) Gram-pos: Tobramycin (90) Gentamycin (66) Gram-neg: Amikacin (44) Gentamycin (40) Tobramycin (43) Kim 1996-1999 Korea 50 0.7-12 mons 64 0 Irrigation Staphylococcus aureus (25) Pseudomonas aeruginosa (15.6) Staphylococcus aureus: Vancomycin (100) Ciprofloxacin (87.5) Pseudomonas aeruginosa ： Ciprofloxacin (100) Amikacin (100) Getamicin (NA) Penicillin G (NA) Bareja NA (before 1990) India 87 NA 67.5 0.9 Conjunctival swab with or without pressure over LS Streptococcus pneumoniae (28.9) Staphylococcus aureus (13.2) Cloxacillin (77) Erythromycin (68) Gentamicin (46.9) Penicilin (100) Streptomycin (97) Polymixin B (98) MacEwen 1988 UK 158 0-12 mons 19.6 0.6 Conjunctival swab Haemophilus influenzae (12) Staphylococcus aureus (8.9) Moraxella catarrhalis (2.5) NA NA Note: LS = lacrimal sac, Mons = months, NA = not applicable. Supplementary Files dataBMC.xlsx Cite Share Download PDF Status: Published Journal Publication published 06 Oct, 2020 Read the published version in BMC Pediatrics → Version 3 posted Submission checks completed at journal 22 Sep, 2020 Editorial decision: Accept 22 Sep, 2020 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-42405","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":2635876,"identity":"f50f0162-42d6-44bc-843e-f2f122c0b7f0","order_by":0,"name":"Xiaoyu Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYBACAwkGhgMMFTVyIIqBgY1oLWeOGZOmhYGxjTmxAcwlRou5dO/Bg1/OsKXPbzxjwPCh7DAD/+wG/Fos55xLOCxTIZPb2HDGgHHGucMMEncOEHDYjRyDwxJn2HKbGc4YMPO2HQY6NYEILZJtzOlsIC1/idVy8GMbcwIPSAsjMVrAfgEGsuEMhmMFB3vOpfNI3CCgBRhihz/+qKiRl59xeOODH2XWcvwzCGhhYOBhYOYB0RIHwJHJQ0g9WA3jDxDN30CE4lEwCkbBKBiRAABoYknE7leilwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-8286-4950","institution":"Zhejiang University School of Medicine Children's Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Xiaoyu","middleName":"","lastName":"Zheng","suffix":""},{"id":2635877,"identity":"a2159c6e-9233-4de0-90a3-18d98758e8bd","order_by":1,"name":"Bonnie Nga Kwan Choy","email":"","orcid":"","institution":"University of Hong Kong","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bonnie","middleName":"Nga Kwan","lastName":"Choy","suffix":""},{"id":2635878,"identity":"2c27bc66-5fd4-4960-80bb-f06a28b64814","order_by":2,"name":"Mingming Zhou","email":"","orcid":"","institution":"Zhejiang University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mingming","middleName":"","lastName":"Zhou","suffix":""},{"id":2635879,"identity":"6b209992-32bd-4d91-b981-1d00748ec7b4","order_by":3,"name":"Caiping Shi","email":"","orcid":"","institution":"Zhejiang University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Caiping","middleName":"","lastName":"Shi","suffix":""},{"id":2635880,"identity":"31c4309f-d446-4108-bcea-29a8ffb3eaa2","order_by":4,"name":"Zhengyan Zhao","email":"","orcid":"","institution":"Zhejiang University School of Medicine Children's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhengyan","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2020-07-13 19:27:56","currentVersionCode":3,"declarations":"","doi":"10.21203/rs.3.rs-42405/v3","doiUrl":"https://doi.org/10.21203/rs.3.rs-42405/v3","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-020-02358-5","type":"published","date":"2020-10-06T12:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":2555309,"identity":"473f475c-556d-40c8-ac61-ac809f86d799","added_by":"auto","created_at":"2020-09-23 13:47:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":58986,"visible":true,"origin":"","legend":"Susceptibility rates of bacterial isolates in CNLDO against different antibiotics.","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-42405/v3/Fig1.png"},{"id":2555310,"identity":"8d4b95f6-08ba-488c-b80a-10873ec4b6c9","added_by":"auto","created_at":"2020-09-23 13:47:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29311,"visible":true,"origin":"","legend":"Non-susceptibility rates of bacterial isolates in CNLDO against different antibiotics.","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-42405/v3/Fig2.png"},{"id":13595948,"identity":"9cee0eb9-adb4-4547-88d7-212271e1af7c","added_by":"auto","created_at":"2021-09-17 05:26:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":429618,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-42405/v3/67962be3-b54f-492d-96f2-c97e5eced16e.pdf"},{"id":2555312,"identity":"b5ab4077-6961-4229-8f88-6557f2c38d7e","added_by":"auto","created_at":"2020-09-23 13:47:51","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":11631,"visible":true,"origin":"","legend":"","description":"","filename":"dataBMC.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-42405/v3/dataBMC.xlsx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eLacrimal Sac Bacteriology and Susceptibility Pattern in Infants with Congenital Nasolacrimal Duct Obstruction in the 1st Year of Life: A Cross-Sectional Study\u0026nbsp;\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eCongenital nasolacrimal duct obstruction (CNLDO) is one of the most common causes of tearing in infants, and as many as 11-20% of newborns could be affected by CNLDO [\u003ca href=\"#_ENREF_1\"\u003e1\u003c/a\u003e, \u003ca href=\"#_ENREF_2\"\u003e2\u003c/a\u003e]. First-line treatment modalities include frequent lacrimal sac (LS) massage and topical antibiotics for the patients passing discharge. If conservative therapy is ineffective, lacrimal duct probing would be advocated. Though controversy exists for the best timing for lacrimal probing [\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e, \u003ca href=\"#_ENREF_4\"\u003e4\u003c/a\u003e], conservative treatment in the first year of life was generally recommended due the high spontaneous recovery rate of CNLDO [\u003ca href=\"#_ENREF_2\"\u003e2\u003c/a\u003e, \u003ca href=\"#_ENREF_5\"\u003e5\u003c/a\u003e, \u003ca href=\"#_ENREF_6\"\u003e6\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eThus, it is essential to analyze the microbiology in the microhabitat of LS during the observation period for the patients in their first year of life, because infants have compromised immune system, and misuse of antibiotics could lead to growth of resistant bacteria, a delayed or maltreated CNLDO would lead to severe complications such as acute dacryocystitis, orbital cellulitis, sepsis or meningitis [\u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe previous studies reporting the bacteria strains of CNLDO have a wider age range, or varied ways of sample collection, and some papers are old [\u003ca href=\"#_ENREF_8\"\u003e8-18\u003c/a\u003e]. Few of the studies focused merely on infants under 1 year of age [\u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e, \u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e], and few looked into the Chinese population [\u003ca href=\"#_ENREF_18\"\u003e18\u003c/a\u003e]. The objective of this study was to analyze the current microbiology spectrum of CNLDO in Chinese children under 1 year old, and to compile a bacterial resistogram which could guide antibiotic regimen.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting, design and population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study conformed to the provisions of the Declaration of Helsinki and was approved by the Institutional Research Ethics Board of Children\u0026rsquo;s Hospital Zhejiang University School of Medicine (ethical approval numer: 2020-IRB-087). Children under 1 year old with unilateral CNLDO who received early lacrimal duct probing from May 1, 2017, through August 31, 2018 were included. Patients with punctal or canalicular abnormalities, previous lacrimal duct irrigation, epiphora caused by diseases other than CNLDO and previous usage of systemic antibiotics were excluded.\u003c/p\u003e\n\u003cp\u003eThe medical records of all the subjects were reviewed. Demographic data including the age, sex, residence, and clinical parameters including manifestation of CNLDO, success rates of probing, microbiology culture results, and susceptibility test were collected. Culture results, whether positive or negative, were reviewed and divided into groups according to the strains identified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment methods and sample collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe diagnosis of CNLDO was made in infants with epiphora, increased tear lake and discharge, and confirmed by probing thereafter. All of them had been treated by conservative methods such as Crigler\u0026rsquo;s LS massage [\u003ca href=\"#_ENREF_19\"\u003e19\u003c/a\u003e]. Levofloxacin, a broad-spectrum antibiotic eye drop, was used if they presented with purulent discharge or any symptoms of ophthalmic infection; if ineffective, tobramycin would be used. No systemic antimicrobial agents were given. Lacrimal duct probing was recommended for the patients who had refractory conjunctivitis that needed continuous use of antibiotics for more than 1 week, patients with severe canthal eczema caused by epiphora, and those whose parents had strong desire for early probing because of their severe anxiety about the babies\u0026rsquo; symptoms, poor compliance to LS massage treatment, or inconvenience in follow-up visits.\u003c/p\u003e\n\u003cp\u003eAll the lacrimal probings were done by a single senior ophthalmologist (Dr. XYZ). After local anesthesia, an antiseptic with 5% povidone-iodine was applied to the conjunctival sac, lid margin and periocular skin. A syringe was passed through the upper punctum after punctal dilation, and normal saline was irrigated, aiming to open up the obstruction. A reflux of discharge was collected with cotton swab during syringing. If high-pressure irrigation could not open the nasolacrimal duct, probing was performed with a #6 stainless steel lacrimal probe in the same session.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobiology investigation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical specimens were inoculated into Columbia blood agar and Haemophilus Chocolate agar (BioM\u0026eacute;rieux, France), and incubated in 5% CO2 for 18-24 hours. At the same time, the samples were incubated anaerobically into Columbia blood agar in GENbox anaer (BioM\u0026eacute;rieux, France). Sabouraud agar (Antu, China) was used for fungal culture. The colonies were identified using Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS, Bruker). Antimicrobial susceptibility test was performed with commercialized microdilution method (VITEK COMPACT, BioM\u0026eacute;rieux, France) or disk diffusion method, as appropriate, and the isolates were divided into susceptible or non-susceptible (intermediate and resistant) categories according to the breakpoints available from Clinical Laboratory Standards Institute (CLSI) guidelines M100-S28.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS software, version 20 (SPSS Inc., Chicago, IL). Means and standard deviations were used for continuous variables, rates and percentages were used for categorical variables. Bacteria characteristics according to subjects\u0026rsquo; age groups were analyzed with Fisher exact tests. Value of\u003cem\u003e P\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eSubgroup analysis was performed for those under 6 months old vs those beyond 6 months old. The division was made on the basis that stagnant bacteria might reduce the success rate of probing after 6 months of age by inflammatory tissue remodling [\u003ca href=\"#_ENREF_20\"\u003e20\u003c/a\u003e, \u003ca href=\"#_ENREF_21\"\u003e21\u003c/a\u003e], and that the bacteria might be changed by intermittent use of local antibiotics.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 32 consecutive otherwise healthy infants with unilateral CNLDO consisting of 23 (71.9%) males and 9 (28.1%) females. Except for 6 patients who did not indicate their residence, 15 (57.7%) children lived in downtown and 11 (42.3%) in countryside. Tearing and purulent discharge were presented in all the patients, who recovered completely after lacrimal probings without developing severe infections such as acute dacryocystitis before or after the procedure. The patients\u0026rsquo; age at probing ranged between 1.7 and 12 months, with a mean of 6.7 \u0026plusmn; 2.4 months.\u003c/p\u003e\n\u003cp\u003eAmong the 32 collected samples, 28 (87.5%) positive cultures were identified, yielding a total of 38 strains of 19 different bacteria. None of the isolates was anaerobic bacterium or fungus. Sixteen (57.1%) samples yielded only Gram-positive bacteria, 7 (25%) only Gram-negative, and 5 (17.9%) both.\u003c/p\u003e\n\u003cp\u003eTable 1 summarizes the details of bacterial strains isolated in CNLDO. In 23 (60.5%) Gram-positive strains, \u003cem\u003eStreptococcus\u003c/em\u003e was the most frequent species (50%), among which \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e (\u003cem\u003eS. pneumoniae\u003c/em\u003e) (23.7%) was predominant, followed by \u003cem\u003eStreptococcus mitis\u003c/em\u003e (10.5%). \u003cem\u003eMethicillin-resistant Staphylococcus aureus\u003c/em\u003e (\u003cem\u003eMRSA\u003c/em\u003e) was detected in 2 (6.3%) infants. In 15 (39.5%) Gram-negative organisms, \u003cem\u003eHaemophilus species\u003c/em\u003e (21.1%) and \u003cem\u003eNeisseriae species\u003c/em\u003e (13.2%) were commonly isolated. For the former type, \u003cem\u003eHaemophilus influenzae\u003c/em\u003e (\u003cem\u003eH. influenza\u003c/em\u003ee) and \u003cem\u003eHaemophilus haemolyticus\u003c/em\u003e were often identified, both accounting for 7.9%.\u003c/p\u003e\n\u003cp\u003eThere was no significant difference with respect to the bacteria spectrum between patients under 6 months old and those beyond (Table 2). Ten mixed cultures (31.3%) were identified with 2 bacterial isolates in a single sample. More patients beyond 6 months old had mixed cultures, but no difference of co-colonization rate was found compared to that of patients under 6 months old (\u003cem\u003eP \u003c/em\u003e= 0.226).\u003c/p\u003e\n\u003cp\u003eAntibiotic susceptibility results were obtained in 22 patients (78.6%). In general, bacteria in CNLDO were most sensitive to chloramphenicol (88%), followed by levofloxacin (84%), ceftriaxone (80%) and vancomycin (76%). \u003cem\u003eStreptococcus species\u003c/em\u003e exhibited high rates of sensitivity to chloramphenicol (100%), ceftriaxone (94.4%), cefotaxime (94.4%), and vancomycin (94.4%).\u003c/p\u003e\n\u003cp\u003eErythromycin and sulfamethoxazole were proven to be ineffective in 40% and 32% of the isolates, respectively. Furthermore, 55.6% of \u003cem\u003eStreptococcus species\u003c/em\u003e showed resistance towards erythromycin. Levofloxacin, which is the most commonly used topical antibiotics in our practice, exhibited a non-susceptibility rate of 16% in all the bacteria. The sensitivity patterns of microorganisms to antibiotic agents routinely tested are presented in Figure 1 and 2.\u003c/p\u003e\n\u003cp\u003eFour patients presented pathogens resistant to levofloxaxin and 3 were beyond 6 months of age. However, the non-susceptibility rate did not differ significantly between infants under and beyond 6 months old (\u003cem\u003eP \u003c/em\u003e= 0.616), though the older group of patients might use levofloxaxin eye drops intermittently for a longer time during the conservative treatment (Table 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study was one of the larger studies targeted at children under 1 year old in China. It demonstrated a high positive culture rate in infantile CNLDO. Among all the colonization, \u003cem\u003eS. pneumoniae\u003c/em\u003e was the major isolate. \u003cem\u003eHaemophilus \u003c/em\u003eand\u003cem\u003e Neisseriae\u003c/em\u003e \u003cem\u003especies\u003c/em\u003e were also commonly detected colonies. Chloramphenicol and levofloxacin were active agents for most of the pathogens in CNLDO, while erythromycin and sulfamethoxazole were proven to be resisted in a relatively high proportion.\u003c/p\u003e\n\u003cp\u003eThere have been a few studies investigating the microbiology in CNLDO, and the bacterial spectrum varies among different age groups and changes over time (Table 3) [\u003ca href=\"#_ENREF_8\"\u003e8-11\u003c/a\u003e, \u003ca href=\"#_ENREF_13\"\u003e13-18\u003c/a\u003e]. Most of the previous literatures included both infants and young children. Only 2 studies focused on infants under 1 year old, which were published 2 to 3 decades ago. The latter revealed a prevalent growth of \u003cem\u003eStaphylococcus aureus \u003c/em\u003e(\u003cem\u003eS. aureus\u003c/em\u003e) with a positive culture rate of 8.9-25%, and few evidence of \u003cem\u003eS. pneumoniae\u003c/em\u003e infection (0-2%) [\u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e, \u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e]. It was inconsistent with our observation, where \u003cem\u003eS. pneumoniae\u003c/em\u003e constituted for a major proportion of 32.1% and \u003cem\u003eMRSA\u003c/em\u003e only 7.1%. Though the details of topical antibiotics which the infants used before probing were not mentioned in these 2 literatures, we speculate that this could cause the differences of microorganisms detected in CNLDO [\u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e].\u003c/p\u003e\n\u003cp\u003eMicrobiota varies in different microhabitats of human eyes. The ocular surface, conjunctiva, lid margin and skin might show respective distinct bacterial spectra [\u003ca href=\"#_ENREF_22\"\u003e22\u003c/a\u003e]. The sampling location is vital to the analysis of microbiome in CNLDO patients. In most of the previous studies, the samples were obtained from conjunctival discharge by compressing LS. The specimen could be contaminated by the conjunctiva or lid margin, or sometimes little discharge with insufficient bacterial load could be obtained. In our study, we first sterilized the conjunctival sac, palpebral margin and skin, then collected the refluxed secretion from the lacrimal puncta by irrigation. This procedure would ensure maximum amount of specimen from LS.\u003c/p\u003e\n\u003cp\u003eUp till now, there have been 3 studies collecting irrigation samples of CNLDO, and they were investigated in Germany and Korea more than 10 years ago [\u003ca href=\"#_ENREF_9\"\u003e9\u003c/a\u003e, \u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e, \u003ca href=\"#_ENREF_15\"\u003e15\u003c/a\u003e]. These literatures showed a high growth of \u003cem\u003eS. aureus\u003c/em\u003e (13-25%), a low growth of \u003cem\u003eNeisseriae\u003c/em\u003e (0.8-2%) and a variable clustering of \u003cem\u003eS. pneumoniae\u003c/em\u003e (2-31%). The above were in contrast to our study which showed that \u003cem\u003eStreptococcus\u003c/em\u003e and \u003cem\u003eNeisseriae\u003c/em\u003e species were the most common, whereas \u003cem\u003eS. aureus\u003c/em\u003e was a rare isolate. The difference could be attributed to microbiol changes with time, race or locality. Prokosch\u0026rsquo;s studies were 10 years later than Kim\u0026rsquo;s, and the former showed prevalence of \u003cem\u003eS. pneumoniae\u003c/em\u003e which was similar to ours [\u003ca href=\"#_ENREF_9\"\u003e9\u003c/a\u003e, \u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e, \u003ca href=\"#_ENREF_15\"\u003e15\u003c/a\u003e]. The Korean children Kim reported were closer to our patients with respect to race (both Asians) and locality compared to those in Prokosch\u0026rsquo;s studies conducted in Germany, which showed a much fewer isolation of \u003cem\u003eS. pneumoniae\u003c/em\u003e. Prior antibiotic use might influence the result, and lead to a relatively low positive culture rate (64% vs 87.5% in our study, 97% in Prokosch\u0026rsquo;s studies) [\u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e]. Non-gonococcal, non-meningococcal \u003cem\u003eNeisseriae\u003c/em\u003e were rarely reported in CNLDO. Antibiotic sensitivity tests of \u003cem\u003eNeisseriae\u003c/em\u003e were not routinely performed in our hospital. Whether the bacteria are not susceptible to levofloxacin or tobramycin, or Chinese are genetically more susceptible to\u003cem\u003e Neisseriae\u003c/em\u003e infection needs further study to prove.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eS. aureus \u003c/em\u003ewas one of the most common bacterial pathogens in neonatal conjunctivitis with a positive rate of 17-37.4% about 30 years ago [\u003ca href=\"#_ENREF_23\"\u003e23\u003c/a\u003e, \u003ca href=\"#_ENREF_24\"\u003e24\u003c/a\u003e]. However, a study from southern China revealed a declining trend of \u003cem\u003eS. aureus\u003c/em\u003e from 2002 to 2016, which was assumed to be attributed to antibiotics abuse [\u003ca href=\"#_ENREF_25\"\u003e25\u003c/a\u003e]. In our study, we advised patients with conjunctivitis to use levofloxacin every time they passed purulent discharge before probing could be performed, which might lead to no detection of \u003cem\u003eS. aureus, \u003c/em\u003eand the result was consistent with that of A. Kuchar [\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e]. So far, \u003cem\u003eMRSA\u003c/em\u003e has been rarely isolated from infants with CNLDO. Sylvia Kodsi reported a case of \u003cem\u003eMRSA\u003c/em\u003e cultured from the regurgitated pus in an 8.5-month-old child [\u003ca href=\"#_ENREF_26\"\u003e26\u003c/a\u003e], while the other 2 cases demonstrated its overgrowth in conjunctiva and blood, respectively [\u003ca href=\"#_ENREF_27\"\u003e27\u003c/a\u003e, \u003ca href=\"#_ENREF_28\"\u003e28\u003c/a\u003e]. MRSA could be related to chronic systemic antibiotics administration [\u003ca href=\"#_ENREF_24\"\u003e24\u003c/a\u003e], recent hospitalization [\u003ca href=\"#_ENREF_25\"\u003e25\u003c/a\u003e] or vertical transmission from the mother [\u003ca href=\"#_ENREF_26\"\u003e26\u003c/a\u003e]. Our study identified 2 infants with \u003cem\u003eMRSA\u003c/em\u003e colonization in a total of 32 patients. No prior systemic antibiotics were used, no special signs of infection were detected in the infants and their family members, and their ocular symptoms resolved completely after an uneventful probing without causing any other infectious diseases.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eH. influenza\u003c/em\u003ee and \u003cem\u003eS. pneumoniae\u003c/em\u003e were reported to be prevalent bacteria in CNLDO patients with a wider range of age (Table 3), both pathogens can induce bacteremia after lacrimal probing [\u003ca href=\"#_ENREF_29\"\u003e29\u003c/a\u003e, \u003ca href=\"#_ENREF_30\"\u003e30\u003c/a\u003e], and \u003cem\u003eS. pneumoniae\u003c/em\u003e can cause severe endophthalmitis following glaucoma or cataract surgeries [\u003ca href=\"#_ENREF_31\"\u003e31\u003c/a\u003e, \u003ca href=\"#_ENREF_32\"\u003e32\u003c/a\u003e]. \u003cem\u003eNeisseriae\u003c/em\u003e \u003cem\u003especies\u003c/em\u003e are part of the normal flora in respiratory system. Non-gonococcal, non-meningococcal \u003cem\u003eNeisseriae\u003c/em\u003e are usually not pathogenic, but they can still lead to severe infections such as sepsis and endocarditis on occasion [\u003ca href=\"#_ENREF_33\"\u003e33\u003c/a\u003e]. Since the high prevalences of \u003cem\u003eStreptococcus,\u003c/em\u003e \u003cem\u003eHaemophilus\u003c/em\u003e and \u003cem\u003eNeisseriae\u003c/em\u003e were reported in our study, empirical use of antibiotics against these bacteria should be considered as the initial treatment if the infants with CNLDO develop sepsis. Furthermore, the need of investigating the bacteriology after lacrimal probing should be emphasized. By knowing the prevalent bacteria and susceptibility results in CNLDO, it which could help prepare the doctors in treating the potential severe infections especially in young children.\u003c/p\u003e\n\u003cp\u003eSince bacterial conjunctivitis occurs intermittently in CNLDO, topical antibiotics should be given when a purulent discharge is present [\u003ca href=\"#_ENREF_34\"\u003e34\u003c/a\u003e]. It\u0026rsquo;s crucial to make prudent choice of antibiotic eye drops for infants, because they might require long term use of eye drops until the infection is treated. Chloramphenicol and levofloxacin were reported to be the most active according to our susceptibility test, and are usually used as topical eye drops instead of systemic antibiotics. Though literatures of infants under 1 year old are uncommon, levofloxacin is still deemed as an effective and safe antibiotic for infants with bacterial conjunctivitis [\u003ca href=\"#_ENREF_35\"\u003e35\u003c/a\u003e, \u003ca href=\"#_ENREF_36\"\u003e36\u003c/a\u003e]. Despite the activity of chloramphenicol against most bacteria in CNLDO, its ineffectiveness has been reported in pediatric conjunctivitis [\u003ca href=\"#_ENREF_37\"\u003e37\u003c/a\u003e]. Furthermore, it is contraindicated in children with G6PD deficiency, which is common in southern China [\u003ca href=\"#_ENREF_38\"\u003e38\u003c/a\u003e], and some doctors have concern for its possible side effects of gray baby syndrome and aplastic anemia in newborn [\u003ca href=\"#_ENREF_39\"\u003e39\u003c/a\u003e, \u003ca href=\"#_ENREF_40\"\u003e40\u003c/a\u003e]. It is noteworthy that tobramycin, a commonly prescribed medicine in pediatric clinic [\u003ca href=\"#_ENREF_18\"\u003e18\u003c/a\u003e], may sometimes be ineffective in CNLDO according to literature review (Table 3). Erythromycin, another frequently prescribed ophthalmic prescription [\u003ca href=\"#_ENREF_41\"\u003e41\u003c/a\u003e], is proven to be ineffective for CNLDO, which is in accordance with most of the previous studies regardless of the year of study. Above all, topical administration of levofloxacin would be a better choice for Chinese infantile CNLDO with purulent discharge.\u003c/p\u003e\n\u003cp\u003ePollard reported that 2.9% of infants with CNLDO would develop acute dacryocystitis [\u003ca href=\"#_ENREF_42\"\u003e42\u003c/a\u003e], among which, 22.7% were concurrent with bacteremia [\u003ca href=\"#_ENREF_43\"\u003e43\u003c/a\u003e]. In such situation, antibiotics are usually given intravenously, including penicillins, cephalosporins, clindamycin, and vancomycin [\u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e], which are consistent with our study.\u003c/p\u003e\n\u003cp\u003eThe limitations of the study lie in the following aspects: 1. the preceding usage of antibiotics could influence the bacteria profile; 2. our hospital is a tertiary referral institution of CNLDO in Zhejiang which is a well-developed province in southern China. The hospital-based study represent the local condition, but might not represent the other areas in China; 3. the bacteriology of asymptomatic CNLDO might not be included; 4. variation of the bacterial spectrum with age was not certain; 5. retrospective design of the study hindered absolute standardization of intervention and data collection, which in turn reduce the level of evidence. However, the strength of this study is a large sample size focusing only on infants under 1 year old, and the unified treatment strategy and a reasonable way of collecting LS specimen. For the further study, a prospective, multi-centered investigation involving more patients of broader age spectrum with both symptomatic and asymptomatic CNLDO should be conducted.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe current study shows that the presence of microorganisms is common in infantile CNLDO, and investigating the LS bacteriology after probing is essential. A high rate of isolation of \u003cem\u003eStreptococcus, Haemophilus \u003c/em\u003eand\u003cem\u003e Neisseriae species\u003c/em\u003e was found in infants with CNLDO. \u003cem\u003eMRSA\u003c/em\u003e infection occurred occasionally. With early probing, we got the latest evidence of LS microbial profile in the first year of life. Most doctors would adopt a conservative approach during this period of time, and thus the choice of topical antibiotics for the relatively frequent occurrence of conjunctivitis would be of concern. The present study shows that topical levofloxacin would be a good choice as an empirical treatment during the expectant period, especially in China.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCLSI: Clinical Laboratory Standards Institute; CNLDO: Congenital nasolacrimal duct obstruction; \u003cem\u003eH. influenza\u003c/em\u003ee:\u003cem\u003e Haemophilus influenzae\u003c/em\u003e; LS: Lacrimal sac; \u003cem\u003eMRSA: Methicillin-resistant Staphylococcus aureus\u003c/em\u003e; \u003cem\u003eS. aureus\u003c/em\u003e: \u003cem\u003eStaphylococcus aureus\u003c/em\u003e; \u003cem\u003eS. pneumoniae: Streptococcus pneumoniae\u003c/em\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all fund providers, participating parents and children who made this study possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXYZ developed the project and wrote the manuscript; BNKC analyzed data, and revised the manuscript; MMZ and CPS collected data; ZYZ interpretated data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Zhejiang Provincial Natural Science Foundation (No. LSY19H180011) and the Health Department of Zhejiang Province, China (Grant 2016KYA130). The sponsor or funding organizations had no role in the design or conduct of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of Children\u0026rsquo;s Hospital Zhejiang University School of Medicine approved this retrospective study and waived informed consent to participate who received medical treatment at Children\u0026rsquo;s Hospital Zhejiang University School of Medicine. (No. 2020-IRB-087)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1, 4 \u003c/sup\u003eDepartment of Ophthalmology, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Department of Ophthalmology, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong, China.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3 \u003c/sup\u003eDepartment of Clinical Lab, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u003c/sup\u003e Department of Child Health Care, the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSathiamoorthi S, Frank RD, Mohney BG. Incidence and clinical characteristics of congenital nasolacrimal duct obstruction. Br J Ophthalmol. 2019;103(4):527-9.\u003c/li\u003e\n\u003cli\u003eMacEwen CJ, Young JD. Epiphora during the first year of life. Eye (Lond). 1991;5 (Pt 5):596-600.\u003c/li\u003e\n\u003cli\u003ePetris C, Liu D. Probing for congenital nasolacrimal duct obstruction. Cochrane Database Syst Rev. 2017;7(7):CD011109.\u003c/li\u003e\n\u003cli\u003ePediatric Eye Disease Investigator G. A randomized trial comparing the cost-effectiveness of 2 approaches for treating unilateral nasolacrimal duct obstruction. Arch Ophthalmol. 2012;130(12):1525-33.\u003c/li\u003e\n\u003cli\u003eKakizaki H, Takahashi Y, Kinoshita S, Shiraki K, Iwaki M. The rate of symptomatic improvement of congenital nasolacrimal duct obstruction in Japanese infants treated with conservative management during the 1st year of age. Clin Ophthalmol. 2008;2(2):291-4.\u003c/li\u003e\n\u003cli\u003eVagge A, Ferro Desideri L, Nucci P, Serafino M, Giannaccare G, Lembo A, Traverso CE. Congenital Nasolacrimal Duct Obstruction (CNLDO): A Review. Diseases. 2018;6(4):96.\u003c/li\u003e\n\u003cli\u003eAli MJ. Pediatric Acute Dacryocystitis. Ophthalmic Plast Reconstr Surg. 2015;31(5):341-7.\u003c/li\u003e\n\u003cli\u003eKuchar A, Lukas J, Steinkogler FJ. Bacteriology and antibiotic therapy in congenital nasolacrimal duct obstruction. Acta Ophthalmol Scand. 2000;78(6):694-8.\u003c/li\u003e\n\u003cli\u003eProkosch V, Prokosch JE, Promesberger J, Idelevich EA, Bohm MR, Thanos S, Stupp T. Bacterial spectrum and antimicrobial susceptibility patterns in acquired and connatal lacrimal duct stenosis. Curr Eye Res. 2014;39(11):1069-75.\u003c/li\u003e\n\u003cli\u003eAl-Faky YH, Naeem T, Al-Sobaie N, Al-Huthail R, Al-Odan H, Osman EA, Mousa A. Value of microbiology study in congenital nasolacrimal duct obstruction. Saudi J Ophthalmol. 2012;26(2):223-8.\u003c/li\u003e\n\u003cli\u003eUsha K, Smitha S, Shah N, Lalitha P, Kelkar R. Spectrum and the susceptibilities of microbial isolates in cases of congenital nasolacrimal duct obstruction. J AAPOS. 2006;10(5):469-72.\u003c/li\u003e\n\u003cli\u003eGerkowicz M, Koziol-Montewka M, Pietras-Trzpiel M, Kosior-Jarecka E, Szczepanik A, Latalska M. Identification of bacterial flora of conjunctival sac in congenital nasolacrimal duct obstruction in children. Klin Oczna. 2005;107(1-3):83-5.\u003c/li\u003e\n\u003cli\u003eBareja U, Ghose S. Clinicobacteriological correlates of congenital dacryocystitis. Indian J Ophthalmol. 1990;38(2):66-9.\u003c/li\u003e\n\u003cli\u003eKim YS, Moon SC, Yoo KW. Congenital nasolacrimal duct obstruction: irrigation or probing? Korean J Ophthalmol. 2000;14(2):90-6.\u003c/li\u003e\n\u003cli\u003eProkosch V, Prokosch JE, Promesberger J, Thanos S, Stupp T. [Bacteriology of occluded nasolacrimal ducts in infants]. Klin Monbl Augenheilkd. 2010;227(7):585-8.\u003c/li\u003e\n\u003cli\u003eMacEwen CJ, Phillips MG, Young JD. Value of bacterial culturing in the course of congenital nasolacrimal duct (NLD) obstruction. J Pediatr Ophthalmol Strabismus. 1994;31(4):246-50.\u003c/li\u003e\n\u003cli\u003eBekmez S, Eris E, Altan EV, Dursun V. The Role of Bacterial Etiology in the Tear Duct Infections Secondary to Congenital Nasolacrimal Duct Obstructions. J Craniofac Surg. 2019;30(7):2214-6.\u003c/li\u003e\n\u003cli\u003eWong VW, Lai TY, Chi SC, Lam DS. Pediatric ocular surface infections: a 5-year review of demographics, clinical features, risk factors, microbiological results, and treatment. Cornea. 2011;30(9):995-1002.\u003c/li\u003e\n\u003cli\u003eCrigler LW. The treatment of congenital dacryocystitis. JAMA. 1923;81(23-4.\u003c/li\u003e\n\u003cli\u003eKatowitz JA, Welsh MG. Timing of initial probing and irrigation in congenital nasolacrimal duct obstruction. Ophthalmology. 1987;94(6):698-705.\u003c/li\u003e\n\u003cli\u003eKashkouli MB, Beigi B, Parvaresh MM, Kassaee A, Tabatabaee Z. Late and very late initial probing for congenital nasolacrimal duct obstruction: what is the cause of failure? Br J Ophthalmol. 2003;87(9):1151-3.\u003c/li\u003e\n\u003cli\u003eOzkan J, Willcox M, Wemheuer B, Wilcsek G, Coroneo M, Thomas T. Biogeography of the human ocular microbiota. Ocul Surf. 2019;17(1):111-8.\u003c/li\u003e\n\u003cli\u003eSandstrom KI, Bell TA, Chandler JW, Kuo CC, Wang SP, Grayston JT, Foy HM, Stamm WE, Cooney MK, Smith AL\u003cem\u003e et al\u003c/em\u003e. Microbial causes of neonatal conjunctivitis. J Pediatr. 1984;105(5):706-11.\u003c/li\u003e\n\u003cli\u003eRao K, Ramji S, Thirupuram S, Prakash K. Clinical and bacteriological study of normal and inflamed neonatal conjunctivae. Indian Pediatr. 1992;29(2):161-5.\u003c/li\u003e\n\u003cli\u003eTang S, Li M, Chen H, Ping G, Zhang C, Wang S. A chronological study of the bacterial pathogen changes in acute neonatal bacterial conjunctivitis in southern China. BMC Ophthalmol. 2017;17(1):174.\u003c/li\u003e\n\u003cli\u003eKodsi S. Community-acquired methicillin-resistant Staphylococcus aureus in association with chronic dacryocystitis secondary to congenital nasolacrimal duct obstruction. J AAPOS. 2006;10(6):583-4.\u003c/li\u003e\n\u003cli\u003eSiddiqui SN, Zafar SN. Congenital Cataract, Nasolacrimal Duct Obstruction, and Methicillin-Resistant Staphylococcus aureus Conjunctivitis: When to Operate? J Pediatr Ophthalmol Strabismus. 2016;53 Online(e29-31.\u003c/li\u003e\n\u003cli\u003eRutar T. Vertically acquired community methicillin-resistant Staphylococcus aureus dacryocystitis in a neonate. J AAPOS. 2009;13(1):79-81.\u003c/li\u003e\n\u003cli\u003eEippert GA, Burnstine RA, Bates JH. Lacrimal-duct-probing-induced bacteremia: should children with congenital heart defects receive antibiotic prophylaxis? J Pediatr Ophthalmol Strabismus. 1998;35(1):38-40.\u003c/li\u003e\n\u003cli\u003eGanguly A, Ali MJ, Padmaja K, Sharma S, Lakshmi V, Naik MN. Bacteremia Following Nasolacrimal Duct Probing: Is There a Role of Preoperative Antibiotic Prophylaxis? Ophthalmic Plast Reconstr Surg. 2016;32(2):90-2.\u003c/li\u003e\n\u003cli\u003eSidoti PA, Lopez PF, Michon J, Heuer DK. Delayed-onset pneumococcal endophthalmitis after mitomycin-C trabeculectomy: association with cryptic nasolacrimal obstruction. J Glaucoma. 1995;4(1):11-5.\u003c/li\u003e\n\u003cli\u003eGood WV, Hing S, Irvine AR, Hoyt CS, Taylor DS. Postoperative endophthalmitis in children following cataract surgery. J Pediatr Ophthalmol Strabismus. 1990;27(6):283-5.\u003c/li\u003e\n\u003cli\u003eFeder HM, Jr., Garibaldi RA. The significance of nongonococcal, nonmeningococcal Neisseria isolates from blood cultures. Rev Infect Dis. 1984;6(2):181-8.\u003c/li\u003e\n\u003cli\u003eSchnall BM. Pediatric nasolacrimal duct obstruction. Curr Opin Ophthalmol. 2013;24(5):421-4.\u003c/li\u003e\n\u003cli\u003eLichtenstein SJ, Rinehart M, Levofloxacin Bacterial Conjunctivitis Study G. Efficacy and safety of 0.5% levofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis in pediatric patients. J AAPOS. 2003;7(5):317-24.\u003c/li\u003e\n\u003cli\u003eSchwab IR, Friedlaender M, McCulley J, Lichtenstein SJ, Moran CT, Levofloxacin Bacterial Conjunctivitis Active Control Study G. A phase III clinical trial of 0.5% levofloxacin ophthalmic solution versus 0.3% ofloxacin ophthalmic solution for the treatment of bacterial conjunctivitis. Ophthalmology. 2003;110(3):457-65.\u003c/li\u003e\n\u003cli\u003eRose PW, Harnden A, Brueggemann AB, Perera R, Sheikh A, Crook D, Mant D. Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9479):37-43.\u003c/li\u003e\n\u003cli\u003eLin F, Lou ZY, Xing SY, Zhang L, Yang LY. The gene spectrum of glucose-6-phosphate dehydrogenase (G6PD) deficiency in Guangdong province, China. Gene. 2018;678(312-7.\u003c/li\u003e\n\u003cli\u003ePineiro-Carrero VM, Pineiro EO. Liver. Pediatrics. 2004;113(4 Suppl):1097-106.\u003c/li\u003e\n\u003cli\u003eLepow ML. Aplastic anemia following chloramphenicol therapy still happens! Pediatrics. 1986;77(6):932-3.\u003c/li\u003e\n\u003cli\u003eUlanovsky I, Shnaider M, Geffen Y, Smolkin T, Mashiah T, Makhoul IR. Erythromycin Prophylaxis for Neonatal Conjunctivitis: Ointment Versus Drops. Isr Med Assoc J. 2016;18(7):404-6.\u003c/li\u003e\n\u003cli\u003ePollard ZF. Treatment of acute dacryocystitis in neonates. J Pediatr Ophthalmol Strabismus. 1991;28(6):341-3.\u003c/li\u003e\n\u003cli\u003eBaskin DE, Reddy AK, Chu YI, Coats DK. The timing of antibiotic administration in the management of infant dacryocystitis. J AAPOS. 2008;12(5):456-9.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:-42.5pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 1\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Bacteriology of children with CNLDO under 1 year of age\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 4.9e+2pt;margin-left:-41.0pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eBacteria isolated\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.2pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNumber of isolates\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113.4pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e% of isolates (n=38)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e% of samples (n=32)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram-positive bacteria\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e23\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e60.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e65.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:14.15pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococci species\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Times New Roman\",serif;color:black;'\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e50.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e59.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style='font-size:15px;font-family:\"Times New Roman\",serif;color:black;'\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e23.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e28.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus mitis\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e10.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e12.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus anginosus\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e5.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e6.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus oralis\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus contellatus\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus intermedius\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e5.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e6.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:14.15pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOthers\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:15px;font-family:SimSun;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStaphylococc\u003c/span\u003e\u003c/em\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eus aureus (MRSA)\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e5.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e6.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eGemella haemolysans\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eCorynebacterium macginleyi\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram-negative bacteria\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e39.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e37.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:14.15pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus species\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e21.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e25.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus influenzae\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e7.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e9.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus parainfluenzae\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus haemolyticus\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e7.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e9.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus aphrophilus \u0026nbsp; \u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:14.15pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eNeisseriae species\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e13.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e15.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003e\u0026nbsp;Neisseriae flavescens\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eNeisseriae sicca\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eNeisseriae elongata\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eNeisseriae macacae\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e5.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e6.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:14.15pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOthers\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStenotrophomonas maltophilia\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:21.2pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eCapnocytophaga sputigena\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e2.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e3.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAnaerobic organisms\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 181.1pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eFungas\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.2pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:113.4pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:99.25pt;border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:37.05pt;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:-42.5pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNote: CNLDO = congenital nasolacrimal duct obstruction, MRSA = methicillin-resistant Staphylococcus aureus.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 2\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Comparison of bacteria profile of 2 subgroups demarcated by 6 months old\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width:657.45pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:28.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAge\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(month)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:28.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNo. of cases\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:28.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePositive samples\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:28.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMixed cultures\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:28.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram staining\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;border-top:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:28.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:179.3pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:28.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eDominant strains\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:70.85pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:28.6pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eResistance to\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:.9pt;text-indent:-.9pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003elevofloxacin\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePos\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:solid windowtext 1.5pt;border-left:none;border-bottom: solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNeg\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:solid windowtext 1.5pt;border-left:none;border-bottom: solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePos+Neg\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border:none;border-bottom:solid windowtext 1.5pt;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococci\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top:solid windowtext 1.5pt;border-left:none;border-bottom: solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.35pt;border-top:solid windowtext 1.5pt;border-left:none;border-bottom:solid windowtext 1.5pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:20.05pt;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eNeisseria\u003c/span\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026lt; 6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026gt; 6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eP\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; 1.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; \u0026nbsp;0.226\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.758\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; \u0026nbsp;1.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 0.419 \u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; \u0026nbsp;1.000\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp; \u0026nbsp;0.616\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNote: Pos = positive, Neg = negative. \u003cem\u003eP\u003c/em\u003e value for Fisher exact tests\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:-56.7pt;'\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 3\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;Review of bacterial pathogen patterns in patients with CNLDO\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e[\u003c/span\u003e\u003ca href=\"#_ENREF_8\" title=\"Kuchar, 2000 #6\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:windowtext;text-decoration:none;'\u003e8-11\u003c/span\u003e\u003c/a\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e,\u0026nbsp;\u003c/span\u003e\u003ca href=\"#_ENREF_13\" title=\"Bareja, 1990 #11\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;color:windowtext;text-decoration:none;'\u003e13-18\u003c/span\u003e\u003c/a\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e]\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"width: 8.2e+2pt;margin-left:-56.7pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStudy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eYear of study\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCountry\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNo. of cases\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAge range\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(mean)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePositive culture rate (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMixed infection rate (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSample collection method\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eDominant bacteria (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSensitivity test (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1.5pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNon-susceptibility (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eZheng (our study)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2017-2018\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eChina\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.7-12 mons\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(6.6 mons)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e87.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e35.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eIrrigation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(23.7) \u003cem\u003eStreptococcus mitis\u003c/em\u003e (10.5) \u003cem\u003eHaemophilus influenzae\u003c/em\u003e (7.9) \u003cem\u003eHaemophilus haemolyticus\u003c/em\u003e (7.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eNeisseriae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(13.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eChloramphenicol (88)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eLevofloxacin (84) Ceftriaxone \u0026nbsp;(80)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-right:-6.6pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eErythromycin (40) Sulfamethoxazole (32)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eBekmez\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2017-2018\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTurkey\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12-36 mons\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(25 mons)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e28.6\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eConjunctival swab\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus haemolyticus\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(20)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus influenzae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(20)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCiprofloxacine (85) Tetracycline (60) Gentamicin (40)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePenicilin (40)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eProkosch\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2007-2012\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGermany\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e132\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0-60 mons\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(27 mons)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e97\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e87\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePressure over LS\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eor irrigation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(28.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStaphylococcus aureus\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(18.3)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus influenzae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(8.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMoraxella catarrhalis\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(8.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCiprofloxacin (99) Chloramphenicol (97)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTobramycin (95)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eLevofloxacin (95)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePenicillin (65)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eErythromycin (41)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGentamicin (22)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eWong\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2005-2010\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eChina\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e16\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0-84 mons\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(26.4mons)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e43.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e12.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eConjunctival scraping\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(18.8)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus influenzae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(12.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eKuchar\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(before 2000)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAustria\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e47\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e8-36 mons\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(21 mons)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e70\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e40\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePressure over LS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(36.4)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus influenzae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(19.2)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOfloxacin (84)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTetracycline (84) Chloramphenicol (84)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCiprofloxacin (62)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNorfloxacin (60)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNeomycin (63)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGentamycin (54.8)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTobramycin (57.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAL-Faky\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1998-2008\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:center;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eSaudi Arabia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e141\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1-108 mons\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(29.9 mons)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e87.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e25.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePressure over LS\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(48.1)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus influenzae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(39.2)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eMoraxella catarrhalis\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(12.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStaphylococcus aureus\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(6.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eBacitracin (NA) \u0026nbsp; \u0026nbsp; Polymyxin B (NA)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eProkosch\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2007\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGermany\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e66\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6-16 mons\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e97\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e87\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eIrrigation \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram-pos:\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(31)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStaphylococcus aureus\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(13)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStreptococcus epidermidis\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(13)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram-neg:\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eBranhamella\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(12)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eHaemophilus influenzae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eChloramphenicol (99)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eFusidic acid (99)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCiprofloxacin (99)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eLevofloxacin (95)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTobramycin (95)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:5.0pt;text-indent:-5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eErythromycin (41)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGentamycin (22)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eUsha\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-right:-7.45pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(before 2006)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eIndia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e187\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0-60 mons\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(14 mons)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e83\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e11.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePressure over LS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(32.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus influenzae\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(31.3) \u003cem\u003eStreptococcus viridans\u003c/em\u003e (14.7)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram-pos:\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:5.25pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eChloramphenicol (98) Vancomycin (82) Ofloxacin (75)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram-neg:\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eOfloxacin (83)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCiprofloxacin (81)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram-pos:\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:5.25pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTobramycin (90) Gentamycin (66)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGram-neg:\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAmikacin (44)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGentamycin (40)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTobramycin (43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eKim\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1996-1999\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eKorea\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e50\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-right:-5.35pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-right:-10.5pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.7-12 mons\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e64\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eIrrigation\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStaphylococcus aureus\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(25)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003ePseudomonas aeruginosa\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(15.6)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStaphylococcus aureus:\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eVancomycin (100)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCiprofloxacin (87.5)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePseudomonas aeruginosa\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:SimSun;\"\u003e：\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCiprofloxacin (100)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;text-indent:5.0pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eAmikacin (100)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGetamicin (NA)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePenicillin G (NA)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eBareja\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;margin-right:-7.45pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e(before 1990)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eIndia\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e87\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e67.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eConjunctival swab with or without pressure over LS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(28.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStaphylococcus aureus\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(13.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eCloxacillin (77)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eErythromycin (68)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eGentamicin (46.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePenicilin (100)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eStreptomycin (97)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003ePolymixin B (98)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 55.35pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eMacEwen\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56.4pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1988\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eUK\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e158\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0-12 mons\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e19.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54.45pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e0.6\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eConjunctival swab\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eHaemophilus influenzae\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(12)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eStaphylococcus aureus\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(8.9)\u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cem\u003e\u003cspan style='font-size:13px;font-family: \"Times New Roman\",serif;'\u003eMoraxella catarrhalis\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;(2.5)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.3pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99.25pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1.5pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;text-align:left;font-size:14px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style='margin:0in;text-align:justify;font-size:14px;font-family:\"Calibri\",sans-serif;margin-left:-49.55pt;'\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNote: LS = lacrimal sac, Mons = months, NA = not applicable.\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Congenital nasolacrimal duct obstruction, Infant, Microbiology, Lacrimal sac, Levofloxacin","lastPublishedDoi":"10.21203/rs.3.rs-42405/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-42405/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCongenital nasolacrimal duct obstruction (CNLDO) is one of the main causes of epiphora in infants, and antibiotics are usually used as a conservative therapy in the first year. Yet, little is known about the bacteriology of the occluded lacrimal drainage system in this group of patients. The aim of this study was to evaluate the microbiology of lacrimal sac (LS) in Chinese children with CNLDO in their first year of life.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003ePatients with CNLDO between May 1, 2017 and August 31, 2018 at a tertiary care children’s hospital were enrolled. The study recruited infants who received lacrimal probing under 1 year old, and refluxed discharge from LS was collected. Samples were cultured and susceptibility test was performed for positive culture.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Thirty-two patients with CNLDO were included. The ratio of male to female was 23:9. The mean age was 6.7 ± 2.4 (1.7-12) months. Positive cultures was identified in 87.5% of the sample, and presented 38 strains of bacteria. Mixed infection was identified in 10 (31.3%) children. Gram-positive bacteria accounted for 60.5% of all the strains, with \u003cem\u003eStreptococcus\u003c/em\u003e (50%) being the most frequent species, whereas \u003cem\u003eHaemophilus\u003c/em\u003e (21.1%) and \u003cem\u003eNeisseriae\u003c/em\u003e (13.2%) were most common isolates for Gram-negative organisms. \u003cem\u003eMethicillin-resistant Staphylococcus aureus\u003c/em\u003e (\u003cem\u003eMRSA\u003c/em\u003e) was detected in 2 infants whose symptoms resolved by a routine probing. No difference of bacteriology pattern was detected between patients under 6 months old and those beyond. The pathogens were highly sensitive to chloramphenicol (88%) and levofloxacin (84%), but resistant to erythromycin (40%) and sulfamethoxazole (32%).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Infants with CNLDO under 1 year of age presented predominance of \u003cem\u003eStreptococcus\u003c/em\u003e as Gram-positive organism, and \u003cem\u003eHaemophilus\u003c/em\u003e as Gram-negative organism. Levofloxacin was an active topical antibiotic agent with few chance of resistance especially for Chinese children. These findings could help clinicians choose optimal medicine for CNLDO as the conservative treatments.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Lacrimal Sac Bacteriology and Susceptibility Pattern in Infants with Congenital Nasolacrimal Duct Obstruction in the 1st Year of Life: A Cross-Sectional Study\u0026nbsp;","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2020-09-23 13:43:52","doi":"10.21203/rs.3.rs-42405/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"checksComplete","content":"","date":"2020-09-22T12:00:00+00:00","index":"","fulltext":""},{"type":"decision","content":"Accept","date":"2020-09-22T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-09-18 16:15:40","doi":"10.21203/rs.3.rs-42405/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-09-17T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-09-16T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-09-15T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-09-15T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-07-17 10:09:01","doi":"10.21203/rs.3.rs-42405/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2020-09-01T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\n1. The objective of the study was well spelt out\n2. The subjects were recruited appropriately.\n3. The discussion can be more robust in exploring the possible reasons for differences observed in the findings from other studies.\n4. Did the workers obtain history of prior antibiotic use while recruiting subjects? If so, how did it affect recruitment?\n5. Is there a scientific basis for sub-dividing the group into \u003c6 months and \u003e 6 months?\n6. Ceftriaxone was mis-spelt in lines 178, 180 and a few other places.\n7. Based on their findings, would the Authors recommend Levofloxacin or Chloramphenicol as first line treatment of CNLDO?* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interest**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"decision","content":"Minor revision","date":"2020-09-01T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-08-20T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n\nComments to Author:\n---\nThe authors of the manuscript describe the bacteriological profile of purulent discharge from congenital nasolacrimal duct blockade in infants. All the 32 enrolled cases were unilateral NLD blockades. Few comments and suggestions:\n\n1. The main limitation is lack of generalisability as authors themselves have mentioned in the manuscript. Retrospective design of the study also limits the level of evidence the manuscript generates, to implement the findings in clinical practice.\n\n2. Line 124 Instead of passed purulent discharge, can use presenting with or complaints of purulent discharge.\n\n3. Line 163 typo error or\n\n4. Line 164 - 165: Are the gram positive and gram negative and both mutually exclusive because the proportions add up to more than 100%\n\n5. Line 219: Sentence not correct\n\n6. Line 240: Instead of discharge add purulent discharge\n\n7. Line 264: 'To improve\" limitations is not a correct statement\n\nThe findings though applicable to a regional context, should have clinical implications.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please publish my name with my report.**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"reviewerAgreed","content":"","date":"2020-08-15T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-07-28T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-07-28T12:00:00+00:00","index":1,"fulltext":""},{"type":"submitted","content":"","date":"2020-07-13T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-07-13T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-07-12T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-07-12T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5c6665b9-7e50-4f8e-8e39-6c57afcb2c23","owner":[],"postedDate":"September 23rd, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":591136,"name":"Pediatrics"}],"tags":[],"updatedAt":"2020-10-11T15:02:24+00:00","versionOfRecord":{"articleIdentity":"rs-42405","link":"https://doi.org/10.1186/s12887-020-02358-5","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2020-10-06 12:00:00","publishedOnDateReadable":"October 6th, 2020"},"versionCreatedAt":"2020-09-23 13:43:52","video":"","vorDoi":"10.1186/s12887-020-02358-5","vorDoiUrl":"https://doi.org/10.1186/s12887-020-02358-5","workflowStages":[]},"version":"v3","identity":"rs-42405","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-42405","identity":"rs-42405","version":["v3"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}