Prevalence and antimicrobial susceptibility patterns of bacteria colonizing the external ocular surfaces of patients undergoing ocular surgeries at Bugando Medical Center in Mwanza, Tanzania

Prevalence and antimicrobial susceptibility patterns of bacteria colonizing the external ocular surfaces of patients undergoing ocular surgeries at Bugando Medical Center in Mwanza, Tanzania | 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 Short Report Prevalence and antimicrobial susceptibility patterns of bacteria colonizing the external ocular surfaces of patients undergoing ocular surgeries at Bugando Medical Center in Mwanza, Tanzania Johannes Rukyaa, Lillian Temba, Princekened Kachira, Christopher Mwanansao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4214866/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Jul, 2024 Read the published version in BMC Research Notes → Version 1 posted 9 You are reading this latest preprint version Abstract Objective Understanding microbiota colonizing ocular surfaces is key to expedite antibiotic prophylactic options for ocular surgeries, and therefore, prevent subsequent surgical site infections (SSIs). To fill this critical gap, we aimed at determining the prevalence and antibiotic susceptibility patterns of bacteria colonizing the external ocular surfaces of 224 patients undergoing ocular surgeries at Bugando Medical Centre (BMC) in Mwanza, Tanzania between May and August 2023. Results The study participants had a median age of 62.5 (interquartile range: 39.5-75.0) years. A total of 78.1% (175/224) ocular swabs were culture positive yielding 196 bacterial isolates. S. epidermidis [43.4% (n=85)] followed by S. aureus [21.9% (n=43)] and Pseudomonas aeruginosa [14.3% (n=28)] were the most common bacteria. There was low proportions of resistance among predominant Gram positive and Gram-negative bacteria to gentamicin (≤25.0%), and similarly, low resistance among Gram negative bacteria was observed against 3 rd generation cephalosporins (≤25.0%) and piperacillin-tazobactam (0.0%). Variable resistance profiles were notable to the most commonly used antibiotics (ciprofloxacin and tetracycline: 0.0% to 66.7%). Our findings underscore an urgent need to revisit antibiotic prophylactic guidelines for ocular surgeries in this tertiary hospital, and calls for prospective evaluation of incident SSIs post-ocular surgeries to guide specific management. Ocular surgeries Bacterial colonization Bugando Medical Centre Tanzania Introduction Surgical site infections (SSI) are defined as infections occurring within 30 days after a surgical procedure affecting the superficial or deep tissue at the operation site [1]. A study conducted in the United States of America assessed the role of topical antibiotics prophylaxis in oculofacial plastic surgery and reported ocular surgical site infections (OSSI) to be more common in the placebo group 2.7% than the antibiotic group 0.0% [2]. Likewise, a study conducted in Brazil reported higher rates of postoperative endophthalmitis in the control group (0.097%) than the group receiving antibiotic prophylaxis (0.018%) [3]. The OSSI predispose patients to increased risk of prolonged post operative hospital stay, lifelong disability, and increased cost of patients management [1, 4]. Infectious postoperative endophthalmitis (IPOE) is the most dreaded complication for ocular surgical procedures [5]. The severity and clinical outcome of OSSI including IPOE depends on the pathogens’ virulence and inoculum, patient’s immunological status, time of diagnosis and treatment, and other external/environmental factors [6, 7]. In most cases of SSI, the causative pathogens are the normal microbiota inhabiting the respective anatomical surgical sites [8], and knowing the types and patterns of these bacteria is pertinent in expediting prophylactic antibiotics, and therefore, decrease the risk of acquiring SSI [9]. In this regard, the most targeted bacterial species for provision of antibiotic prophylaxis are Gram positive bacteria such as S. aureus, Staphylococcus epidermidis and other Coagulase-negative Staphylococci (CoNS). Various Streptococci and Enterococci species are also of significant importance [7, 10, 11]. The continuous shift of ocular microbial flora due to factors such as age, occupation, place of residence, co-existing morbidities, and previous history of antibiotic use and hospital admission (to mention a few), may challenge the existing pre-operative prophylactic guidelines and foster increased chances of developing antimicrobial resistance (AMR) attributable OSSIs [12, 13]. Therefore; this study was designed to evaluate etiologies and antibiotic susceptibility patterns of bacteria residing on the external ocular surface of pre-operative ocular surgical patients so as to come up with up-to-date information that can be used to formulate prophylactic guidelines based on local evidence. Methods Study design, duration and setting This was a hospital based cross sectional analytical study conducted from May 2023 to August 2023 in the Ophthalmology Department at Bugando Medical center (BMC). The BMC is a 1000-bed capacity zonal tertiary consultant and teaching hospital serving approximately 20 million people in the north-western part of Tanzanian [14, 15]. The Ophthalmology Department has a bed capacity of 50, it attends approximately 400 patients monthly in the outpatient clinics, and performs approximately 80 ocular surgeries per month. Study population , Selection criteria and sampling This study included all ophthalmology surgical patients presenting at BMC for ocular surgeries, and excluded all patients who presented with signs and symptoms of an active ocular infections. Using a Kish-Leslie formula for cross-sectional studies, and a proportion of conjuctival bacterial colonisation of 26.6% from a previous study in Taiwan among patients undergoing cataract surgery, a minimum sample size of 300 patients were anticipated to be enrolled [16, 17]. However, this study ended up into enrolling a total of 240 patients . A total of 16 patients were excluded either due to missing data or had an active eye infection, bringing the number of study participants to 224 patients. Data collection and laboratory procedures A pretested-structured questionnaire was developed and then, fed into the Epi-collect- 5 software ® (Centre for Genomic Pathogen Surveillance, UK) and subsequently used to collect socio-demographic and clinical information from patients. Each patient was informed about the study procedures, risks, benefits and rights to participate or withdrawal from the study, and then, those who voluntarily agreed to participate were enrolled and their respective data and samples collected. Ocular swabs were aseptically collected by the principal investigator (or trained research assistant) from each patient in the morning on the day of the surgical procedure before the application of topical anesthetic, mydriatics, antibiotic or povidone-iodine. The patient was asked to look up, and then the eyelid margin was swabbed with a sterile cotton swab moistened with sterile saline, employing a continuous stroke from the nasal to temporal side and then a second stroke from temporal to nasal side without touching the eyelashes, and then, placed in the swab’s transport media (Bio lab, HUNGARY®). Samples were transported to the Clinical Microbiology Laboratory of the Catholic University of Health and Allied Sciences in the cool box. In the laboratory, the swabs from patients were inoculated into Brain-heart infusion (BHI) broth (OXOID, Hampshire, United Kingdom) for enrichment and then processed in the laboratory after 18 - 24 hours incubation at 35-37 o C. Culture, bacterial identification and drug susceptibility testing A portion of homogenized BHI was obtained using a sterile wire loop and inoculated onto blood agar (BA) and MacConkey agar (MCA) (OXOID, Hampshire, United Kingdom) incubated for 18-24hrs at 35-37°c. Identification of the organisms was done based on the growth characteristics on BA, MCA, secondary gram stain, and biochemical characteristics [18]. A single colony of bacteria from a fresh pure culture plate was emulsified into sterile normal saline to achieve a concentration equivalent to 0.5 McFarland turbidity solution, a sterile cotton swab was then used to obtain bacteria from the suspension, the swab was then squeezed against the wall of the tube to remove excess fluid before being seeded uniformly onto Muller-Hinton agar (OXOID, Hampshire, United Kingdom) plate. Antibiotics of the right potency was placed on the agar to test for antibiotic susceptibility patterns using Kirby Bauer’s disc diffusion method as guided by the Clinical Laboratory Standard Institute (CLSI) 30 th edition M100 document, 2020 [19]. Antibiotics discs for gram positive includes: ampicillin(10µg), cefoxitin(30µg), trimethoprim-sulfamethoxazole (1.25/23.75µg), ciprofloxacin (5µg), erythromycin (15µg), clindamycin (2µg), vancomycin (30µg), linezolid (30µg), gentamicin (10µg), clindamycin (2µg), tetracycline (30µg) whereas the antibiotics discs for gram negative bacteria was: ceftriaxone (30µg), cefepime (30µg), ciprofloxacin (5µg), ceftazidime(30µg), piperacillin-tazobactam (100/10µg), amoxicillin/clavulanate (20/10µg), trimethoprim-sulfamethoxazole (1.25/23.75µg), meropenem (10µg), gentamicin (10µg) and tetracycline (30µg). All S. aureus and S. epidermidis with a zone of inhibition on cefoxitin (30µg) disc of ≤ 21 mm was regarded as methicillin resistant S. aureus (MRSA) and methicillin resistant coagulase negative Staphylococcus (MRCoNS), respectively. Inducible clindamycin resistance was tested by observing the blunting of the zone of inhibition around the clindamycin disc placed adjacent to the erythromycin disc. For gram negative bacteria; extended spectrum beta lactamase (ESBL) phenotype was confirmed using combined disc method using cefotaxime 30µg and/or ceftazidime 30μg (with and without clavulanic acid 10µg)[20]. Quality control Aseptic techniques were strictly observed during sample collection, transportation and processing. Control strains of Staphylococcus aureus (ATCC 25923) and Escherichia coli ( ATCC 25922) was used for quality control of the performance of the culture media and the antibiotic discs FOR Gram positive and Gram negative bacteria, respectively [20]. Statistical analysis and Ethical consideration Excel data sheet was extracted from Epi-collect- 5 software ® and then, laboratory data were also added into the Microsoft Excel for cleaning and coding. Data was then transferred to STATA version15 (College Station, Texas, USA) for analysis. Continuous data was summarized using a medium with an inter-quartile range (IQR). Categorical data was summarized using proportion (percent). Pearson chi squared test (or Fisher’s exact where applicable) and a two-sample test of proportions was used to assess the distribution of categorical variables against ocular colonization culture positivity. A p-value cut-off of less than 0.05 was considered statistically significant. This study obtained an ethical clearance from the joint CUHAS/BMC Research Ethics and review committee (CREC 2900/2023). Permission to conduct the study was obtained from the BMC hospital Director General, whereas voluntary informed consent from participants was obtained before proceeding to data and specimen collection. Confidentiality of the patients was observed throughout the study.Final results from this study were communicated to the Department of Ophthalmology to guide future revision of antimicrobial prophylaxis guidelines. Results Socio-demographic information of the study participants. This study enrolled a total of 224 patients, majority of the study participants were male 54.5% (n=122). The median age of the study participants was 62.5 [IQR 39.5-75.0] years with the majority of the study participants being self-employed 50.0% (n=122) and had attended primary education level 47.3% (n=106), Table 1. Table 1: Social-demographic characteristics of study participants Variables Category Frequency (%) Gender Male 122(54.5) Female 102 (45.5) Marital status Divorced 9 (4.0) Married 120 ( 53.6) Not married 47 (21.0) Widow 48 (21.4) Education level Primary 106 (47.3) Secondary 43 (19.2) Tertiary 24 (10.7) Never attended school 51 (22.8) Occupation Employed 17 (7.6) Self employed 112 (50.0) Retired 65 (29.0) Student 30 (13.4) Ward Female ward 97 (43.3) Male ward 107 (47.8) Pediatric ward 20 (8.9) Majority of the study participants underwent cataract removal 57.6% (n=129). Comorbidities were observed in 34.8% (n=78) of study participants, and high blood pressure predominated, 19.2% (n=43) as shown in Table 2. Table 2. Clinical characteristics of study participants Variables Category Frequency (%) Type of ocular procedure Cataract removal 129 ( 57.6) Glaucoma 2 (0.9) Intraocular surgeries 93 (41.5) Antibiotic consumption No 221 (98.7) Yes 3 (1.3) Type of antibiotic used Ceftriaxone 1 (0.5) Ampicillin-cloxacillin 2 (0.8) N/A 221 (98.7) Mode of antibiotic acquisition Self-prescription 2 (0.8) Doctor’s prescription 1 (0.5) N/A 221 (98.7) Duration of antibiotic use 2(days) 2 (0.8) 3(days) 1 (0.5) N/A 221 (98.7) Comorbidities No 146 (65.2) Yes 78 (34.8) Type of comorbidities High blood pressure 43 (19.2) Diabetes mellitus 10 (4.5) Peptic ulcers 9 (4.0) None 146 (65.2) Others** 16 (7.1) ** Unspecified ear problem (3), Cardiomegaly (3), Joint pain (3), Unspecified febrile illness (2) Prostate cancer (1), Leg pain (1), Kidney problem (1), Hernia (1), and Tuberculosis(1) Prevalence of bacteria colonizing external ocular surfaces Out of 224 non repetitive ocular swabs collected, 175 (78.1%) were culture positive for bacteria colonizing external ocular surfaces. A total of 21 (9.4%) of the study participants had positive culture for more than one bacteria isolates, resulting into a total of 196 bacteria isolates. Culture positivity was significantly higher among patients with comorbidities compared to those who without comorbidities (85.9% versus 74.0%, p=0.040) Table 3. Table 3: Study variables vs culture positivity among study participants Variables Category Culture results Pearson chi 2 test p-value Positive, n (%) Negative, n (%) Gender Male 100(82.0) 22 (18.0) 2.314 0.128 Female 75 (73.5) 27 (26.5) Education level Primary 80 (75.5) 26 (24.5) 2.595 0.458 Secondary 35 (81.4) 8 (18.6) Tertiary 17 (70.8) 7 (29.2) Never attended school 43 (84.3) 8 (15.7) Occupation Employed 9 (52.9) 8 (47.1) 7.397 0.060 Self employed 89 (79.5) 23 (20.5) Retired 54 (83.1) 11 (16.9) Student 23 (76.7) 7 (23.3) Ocular procedure Cataract removal 32 (24.2) 97 (75.8) - 0.173* Glaucoma 1 (50.0) 1 (50.0) Intraocular surgeries 77 (82.8) 16 (17.2) Comorbidities No 108 (74.0) 38 (26.0) 4.230 0.040 Yes 67(85.9) 11 ( 14.1) *p-value based on one-sided Fisher’s exact. Distribution of bacterial isolates colonizing external ocular surfaces and their antimicrobial susceptibility patterns A total of 196 bacteria were isolated from non-repetitive ocular swabs in this study, S. epidermidis, S. aureus , and P. aeruginosa were the commonest isolates: 43.4% (n=85), 21.9% (n=43) and 14.3% (n=28), respectively. Low level resistance among S. epidermidis and S. aureus were observed against clindamycin (28.2% and 27.9%, respectively) and gentamicin (14.1% and 16.3%, respectively). For the predominant Gram negative bacteria, P. aeruginosa and Klebsiella spp., showed low level resistance was observed against ceftazidime at 21.4% and 12.5%, respectively. All Gram negative bacteria were were sensitive to meropenem except one Klebsiella pneumoniae isolate. Variable resistance profiles were notable to the most commonly used antibiotics like ciprofloxacin and tetracycline, ranging from 0.0% to 66.7%. This study observed high proportion of MRCoNS and MRSA at 52.9% and 46.5%, respectively although the difference was not statistically significant (p=0.494). There was low ESBL production among Gram negative Enterobacterales (15.4%, 4/26), Table 3. Table 4: Antibiotic susceptibility patterns of bacteria isolated from patients Bacteria, n (%) Antibiotics susceptibility patterns CIP(%) TET(%) E (%) CD(%) COT(%) FOX (%) GEN (%) LZ (%) FEP (%) CRO(%) CAZ(%) AMC(%) TZP(%) S.epidermidis, 85 (43.4) S 47(55.2) 32(37.6) 25(29.4) 61(71.8) 11(12.9) 40(47.1) 73(85.9) 84(98.8) NA NA NA NA NA R 38(44.8) 53(62.4) 60(70.6) 24(28.2) 74(87.1) 45(52.9) 12(14.1) 1(0.2) NA NA NA NA NA P. aeruginosa, 28 (14.3) S 28(100) NA NA NA NA NA 26(92.9) NA 27(96.4) NA 22(78.6) NA 27(96.4) R 0 (0.0) NA NA NA NA NA 2(7.1) NA 1(3.6) NA 6(21.4) NA 1 (3.6) S. aureus, 43 (21.9) S 29(67.4) 16(37.2) 14(32.6) 31(72.16) 11(25.6) 23(53.5) 36(83.7) 42(97.7) NA NA NA NA NA R 14(32.6) 27(62.8) 29(67.4) 12(27.9) 32(74.4) 20(46.5) 7(16.3) 1(2.3) NA NA NA NA NA Klebsiella spp, 24(12.2) S 21(87.5) 24(100) NA NA 22(91.7) NA 22(91.7) NA 21(87.5) 21(87.5) 21(87.5) 7(29.2) 24(100.0) R 3(12.5) 0 (0.0) NA NA 2(8.3) NA 2(8.3) NA 3(12.5) 3(12.5) 3(12.5) 17(70.8)%) 0 (0.0) viridans, 9 (4.6) S 3(33.3) 5(55.5) 5(55.5) 8(88.9) 1(11.1) NA 4(45.5) 9(100) NA NA NA NA NA R 6(66.7) 4(45.5) 4(45.5) 1(11.1) 8(88.9) NA 5(55.5) 0 (0.0) NA NA NA NA NA Other GNB * , 3 (1.5) S 2(66.7) 2(66.7) NA NA 2(66.7) NA 2(66.7) NA 2(66.7) 2(66.7) 2(66.7) 0 (0.0) 3(100) R 1(33.3) 1(33.3) NA NA 1(33.3) NA 1(33.3) NA 1(33.3) 1(33.3) 1(33.3) 3(100) 0(0.0) Total, 196 (100.0) * Escherichia coli (2) , Acinetobacter spp (1) Note: CIP: Ciprofloxacin, TET: Tetracycline, E: Erythromycin, CD: Clindamycin, FOX: Cefoxitin, GEN: Gentamicin, COT: Trimethoprim-sulfamethoxazole, LZ: Linezolid, FEP: Cefepime, CRO: Ceftriaxone, CAZ: Ceftazidime, AMC: Amoxicillin/clavulanate, TZP: Piperacillin-tazobactam, NA: Not Applicable, R: Resistant; S: Sensitive. Discussion This study enrolled a total of 224 patients attending the Ophthalmology Department at BMC with the majority of participants being male, similar to other studies[21, 22]. This study observed high proportion for ocular surface colonization by bacteria (78.1%), than 59.5% and 32.5% reported from a study conducted at a tertiary hospital in Uganda in 2013 and another study conducted in Mexico in 2021, respectively [23, 24], however; our study findings are lower than 85% reported from USA in 2015 [25]. These high proportions reported in both studies are indicative of the high proportion colonization in the external ocular surfaces of patients undergoing ocular surgeries attributed to the fact that the eye lid margins mark the border between the external and internal ocular surface, therefore, being in close proximity with the skin which harbors high loads of skin microbiota [26, 27]. This study reported predominance of Gram-positive skin microbiota ( S. epidermidis and S. aureus ) colonizing external ocular surfaces of the study participants, which is not suprising and is in agreement with those from Uganda and the USA [23, 24]. It is well known that these skin microbiota are preferentially are important in preventing pathogenic bacteria from causing OSSIs, however, during ocular surgeries, they can be introduced into internal ocular structures and potentially cause OSSIs if appropriate antibiotic prophylaxis are not administered [28, 29]. Furthermore; we observed the unusual isolation of Gram negative pathogenic bacteria like P. aeruginosa and Klebsiella spp.from the external ocular surfaces, similar to findings from a study in Mexico [24]. These findings may be attributed to contamination from various inanimate/environmental surfaces and patients anatomical sites such as the perianal areas [30, 31]. Therefore, this calls for strengthening of hygienic and sanitation practices among patients, and blocking this transmission cycle[32]. The findings are reiterated by similar occurrence of these pathogens in other hospital environmental premises at BMC which are linked to neonatal sepsis and neonatal deaths, and therefore, a need to strengthen hospital-wide infection prevention and control measures through environmental cleaning and decontamination [33, 34]. These altogether, highlight a need to conduct prospective study in patients undergoing ocular surgeries to evaluation potential involvement of these pathogens in the OSSIs, and expedite specific antimicrobial therapies. High proportion of resistance of S. epidermidis and S. aureus was observed towards commonly used antibiotics like trimethoprim/sulfamethoxazole, erythromycin and tetracycline, unlike less commonly used agents like gentamicin. Similarly, Klebsiella spp. displayed high proportion of resistance towards amoxicillin/clavulanic acid, compared to less commonly used agents like gentamicin, 3 rd generation cephalosporin and piperacilllin-tazobactam. These findings provided a wake-up calls as antibiotics like erythromycin and tetracycline are commonly used at BMC Ophthalmology Department as prophylaxis for ocular surgical patients, and in other lower- and middle-income countries (LMIC’s) settings [35, 36]. Therefore, these findings are pertinent to guide revisiting of antibiotic prophylactic options for ocular surgeries at BMC in Mwanza, Tanzania. This study observed high proportions of MRCoNS and MRSA in S. epidemidis and S. aureus isolates, respectively on external ocular surfaces of pre operative patients posing a risk for subsequent OSSIs attributed to these notorous and difficult to manage strains. This may further lead to prolonged hospitalization of patients, lifelong disability and an increased cost for patient care [37]. The findings highlight an emergening antimicrobial selective pressure not only to pathogens but also to normal microbiota, and hence, a need to escalate our responsive measures towards AMR surveillance and antimicrobial stewardship programs at BMC [38]. On the other hand, there was low resistance to the 3 rd generation cephalosporins marked by ESBL production in Gram negative Enterobacterales, emphasizing a need to foster rational use of these agents and maintain their efficacy for prophylaxis and therapeutic roles. We observed that having comorbidity was a risk factor for ocular colonization. This is likely to be associated with recurrent exposure to hospital environment (outpatient visitis and hospital admissions) and antibiotics, which altogether are known to be driving factors for MDR pathogens in patients. Therefore, priority screeing for patients with comorbidities is emphasized to as to guide specific choice of antibiotic prophylactic agents. Conclusions Eight out of every ten patients undergoing ocular surgical procedures at BMC are colonized by normal microbiota and pathogenic bacteria in their external ocular surfaces. These bacteria display high proportions of resistance towards erythromycin, tetracycline, and ciprofloxacin which are commonly used as prophylaxis for ocular surgeries in this setting. Gentamicin, 3 rd generation cephalosporins and piperacillin-tazobactam showed low resistance (≤25.0%), and are potential antimicrobial prophylactic options in this hospital upon revisiting hospital guidelines. Prospective studies at BMC should focus on evaluating relationship between ocular colonization and incident OSSIs, as well as transmission dynamics of these pathogens between patients and hospital environmental premises using genomic approaches are reiterated. Limitations This study employed conventional culture techniques which might have missed the isolation of difficult to culture bacteria pathogens, and therefore, may have under reported the actual burden for bacterial ocular colonization. This study did not asses the relationship between ocular colonization and incident OSSIs., which may be a pivotal area of interest for future studies at BMC. Abbreviations AMR Antimicrobial resistance ATCC American type culture collection BA Blood agar BHI Brain-heart infusion BMC Bugando Medical center BMC Bugando Medical Centre CoNS Coagulase-negative staphylococci CUHAS Catholic university of health and allied sciences ESBL Extended spectrum beta lactamase IPOE Infectious postoperative endophthalmitis MCA MacConkey agar OSSI Ocular surgical site infections SSI Surgical site infections Declarations Acknowledgment We are grateful to all staff in the Department of Ophthalmology at BMC, and the Microbiology and Immunology Department at the CUHAS for their technical support throughout the study period. Author contribution JR, LT, CM and JS: Study conception, design and execution. JR, LT and PK: Data collection, sample collection and processing, data analysis and initial drafting of the manuscript. CM and JS: Overall study supervision, in-kind contribution to the study reagents and supplies, and critical review of manuscript. Funding No external funding was received for this study. Authors provided in-kind contribution to support study execution. Data availability All data generated during this study are included in this article and its dataset can be accessed upon request to the corresponsing author. Authors declare to have no competing interests. Ethical approval and consent to participate This study obtained an ethical clearance from the joint CUHAS/BMC Research Ethics and review committee (CREC 2900/2023). Permission to conduct the study was obtained from the BMC Hospital Director General, whereas voluntary informed consent from participants was obtained before proceeding to data and specimen collection. Confidentiality of the patients was observed throughout the study. Consent for publication All authors have consented for this manuscript generated from study findings be published. References Owens C, Stoessel K: Surgical site infections: epidemiology, microbiology and prevention. 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Erb S, D’Mello-Guyett L, Malebo HM, Njee RM, Matwewe F, Ensink J, Hinic V, Widmer A, Frei R: High prevalence of ESBL-Producing E. coli in private and shared latrines in an informal urban settlement in Dar es Salaam, Tanzania. Antimicrobial Resistance & Infection Control 2018, 7:1-6. Silago V, Kovacs D, Msanga DR, Seni J, Matthews L, Oravcová K, Zadoks RN, Lupindu AM, Hoza AS, Mshana SE: Bacteremia in critical care units at Bugando Medical Centre, Mwanza, Tanzania: the role of colonization and contaminated cots and mothers’ hands in cross-transmission of multidrug resistant Gram-negative bacteria. Antimicrobial Resistance & Infection Control 2020, 9:1-14. Bloomfield SF, Exner M, Signorelli C, Nath K, Scott E: The chain of infection transmission in the home and everyday life settings, and the role of hygiene in reducing the risk of infection. In: International scientific forum on home hygiene: 2012 ; 2012. Marando R, Seni J, Mirambo MM, Falgenhauer L, Moremi N, Mushi MF, Kayange N, Manyama F, Imirzalioglu C, Chakraborty T: Predictors of the extended-spectrum-beta lactamases producing Enterobacteriaceae neonatal sepsis at a tertiary hospital, Tanzania. International Journal of Medical Microbiology 2018, 308(7):803-811. Kovacs D, Silago V, Msanga DR, Mshana SE, Seni J, Oravcova K, Matthews L: The hospital environment versus carriage: Transmission pathways for third-generation cephalosporin-resistant bacteria in blood in neonates in a low-resource country healthcare setting. Scientific Reports 2022, 12(1):8347. Kariyawasam RM, Julien DA, Jelinski DC, Larose SL, Rennert-May E, Conly JM, Dingle TC, Chen JZ, Tyrrell GJ, Ronksley PE: Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019–June 2021). Antimicrobial Resistance & Infection Control 2022, 11(1):45. Ndaki PM, Mushi MF, Mwanga JR, Konje ET, Ntinginya NE, Mmbaga BT, Keenan K, Sabiiti W, Kesby M, Benitez-Paez F: Dispensing antibiotics without prescription at community pharmacies and accredited drug dispensing outlets in Tanzania: a cross-sectional study. Antibiotics 2021, 10(8):1025. Serra-Burriel M, Keys M, Campillo-Artero C, Agodi A, Barchitta M, Gikas A, Palos C, López-Casasnovas G: Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PloS one 2020, 15(1):e0227139. Beyer P, Paulin S: Priority pathogens and the antibiotic pipeline: an update. Bulletin of the World Health Organization 2020, 98(3):151. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Jul, 2024 Read the published version in BMC Research Notes → Version 1 posted Editorial decision: Revision requested 07 May, 2024 Reviewers agreed at journal 16 Apr, 2024 Reviews received at journal 15 Apr, 2024 Reviewers agreed at journal 15 Apr, 2024 Reviewers invited by journal 15 Apr, 2024 Editor invited by journal 08 Apr, 2024 Submission checks completed at journal 07 Apr, 2024 Editor assigned by journal 07 Apr, 2024 First submitted to journal 03 Apr, 2024 You are reading this latest preprint version 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. 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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-4214866","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":288922542,"identity":"bd92043b-228e-4b26-a1d4-a745a312e3ff","order_by":0,"name":"Johannes Rukyaa","email":"","orcid":"","institution":"Catholic University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Johannes","middleName":"","lastName":"Rukyaa","suffix":""},{"id":288922544,"identity":"b7c249ea-155f-42a3-9224-db09db5bd27d","order_by":1,"name":"Lillian Temba","email":"","orcid":"","institution":"Catholic University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Lillian","middleName":"","lastName":"Temba","suffix":""},{"id":288922545,"identity":"17c0d229-cc28-4f5c-8b6d-01562a1dab34","order_by":2,"name":"Princekened Kachira","email":"","orcid":"","institution":"Catholic University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Princekened","middleName":"","lastName":"Kachira","suffix":""},{"id":288922546,"identity":"6ddddb9b-76d1-4682-bfaa-05dccd49ad6e","order_by":3,"name":"Christopher Mwanansao","email":"","orcid":"","institution":"Catholic University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"","lastName":"Mwanansao","suffix":""},{"id":288922547,"identity":"4a0f3eaa-f0c0-43fc-b79c-885e6c21a9e7","order_by":4,"name":"Jeremiah Seni","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYJCCAxI8Njz8IFZCAfFa0uQkG0BaDIi36LCxwQEQTYwW+fbegwcsZNISN59fnfjhgQGDPL/YAfxaDM6cSwD5JXHbjbebJYAOM5w5O4GAFokcA5BfgFrObgBpSTC4TUCL/Pw3IC2HEzfPOLv5B1FaGG7wgLUYG/D3biPOFoMzEIfJSdzg3WaRYCBB2C/y7WeMP0v2AKOy/+zmmz8qbOT5pQk5DAiYJXuApARYpQRh5SDA+OEHkOQ/QJzqUTAKRsEoGHkAAO5vRmOi0Ia7AAAAAElFTkSuQmCC","orcid":"","institution":"Catholic University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Jeremiah","middleName":"","lastName":"Seni","suffix":""}],"badges":[],"createdAt":"2024-04-03 21:44:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4214866/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4214866/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13104-024-06851-3","type":"published","date":"2024-07-11T00:29:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60108971,"identity":"523b3c6c-d755-4db3-b3ba-bf4f9a6b5303","added_by":"auto","created_at":"2024-07-12 00:29:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":818513,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4214866/v1/5c670df5-840f-4a12-a157-616999f440da.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and antimicrobial susceptibility patterns of bacteria colonizing the external ocular surfaces of patients undergoing ocular surgeries at Bugando Medical Center in Mwanza, Tanzania","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSurgical site infections (SSI) are defined as infections occurring within 30 days after a surgical procedure affecting the superficial or deep tissue at the operation site [1]. A study conducted in the United States of America assessed the role of topical antibiotics prophylaxis in oculofacial plastic surgery and reported ocular surgical site infections (OSSI) to be more common in the placebo group 2.7% than the antibiotic group 0.0% [2]. Likewise, a study conducted in Brazil reported higher rates of postoperative endophthalmitis in the control group (0.097%) than the group receiving antibiotic prophylaxis (0.018%) [3]. \u003c/p\u003e\n\u003cp\u003eThe OSSI predispose patients to increased risk of prolonged post operative hospital stay, lifelong disability, and increased cost of patients management [1, 4]. Infectious postoperative endophthalmitis (IPOE) is the most dreaded complication for ocular surgical procedures [5]. The severity and clinical outcome of OSSI including IPOE depends on the pathogens\u0026rsquo; virulence and inoculum, patient\u0026rsquo;s immunological status, time of diagnosis and treatment, and other external/environmental factors [6, 7].\u003c/p\u003e\n\u003cp\u003eIn most cases of SSI, the causative pathogens are the normal microbiota inhabiting the respective anatomical surgical sites [8], and knowing the types and patterns of these bacteria is pertinent in expediting prophylactic antibiotics, and therefore, decrease the risk of acquiring SSI [9]. In this regard, the most targeted bacterial species for provision of antibiotic prophylaxis are Gram positive bacteria such as \u003cem\u003eS. aureus, Staphylococcus epidermidis\u003c/em\u003e and other Coagulase-negative Staphylococci (CoNS). Various Streptococci and Enterococci species are also of significant importance [7, 10, 11]. \u003c/p\u003e\n\u003cp\u003eThe continuous shift of ocular microbial flora due to factors such as age, occupation, place of residence, co-existing morbidities, and previous history of antibiotic use and hospital admission (to mention a few), may challenge the existing pre-operative prophylactic guidelines and foster increased chances of developing antimicrobial resistance (AMR) attributable OSSIs [12, 13].\u003c/p\u003e\n\u003cp\u003eTherefore; this study was designed to evaluate etiologies and antibiotic susceptibility patterns of bacteria residing on the external ocular surface of pre-operative ocular surgical patients so as to come up with up-to-date information that can be used to formulate prophylactic guidelines based on local evidence.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003e\u003cstrong\u003eStudy design, duration and \u003c/strong\u003e\u003cstrong\u003esetting\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis was a hospital based cross sectional analytical study conducted from May 2023 to August 2023 in the Ophthalmology Department at Bugando Medical center (BMC). The BMC is a 1000-bed capacity zonal tertiary consultant and teaching hospital serving approximately 20 million people in the north-western part of Tanzanian [14, 15]. The Ophthalmology Department has a bed capacity of 50, it attends approximately 400 patients monthly in the outpatient clinics, and performs approximately 80 ocular surgeries per month.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003cstrong\u003e, Selection criteria and sampling\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study included all ophthalmology surgical patients presenting at BMC for ocular surgeries, and excluded all patients who presented with signs and symptoms of an active ocular infections. Using a Kish-Leslie formula for cross-sectional studies, and a proportion of conjuctival bacterial colonisation of 26.6% from a previous study in Taiwan among patients undergoing cataract surgery, a minimum sample size of 300 patients were anticipated to be enrolled [16, 17]. However, this study ended up into enrolling a total of 240 patients . A total of 16 patients were excluded either due to missing data or had an active eye infection, bringing the number of study participants to 224 patients. \u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eData\u003c/strong\u003e\u003cstrong\u003e collection and laboratory \u003c/strong\u003e\u003cstrong\u003eprocedures\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA pretested-structured questionnaire was developed and then, fed into the Epi-collect- 5 software\u003csup\u003e\u0026reg;\u003c/sup\u003e (Centre for Genomic Pathogen Surveillance, UK) and subsequently used to collect socio-demographic and clinical information from patients. Each patient was informed about the study procedures, risks, benefits and rights to participate or withdrawal from the study, and then, those who voluntarily agreed to participate were enrolled and their respective data and samples collected. Ocular swabs were aseptically collected by the principal investigator (or trained research assistant) from each patient in the morning on the day of the surgical procedure before the application of topical anesthetic, mydriatics, antibiotic or povidone-iodine. The patient was asked to look up, and then the eyelid margin was swabbed with a sterile cotton swab moistened with sterile saline, employing a continuous stroke from the nasal to temporal side and then a second stroke from temporal to nasal side without touching the eyelashes, and then, placed in the swab\u0026rsquo;s transport media (Bio lab, HUNGARY\u0026reg;). Samples were transported to the Clinical Microbiology Laboratory of the Catholic University of Health and Allied Sciences in the cool box. In the laboratory, the swabs from patients were inoculated into Brain-heart infusion (BHI) broth (OXOID, Hampshire, United Kingdom) for enrichment and then processed in the laboratory after 18 - 24 hours incubation at 35-37\u003csup\u003eo\u003c/sup\u003eC. \u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eCulture, bacterial identification\u003c/strong\u003e\u003cstrong\u003e and drug susceptibility testing\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA portion of homogenized BHI was obtained using a sterile wire loop and inoculated onto blood agar (BA) and MacConkey agar (MCA) (OXOID, Hampshire, United Kingdom) incubated for 18-24hrs at 35-37\u0026deg;c. Identification of the organisms was done based on the growth characteristics on BA, MCA, secondary gram stain, and biochemical characteristics [18].\u003c/p\u003e\n\u003cp\u003eA single colony of bacteria from a fresh pure culture plate was emulsified into sterile normal saline to achieve a concentration equivalent to 0.5 McFarland turbidity solution, a sterile cotton swab was then used to obtain bacteria from the suspension, the swab was then squeezed against the wall of the tube to remove excess fluid before being seeded uniformly onto Muller-Hinton agar (OXOID, Hampshire, United Kingdom) plate. Antibiotics of the right potency was placed on the agar to test for antibiotic susceptibility patterns using Kirby Bauer\u0026rsquo;s disc diffusion method as guided by the Clinical Laboratory Standard Institute (CLSI) 30\u003csup\u003eth\u003c/sup\u003e edition M100 document, 2020 [19]. \u003c/p\u003e\n\u003cp\u003eAntibiotics discs for gram positive includes: ampicillin(10\u0026micro;g), cefoxitin(30\u0026micro;g), trimethoprim-sulfamethoxazole (1.25/23.75\u0026micro;g), ciprofloxacin (5\u0026micro;g), erythromycin (15\u0026micro;g), clindamycin (2\u0026micro;g), vancomycin (30\u0026micro;g), linezolid (30\u0026micro;g), gentamicin (10\u0026micro;g), clindamycin (2\u0026micro;g), tetracycline (30\u0026micro;g) whereas the antibiotics discs for gram negative bacteria was: ceftriaxone (30\u0026micro;g), cefepime (30\u0026micro;g), ciprofloxacin (5\u0026micro;g), ceftazidime(30\u0026micro;g), piperacillin-tazobactam (100/10\u0026micro;g), amoxicillin/clavulanate (20/10\u0026micro;g), trimethoprim-sulfamethoxazole (1.25/23.75\u0026micro;g), meropenem (10\u0026micro;g), gentamicin (10\u0026micro;g) and tetracycline (30\u0026micro;g). \u003c/p\u003e\n\u003cp\u003eAll \u003cem\u003eS. aureus \u003c/em\u003eand \u003cem\u003eS. epidermidis \u003c/em\u003ewith a zone of inhibition on cefoxitin (30\u0026micro;g) disc of \u0026le; 21 mm was regarded as methicillin resistant \u003cem\u003eS. aureus\u003c/em\u003e (MRSA) and methicillin resistant coagulase negative \u003cem\u003eStaphylococcus \u003c/em\u003e(MRCoNS), respectively. Inducible clindamycin resistance was tested by observing the blunting of the zone of inhibition around the clindamycin disc placed adjacent to the erythromycin disc. For gram negative bacteria; extended spectrum beta lactamase (ESBL) phenotype was confirmed using combined disc method using cefotaxime 30\u0026micro;g and/or ceftazidime 30\u0026mu;g (with and without clavulanic acid 10\u0026micro;g)[20].\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eQuality control\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAseptic techniques were strictly observed during sample collection, transportation and processing. Control strains of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (ATCC 25923) and \u003cem\u003eEscherichia coli\u003c/em\u003e ( ATCC 25922) was used for quality control of the performance of the culture media and the antibiotic discs FOR Gram positive and Gram negative bacteria, respectively [20].\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003cstrong\u003e and Ethical consideration\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eExcel data sheet was extracted from Epi-collect- 5 software\u003csup\u003e\u0026reg;\u003c/sup\u003e and then, laboratory data were also added into the Microsoft Excel for cleaning and coding. Data was then transferred to STATA version15 (College Station, Texas, USA) for analysis. Continuous data was summarized using a medium with an inter-quartile range (IQR). Categorical data was summarized using proportion (percent). Pearson chi squared test (or Fisher\u0026rsquo;s exact where applicable) and a two-sample test of proportions was used to assess the distribution of categorical variables against ocular colonization culture positivity. A p-value cut-off of less than 0.05 was considered statistically significant. This study obtained an ethical clearance from the joint CUHAS/BMC Research Ethics and review committee (CREC 2900/2023). Permission to conduct the study was obtained from the BMC hospital Director General, whereas voluntary informed consent from participants was obtained before proceeding to data and specimen collection. Confidentiality of the patients was observed throughout the study.Final results from this study were communicated to the Department of Ophthalmology to guide future revision of antimicrobial prophylaxis guidelines.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003e\u003cstrong\u003eSocio-demographic information of the study participants.\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study enrolled a total of 224 patients, majority of the study participants were male 54.5% (n=122). The median age of the study participants was 62.5 [IQR 39.5-75.0] years with the majority of the study participants being self-employed 50.0% (n=122) and had attended primary education level 47.3% (n=106), Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Social-demographic characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"478\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.194154488517746%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.194154488517746%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003e122(54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e102 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.194154488517746%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003e9 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e120 (\u0026nbsp;53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNot married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e47 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e48 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.194154488517746%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003e106 \u0026nbsp;(47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e43 \u0026nbsp;(19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e24 \u0026nbsp;(10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eNever attended school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e51\u0026nbsp;(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.194154488517746%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003e17\u0026nbsp;(7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eSelf employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e112\u0026nbsp;(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e65\u0026nbsp;(29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e30\u0026nbsp;(13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.194154488517746%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eWard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003eFemale ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.40292275574113%\" valign=\"top\"\u003e\n \u003cp\u003e97 \u0026nbsp;(43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eMale ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e107\u0026nbsp;(47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003ePediatric ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e20 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMajority of the study participants underwent cataract removal 57.6% (n=129). Comorbidities were observed in 34.8% (n=78) of study participants, and high blood pressure predominated, 19.2% (n=43) as shown in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Clinical characteristics of study participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"464\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.88793103448276%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.758620689655174%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.353448275862068%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.88793103448276%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eType of ocular procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.758620689655174%\" valign=\"top\"\u003e\n \u003cp\u003eCataract removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.353448275862068%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;129 ( 57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eGlaucoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;2 \u0026nbsp;(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eIntraocular surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e93\u0026nbsp;(41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.88793103448276%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAntibiotic consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.758620689655174%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.353448275862068%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; 221 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e3 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.88793103448276%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eType of antibiotic used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.758620689655174%\" valign=\"top\"\u003e\n \u003cp\u003eCeftriaxone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.353448275862068%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eAmpicillin-cloxacillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;221 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.88793103448276%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eMode of antibiotic acquisition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.758620689655174%\" valign=\"top\"\u003e\n \u003cp\u003eSelf-prescription\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.353448275862068%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eDoctor\u0026rsquo;s prescription\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;221 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.88793103448276%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDuration of antibiotic use\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.758620689655174%\" valign=\"top\"\u003e\n \u003cp\u003e2(days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.353448275862068%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003e3(days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;221 (98.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.88793103448276%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.758620689655174%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.353448275862068%\" valign=\"top\"\u003e\n \u003cp\u003e146\u0026nbsp;(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e78\u0026nbsp;(34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.88793103448276%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eType of comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.758620689655174%\" valign=\"top\"\u003e\n \u003cp\u003eHigh blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.353448275862068%\" valign=\"top\"\u003e\n \u003cp\u003e43 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e10 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003ePeptic ulcers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e9 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e146\u0026nbsp;(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.35849056603774%\" valign=\"top\"\u003e\n \u003cp\u003eOthers**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.64150943396226%\" valign=\"top\"\u003e\n \u003cp\u003e16 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e** Unspecified ear problem (3), Cardiomegaly (3), Joint pain (3), Unspecified febrile illness (2) Prostate cancer (1), Leg pain (1), Kidney problem (1), Hernia (1),\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;Tuberculosis(1)\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003ePrevalence of bacteria colonizing external ocular surfaces\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOut of 224 non repetitive ocular swabs collected, 175 (78.1%) were culture positive for bacteria colonizing external ocular surfaces. A total of 21 (9.4%) of the study participants had positive culture for more than one bacteria isolates, resulting into a total of 196 bacteria isolates. Culture positivity was significantly higher among patients with comorbidities compared to those who without comorbidities (85.9% versus 74.0%, p=0.040) Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Study variables vs culture positivity among study participants \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"660\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.87745839636914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.818456883509832%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.44175491679274%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCulture results\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.36459909228442%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePearson chi\u003csup\u003e2\u003c/sup\u003e test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.497730711043873%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.862144420131294%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.2253829321663%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.91247264770241%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative,\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.87745839636914%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.818456883509832%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.674735249621785%\" valign=\"top\"\u003e\n \u003cp\u003e100(82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.767019667170953%\" valign=\"top\"\u003e\n \u003cp\u003e22 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.36459909228442%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.497730711043873%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e75 (73.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e27 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.87745839636914%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.818456883509832%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.674735249621785%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;80 (75.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.767019667170953%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;26 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.36459909228442%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e2.595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.497730711043873%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e35 (81.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;8 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;17 (70.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;7 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eNever attended school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e43 (84.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;8 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.87745839636914%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.818456883509832%\" valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.674735249621785%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;9 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.767019667170953%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;8 \u0026nbsp; \u0026nbsp; (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.36459909228442%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e7.397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.497730711043873%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eSelf employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;89 (79.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e23 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;54 (83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e11 (16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e23 (76.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;7 (23.3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.87745839636914%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eOcular procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.818456883509832%\" valign=\"top\"\u003e\n \u003cp\u003eCataract removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.674735249621785%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;32 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.767019667170953%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;97 (75.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.36459909228442%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.497730711043873%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.173*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eGlaucoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e1 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e1 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eIntraocular surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e77 \u0026nbsp;(82.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;16 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.87745839636914%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.818456883509832%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.674735249621785%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;108 (74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.767019667170953%\" valign=\"top\"\u003e\n \u003cp\u003e38 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.36459909228442%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e4.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.497730711043873%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.06583072100314%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.407523510971785%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;67(85.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.526645768025077%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;11 \u0026nbsp;( 14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p-value based on one-sided Fisher\u0026rsquo;s exact.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eDistribution of bacterial isolates colonizing external ocular surfaces and their antimicrobial susceptibility patterns\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eA total of 196 bacteria were isolated from non-repetitive ocular swabs in this study, \u003cem\u003eS. epidermidis, S. aureus\u003c/em\u003e, and \u003cem\u003eP. aeruginosa\u003c/em\u003e were the commonest isolates: 43.4% (n=85), 21.9% (n=43) and 14.3% (n=28), respectively. Low level resistance among \u003cem\u003eS. epidermidis\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;S. aureus\u0026nbsp;\u003c/em\u003ewere observed against clindamycin (28.2% and 27.9%, respectively) and gentamicin (14.1% and 16.3%, respectively). For the predominant Gram negative bacteria, \u003cem\u003eP. aeruginosa\u003c/em\u003e and \u003cem\u003eKlebsiella\u003c/em\u003e spp., showed low level resistance was observed against ceftazidime at 21.4% and 12.5%, respectively. All Gram negative bacteria were were sensitive to meropenem except one \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e isolate. Variable resistance profiles were notable to the most commonly used antibiotics like ciprofloxacin and tetracycline, ranging from 0.0% to 66.7%. This study observed high proportion of MRCoNS and MRSA at 52.9% and 46.5%, respectively although the difference was not statistically significant (p=0.494). There was low ESBL production among Gram negative Enterobacterales (15.4%, 4/26), Table 3.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Antibiotic susceptibility patterns of bacteria isolated from patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"999\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.414414414414415%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBacteria, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"85.58558558558559%\" colspan=\"14\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotics susceptibility patterns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.9342723004694835%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.690140845070423%\" valign=\"top\"\u003e\n \u003cp\u003eCIP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.042253521126761%\" valign=\"top\"\u003e\n \u003cp\u003eTET(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eE (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003eCD(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003eCOT(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eFOX (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eGEN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eLZ (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eFEP (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eCRO(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eCAZ(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eAMC(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981220657276995%\" valign=\"top\"\u003e\n \u003cp\u003eTZP(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.457831325301205%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eS.epidermidis,\u0026nbsp;\u003c/em\u003e85 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5100401606425704%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.72289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e47(55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\" valign=\"top\"\u003e\n \u003cp\u003e32(37.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003e25(29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e61(71.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e11(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e40(47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e73(85.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e84(98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.827309236947791%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.9342723004694835%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.690140845070423%\" valign=\"top\"\u003e\n \u003cp\u003e38(44.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.042253521126761%\" valign=\"top\"\u003e\n \u003cp\u003e53(62.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003e60(70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003e24(28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003e74(87.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e45(52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e12(14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e1(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981220657276995%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.457831325301205%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP. aeruginosa, 28\u003c/em\u003e(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5100401606425704%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.72289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e28(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e26(92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e27(96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e22(78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.827309236947791%\" valign=\"top\"\u003e\n \u003cp\u003e27(96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.9342723004694835%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.690140845070423%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.042253521126761%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e2(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e1(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e6(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981220657276995%\" valign=\"top\"\u003e\n \u003cp\u003e1 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.457831325301205%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eS. aureus,\u0026nbsp;\u003c/em\u003e43 (21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5100401606425704%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.72289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e29(67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\" valign=\"top\"\u003e\n \u003cp\u003e16(37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003e14(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e31(72.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e11(25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e23(53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e36(83.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e42(97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.827309236947791%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.9342723004694835%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.690140845070423%\" valign=\"top\"\u003e\n \u003cp\u003e14(32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.042253521126761%\" valign=\"top\"\u003e\n \u003cp\u003e27(62.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003e29(67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003e12(27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003e32(74.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e20(46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e7(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e1(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981220657276995%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.457831325301205%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella\u0026nbsp;\u003c/em\u003espp, 24(12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5100401606425704%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.72289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\" valign=\"top\"\u003e\n \u003cp\u003e24(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e22(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e22(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e21(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003e7(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.827309236947791%\" valign=\"top\"\u003e\n \u003cp\u003e24(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.9342723004694835%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.690140845070423%\" valign=\"top\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.042253521126761%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e2(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e3(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003e17(70.8)%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981220657276995%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.457831325301205%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003col start=\"19\"\u003e\n \u003cli\u003e\u003cem\u003eviridans,\u0026nbsp;\u003c/em\u003e9 (4.6)\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5100401606425704%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.72289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e3(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\" valign=\"top\"\u003e\n \u003cp\u003e5(55.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003e5(55.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e8(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e1(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e4(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e9(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.827309236947791%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.9342723004694835%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.690140845070423%\" valign=\"top\"\u003e\n \u003cp\u003e6(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.042253521126761%\" valign=\"top\"\u003e\n \u003cp\u003e4(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003e4(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003e1(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003e8(88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e5(55.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981220657276995%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.457831325301205%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eOther GNB\u003cem\u003e*\u003c/em\u003e, 3 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5100401606425704%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.72289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\" valign=\"top\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.827309236947791%\" valign=\"top\"\u003e\n \u003cp\u003e3(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"2.9342723004694835%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.690140845070423%\" valign=\"top\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.042253521126761%\" valign=\"top\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.15962441314554%\" valign=\"top\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.746478873239437%\" valign=\"top\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276995305164319%\" valign=\"top\"\u003e\n \u003cp\u003e3(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981220657276995%\" valign=\"top\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.457831325301205%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal,\u003cem\u003e\u0026nbsp;\u003c/em\u003e196 (100.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5100401606425704%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.72289156626506%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.024096385542169%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.124497991967871%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.626506024096385%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.224899598393574%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.827309236947791%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*\u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003e(2)\u003cem\u003e, Acinetobacter\u0026nbsp;\u003c/em\u003espp\u003cem\u003e\u0026nbsp;\u003c/em\u003e(1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u0026nbsp;\u003c/strong\u003eCIP:\u0026nbsp;Ciprofloxacin,\u0026nbsp;TET: Tetracycline, E:\u0026nbsp;Erythromycin, CD:\u0026nbsp;Clindamycin, FOX:\u0026nbsp;Cefoxitin, GEN:\u0026nbsp;Gentamicin,\u003c/p\u003e\n\u003cp\u003eCOT: Trimethoprim-sulfamethoxazole,\u0026nbsp;LZ: Linezolid, FEP: Cefepime, CRO:\u0026nbsp;Ceftriaxone, CAZ:\u0026nbsp;Ceftazidime,\u003c/p\u003e\n\u003cp\u003eAMC: Amoxicillin/clavulanate, TZP: Piperacillin-tazobactam, NA: Not Applicable, R: Resistant; S: Sensitive.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study enrolled a total of 224 patients attending the Ophthalmology Department at BMC with the majority of participants being male, similar to other studies[21, 22]. This study observed high proportion for ocular surface colonization by bacteria (78.1%), than 59.5% and 32.5% reported from a study conducted at a tertiary hospital in Uganda in 2013 and another study conducted in Mexico in 2021, respectively [23, 24], however; our study findings are lower than 85% reported from USA in 2015 [25]. These high proportions reported in both studies are indicative of the high proportion colonization in the external ocular surfaces of patients undergoing ocular surgeries attributed to the fact that the eye lid margins mark the border between the external and internal ocular surface, therefore, being in close proximity with the skin which harbors high loads of skin microbiota [26, 27]. \u003c/p\u003e\n\u003cp\u003eThis study reported predominance of Gram-positive skin microbiota (\u003cem\u003eS. epidermidis \u003c/em\u003eand \u003cem\u003eS. aureus\u003c/em\u003e) colonizing external ocular surfaces of the study participants, which is not suprising and is in agreement with those from Uganda and the USA [23, 24]. It is well known that these skin microbiota are preferentially are important in preventing pathogenic bacteria from causing OSSIs, however, during ocular surgeries, they can be introduced into internal ocular structures and potentially cause OSSIs if appropriate antibiotic prophylaxis are not administered [28, 29]. Furthermore; we observed the unusual isolation of Gram negative pathogenic bacteria like \u003cem\u003eP. aeruginosa \u003c/em\u003eand \u003cem\u003eKlebsiella\u003c/em\u003e spp.from the external ocular surfaces, similar to findings from a study in Mexico [24]. These findings may be attributed to contamination from various inanimate/environmental surfaces and patients anatomical sites such as the perianal areas [30, 31]. Therefore, this calls for strengthening of hygienic and sanitation practices among patients, and blocking this transmission cycle[32]. The findings are reiterated by similar occurrence of these pathogens in other hospital environmental premises at BMC which are linked to neonatal sepsis and neonatal deaths, and therefore, a need to strengthen hospital-wide infection prevention and control measures through environmental cleaning and decontamination [33, 34]. These altogether, highlight a need to conduct prospective study in patients undergoing ocular surgeries to evaluation potential involvement of these pathogens in the OSSIs, and expedite specific antimicrobial therapies. \u003c/p\u003e\n\u003cp\u003eHigh proportion of resistance of \u003cem\u003eS. epidermidis \u003c/em\u003eand\u003cem\u003e S. aureus \u003c/em\u003ewas observed towards commonly used antibiotics like trimethoprim/sulfamethoxazole, erythromycin and tetracycline, unlike less commonly used agents like gentamicin. Similarly, \u003cem\u003eKlebsiella\u003c/em\u003e spp. displayed high proportion of resistance towards amoxicillin/clavulanic acid, compared to less commonly used agents like gentamicin, 3\u003csup\u003erd\u003c/sup\u003e generation cephalosporin and piperacilllin-tazobactam. These findings provided a wake-up calls as antibiotics like erythromycin and tetracycline are commonly used at BMC Ophthalmology Department as prophylaxis for ocular surgical patients, and in other lower- and middle-income countries (LMIC\u0026rsquo;s) settings [35, 36]. Therefore, these findings are pertinent to guide revisiting of antibiotic prophylactic options for ocular surgeries at BMC in Mwanza, Tanzania.\u003c/p\u003e\n\u003cp\u003eThis study observed high proportions of MRCoNS and MRSA in \u003cem\u003eS. epidemidis\u003c/em\u003e and \u003cem\u003eS. aureus\u003c/em\u003e isolates, respectively on external ocular surfaces of pre operative patients posing a risk for subsequent OSSIs attributed to these notorous and difficult to manage strains. This may further lead to prolonged hospitalization of patients, lifelong disability and an increased cost for patient care [37]. The findings highlight an emergening antimicrobial selective pressure not only to pathogens but also to normal microbiota, and hence, a need to escalate our responsive measures towards AMR surveillance and antimicrobial stewardship programs at BMC [38]. On the other hand, there was low resistance to the 3\u003csup\u003erd\u003c/sup\u003e generation cephalosporins marked by ESBL production in Gram negative Enterobacterales, emphasizing a need to foster rational use of these agents and maintain their efficacy for prophylaxis and therapeutic roles. We observed that having comorbidity was a risk factor for ocular colonization. This is likely to be associated with recurrent exposure to hospital environment (outpatient visitis and hospital admissions) and antibiotics, which altogether are known to be driving factors for MDR pathogens in patients. Therefore, priority screeing for patients with comorbidities is emphasized to as to guide specific choice of antibiotic prophylactic agents. \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eEight out of every ten patients\u0026nbsp;undergoing ocular surgical procedures at BMC are colonized by normal microbiota and pathogenic bacteria in their external ocular surfaces. These bacteria display high proportions of resistance towards erythromycin, tetracycline, and ciprofloxacin which are commonly used as prophylaxis for ocular surgeries in this setting. Gentamicin, 3\u003csup\u003erd\u003c/sup\u003e generation cephalosporins and piperacillin-tazobactam showed low resistance (\u0026le;25.0%), and are potential antimicrobial prophylactic options in this hospital upon revisiting hospital guidelines. Prospective studies at BMC should focus on evaluating relationship between ocular colonization and incident OSSIs, as well as transmission dynamics of these pathogens between patients and hospital environmental premises using genomic approaches are reiterated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed conventional culture techniques which might have missed the isolation of difficult to culture bacteria pathogens, and therefore, may have under reported the actual burden for bacterial ocular colonization. This study did not asses the relationship between ocular colonization and incident OSSIs., which may be a pivotal area of interest for future studies at BMC. \u0026nbsp; \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAMR \u0026nbsp; \u0026nbsp; Antimicrobial resistance\u003c/p\u003e\n\u003cp\u003eATCC \u0026nbsp; American type culture collection\u003c/p\u003e\n\u003cp\u003eBA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Blood agar\u003c/p\u003e\n\u003cp\u003eBHI \u0026nbsp; \u0026nbsp; \u0026nbsp; Brain-heart infusion\u003c/p\u003e\n\u003cp\u003eBMC \u0026nbsp; \u0026nbsp; Bugando Medical center\u003c/p\u003e\n\u003cp\u003eBMC \u0026nbsp; \u0026nbsp; \u0026nbsp;Bugando Medical Centre\u003c/p\u003e\n\u003cp\u003eCoNS \u0026nbsp; \u0026nbsp; Coagulase-negative staphylococci\u003c/p\u003e\n\u003cp\u003eCUHAS Catholic university of health and allied sciences\u003c/p\u003e\n\u003cp\u003eESBL \u0026nbsp; \u0026nbsp; Extended spectrum beta lactamase\u003c/p\u003e\n\u003cp\u003eIPOE \u0026nbsp; \u0026nbsp; \u0026nbsp; Infectious postoperative endophthalmitis\u003c/p\u003e\n\u003cp\u003eMCA \u0026nbsp; \u0026nbsp; \u0026nbsp;MacConkey agar\u003c/p\u003e\n\u003cp\u003eOSSI \u0026nbsp; \u0026nbsp; \u0026nbsp; Ocular surgical site infections\u003c/p\u003e\n\u003cp\u003eSSI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Surgical site infections\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAcknowledgment\u003c/h2\u003e\n\u003cp\u003eWe are grateful to all staff in the Department of Ophthalmology at BMC, and the Microbiology and Immunology Department at the CUHAS for their technical support throughout the study period.\u003c/p\u003e\n\u003ch2\u003eAuthor contribution\u003c/h2\u003e\n\u003cp\u003eJR, LT, CM and JS: Study conception, design and execution. JR, LT and PK: Data collection, sample collection and processing, data analysis and initial drafting of the manuscript. CM and JS: Overall study supervision, in-kind contribution to the study reagents and supplies, and critical review of manuscript.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNo external funding was received for this study. Authors provided in-kind contribution to support study execution.\u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eAll data generated during this study are included in this article and its dataset can be accessed upon request to the corresponsing author.\u003c/p\u003e\n\u003ch2\u003eAuthors declare to have no competing interests.\u003c/h2\u003e\n\u003ch2\u003eEthical approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study obtained an ethical clearance from the joint CUHAS/BMC Research Ethics and review committee (CREC 2900/2023). Permission to conduct the study was obtained from the BMC Hospital Director General, whereas voluntary informed consent from participants was obtained before proceeding to data and specimen collection. Confidentiality of the patients was observed throughout the study.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eAll authors have consented for this manuscript generated from study findings be published.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOwens C, Stoessel K: Surgical site infections: epidemiology, microbiology and prevention. \u003cem\u003eJournal of hospital infection\u0026nbsp;\u003c/em\u003e2008, 70:3-10.\u003c/li\u003e\n \u003cli\u003eAshraf DC, Idowu OO, Wang Q, YeEun T, Copperman TS, Tanaboonyawat S, Arnold BF, Oldenburg CE, Vagefi MR, Kersten RC: The role of topical antibiotic prophylaxis in oculofacial plastic surgery: a randomized controlled study. \u003cem\u003eOphthalmology\u0026nbsp;\u003c/em\u003e2020, 127(12):1747-1754.\u003c/li\u003e\n \u003cli\u003ede Sousa Casavechia LN, Meireles AC, Schapira E, Fernandes RAB, Fernandes AG: The impact of antibiotic prophylaxis with intracameral cefuroxime on postoperative infectious endophthalmitis rates in a high-volume cataract surgery center. \u003cem\u003eScientific Reports\u0026nbsp;\u003c/em\u003e2023, 13(1):18031.\u003c/li\u003e\n \u003cli\u003eReichman DE, Greenberg JA: Reducing surgical site infections: a review. \u003cem\u003eReviews in Obstetrics and Gynecology\u0026nbsp;\u003c/em\u003e2009, 2(4):212.\u003c/li\u003e\n \u003cli\u003eBehndig A, Cochener B, G\u0026uuml;ell JL, Kodjikian L, Mencucci R, Nuijts RM, Pleyer U, Rosen P, Szaflik JP, Tassignon M-J: Endophthalmitis prophylaxis in cataract surgery: overview of current practice patterns in 9 European countries. \u003cem\u003eJournal of Cataract \u0026amp; Refractive Surgery\u0026nbsp;\u003c/em\u003e2013, 39(9):1421-1431.\u003c/li\u003e\n \u003cli\u003eLee PJ, Seal DV, Payman G: Endophthalmitis: diagnosis and management: CRC Press LLC; 2004.\u003c/li\u003e\n \u003cli\u003eBarry P, Behrens-Baumann W, Pleyer U, Seal D: ESCRS Guidelines on prevention, investigation and management of post-operative endophthalmitis. \u003cem\u003eVersion\u0026nbsp;\u003c/em\u003e2007, 2:14.\u003c/li\u003e\n \u003cli\u003eKhairy GA, Kambal AM, Al-Dohayan AA, Al-Shehri MY, Zubaidi AM, Al-Naami MY, AlSaif FA, Al-Obaid OA, Al-Saif AA, El-Farouk OY: Surgical site infection in a teaching hospital: a prospective study. \u003cem\u003eJournal of Taibah University Medical Sciences\u0026nbsp;\u003c/em\u003e2011, 6(2):114-120.\u003c/li\u003e\n \u003cli\u003eBowater RJ, Stirling SA, Lilford RJ: Is antibiotic prophylaxis in surgery a generally effective intervention?: testing a generic hypothesis over a set of meta-analyses. \u003cem\u003eAnnals of surgery\u0026nbsp;\u003c/em\u003e2009, 249(4):551-556.\u003c/li\u003e\n \u003cli\u003eGroup EVS: Results of the endophthalmitis vitrectomy study. \u003cem\u003eArch Ophthalmol\u0026nbsp;\u003c/em\u003e1995, 113:1479-1496.\u003c/li\u003e\n \u003cli\u003eFisch A, Prazuck T, Gerbaud L, Coscas G, Lafaix C, Salvanet A, Forestier F, Endophthalmitis FCSGo: Epidemiology of infective eridophthalmitis in France. \u003cem\u003eThe Lancet\u0026nbsp;\u003c/em\u003e1991, 338(8779):1373-1376.\u003c/li\u003e\n \u003cli\u003eStorey P, Dollin M, Rayess N, Pitcher J, Reddy S, Vander J, Hsu J, Garg S, Team P-IES: The effect of prophylactic topical antibiotics on bacterial resistance patterns in endophthalmitis following intravitreal injection. \u003cem\u003eGraefe\u0026apos;s Archive for Clinical and Experimental Ophthalmology\u0026nbsp;\u003c/em\u003e2016, 254:235-242.\u003c/li\u003e\n \u003cli\u003eMalik B, Bhattacharyya S: Antibiotic drug-resistance as a complex system driven by socio-economic growth and antibiotic misuse. \u003cem\u003eScientific reports\u0026nbsp;\u003c/em\u003e2019, 9(1):1-12.\u003c/li\u003e\n \u003cli\u003eClinical Services Updates [https://www.bugandomedicalcentre.go.tz/index.php?bmc=61]\u003c/li\u003e\n \u003cli\u003eUnited Republic of Tanzania. 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In\u003cem\u003e.\u003c/em\u003e; 2020.\u003c/li\u003e\n \u003cli\u003eGonzalez-De La Torre A, Franco-Cendejas R, Gonzalez-Veliz A, Zarza-Garcia V, ML GH, Barrientos-Gutierrez T: Ocular Surface Characteristics and Colonization in a Burn Center: A Prospective Cohort Study. \u003cem\u003eJournal of Burn Care \u0026amp; Research: Official Publication of the American Burn Association\u0026nbsp;\u003c/em\u003e2022, 43(1):43-50.\u003c/li\u003e\n \u003cli\u003eZhao H, Chen Y, Zheng Y, Xu J, Zhang C, Fu M, Xiong K: Conjunctival sac microbiome in anophthalmic patients: Flora diversity and the impact of ocular prosthesis materials. \u003cem\u003eFrontiers in Cellular and Infection Microbiology\u0026nbsp;\u003c/em\u003e2023, 13:1117673.\u003c/li\u003e\n \u003cli\u003eMshangila B, Paddy M, Kajumbula H, Ateenyi-Agaba C, Kahwa B, Seni J: External ocular surface bacterial isolates and their antimicrobial susceptibility patterns among pre-operative cataract patients at Mulago National Hospital in Kampala, Uganda. \u003cem\u003eBMC ophthalmology\u0026nbsp;\u003c/em\u003e2013, 13(1):1-6.\u003c/li\u003e\n \u003cli\u003eDe La Parra-Colin P, Gonzalez-De La Torre A, Franco-Cendejas R, Gonzalez-Veliz A, Zarza-Garcia V, V\u0026aacute;zquez Mellado Mart\u0026iacute;nez IP, Garc\u0026iacute;a Hern\u0026aacute;ndez MdL, Barrientos-Gutierrez T: Ocular surface characteristics and colonization in a burn center: A prospective cohort study. \u003cem\u003eJournal of Burn Care \u0026amp; Research\u0026nbsp;\u003c/em\u003e2022, 43(1):43-50.\u003c/li\u003e\n \u003cli\u003eJassim SH, Sivaraman KR, Jimenez JC, Jaboori AH, Federle MJ, de la Cruz J, Cortina MS: Bacteria colonizing the ocular surface in eyes with boston type 1 keratoprosthesis: analysis of biofilm-forming capability and vancomycin tolerance. \u003cem\u003eInvestigative Ophthalmology \u0026amp; Visual Science\u0026nbsp;\u003c/em\u003e2015, 56(8):4689-4696.\u003c/li\u003e\n \u003cli\u003eBrown MM, Horswill AR: Staphylococcus epidermidis\u0026mdash;Skin friend or foe? \u003cem\u003ePLoS pathogens\u0026nbsp;\u003c/em\u003e2020, 16(11):e1009026.\u003c/li\u003e\n \u003cli\u003eParlet CP, Brown MM, Horswill AR: Commensal staphylococci influence Staphylococcus aureus skin colonization and disease. \u003cem\u003eTrends in microbiology\u0026nbsp;\u003c/em\u003e2019, 27(6):497-507.\u003c/li\u003e\n \u003cli\u003eSevern MM, Horswill AR: Staphylococcus epidermidis and its dual lifestyle in skin health and infection. \u003cem\u003eNature Reviews Microbiology\u0026nbsp;\u003c/em\u003e2023, 21(2):97-111.\u003c/li\u003e\n \u003cli\u003eKrishna S, Miller LS: Host\u0026ndash;pathogen interactions between the skin and Staphylococcus aureus. \u003cem\u003eCurrent opinion in microbiology\u0026nbsp;\u003c/em\u003e2012, 15(1):28-35.\u003c/li\u003e\n \u003cli\u003eErb S, D\u0026rsquo;Mello-Guyett L, Malebo HM, Njee RM, Matwewe F, Ensink J, Hinic V, Widmer A, Frei R: High prevalence of ESBL-Producing E. coli in private and shared latrines in an informal urban settlement in Dar es Salaam, Tanzania. \u003cem\u003eAntimicrobial Resistance \u0026amp; Infection Control\u0026nbsp;\u003c/em\u003e2018, 7:1-6.\u003c/li\u003e\n \u003cli\u003eSilago V, Kovacs D, Msanga DR, Seni J, Matthews L, Oravcov\u0026aacute; K, Zadoks RN, Lupindu AM, Hoza AS, Mshana SE: Bacteremia in critical care units at Bugando Medical Centre, Mwanza, Tanzania: the role of colonization and contaminated cots and mothers\u0026rsquo; hands in cross-transmission of multidrug resistant Gram-negative bacteria. \u003cem\u003eAntimicrobial Resistance \u0026amp; Infection Control\u0026nbsp;\u003c/em\u003e2020, 9:1-14.\u003c/li\u003e\n \u003cli\u003eBloomfield SF, Exner M, Signorelli C, Nath K, Scott E: The chain of infection transmission in the home and everyday life settings, and the role of hygiene in reducing the risk of infection. In: \u003cem\u003eInternational scientific forum on home hygiene: 2012\u003c/em\u003e; 2012.\u003c/li\u003e\n \u003cli\u003eMarando R, Seni J, Mirambo MM, Falgenhauer L, Moremi N, Mushi MF, Kayange N, Manyama F, Imirzalioglu C, Chakraborty T: Predictors of the extended-spectrum-beta lactamases producing Enterobacteriaceae neonatal sepsis at a tertiary hospital, Tanzania. \u003cem\u003eInternational Journal of Medical Microbiology\u0026nbsp;\u003c/em\u003e2018, 308(7):803-811.\u003c/li\u003e\n \u003cli\u003eKovacs D, Silago V, Msanga DR, Mshana SE, Seni J, Oravcova K, Matthews L: The hospital environment versus carriage: Transmission pathways for third-generation cephalosporin-resistant bacteria in blood in neonates in a low-resource country healthcare setting. \u003cem\u003eScientific Reports\u0026nbsp;\u003c/em\u003e2022, 12(1):8347.\u003c/li\u003e\n \u003cli\u003eKariyawasam RM, Julien DA, Jelinski DC, Larose SL, Rennert-May E, Conly JM, Dingle TC, Chen JZ, Tyrrell GJ, Ronksley PE: Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019\u0026ndash;June 2021). \u003cem\u003eAntimicrobial Resistance \u0026amp; Infection Control\u0026nbsp;\u003c/em\u003e2022, 11(1):45.\u003c/li\u003e\n \u003cli\u003eNdaki PM, Mushi MF, Mwanga JR, Konje ET, Ntinginya NE, Mmbaga BT, Keenan K, Sabiiti W, Kesby M, Benitez-Paez F: Dispensing antibiotics without prescription at community pharmacies and accredited drug dispensing outlets in Tanzania: a cross-sectional study. \u003cem\u003eAntibiotics\u0026nbsp;\u003c/em\u003e2021, 10(8):1025.\u003c/li\u003e\n \u003cli\u003eSerra-Burriel M, Keys M, Campillo-Artero C, Agodi A, Barchitta M, Gikas A, Palos C, L\u0026oacute;pez-Casasnovas G: Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. \u003cem\u003ePloS one\u0026nbsp;\u003c/em\u003e2020, 15(1):e0227139.\u003c/li\u003e\n \u003cli\u003eBeyer P, Paulin S: Priority pathogens and the antibiotic pipeline: an update. \u003cem\u003eBulletin of the World Health Organization\u0026nbsp;\u003c/em\u003e2020, 98(3):151.\u003c/li\u003e\n\u003c/ol\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-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ocular surgeries, Bacterial colonization, Bugando Medical Centre, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-4214866/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4214866/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e Understanding microbiota colonizing ocular surfaces is key to expedite antibiotic prophylactic options for ocular surgeries, and therefore, prevent subsequent surgical site infections (SSIs). To fill this critical gap, we aimed at determining the prevalence and antibiotic susceptibility patterns of bacteria colonizing the external ocular surfaces of 224 patients undergoing ocular surgeries at Bugando Medical Centre (BMC) in Mwanza, Tanzania between May and August 2023.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e The study participants had a median age of 62.5 (interquartile range: 39.5-75.0) years. A total of 78.1% (175/224) ocular swabs were culture positive yielding 196 bacterial isolates. \u003cem\u003eS. epidermidis \u003c/em\u003e[43.4% (n=85)] followed by \u003cem\u003eS. aureus \u003c/em\u003e[21.9% (n=43)] and \u003cem\u003ePseudomonas aeruginosa \u003c/em\u003e[14.3% (n=28)] were the most common bacteria. There was low proportions of resistance among predominant Gram positive and Gram-negative bacteria to gentamicin (≤25.0%), and similarly, low resistance among Gram negative bacteria was observed against 3\u003csup\u003erd\u003c/sup\u003e generation cephalosporins (≤25.0%) and piperacillin-tazobactam (0.0%). Variable resistance profiles were notable to the most commonly used antibiotics (ciprofloxacin and tetracycline: 0.0% to 66.7%). Our findings underscore an urgent need to revisit antibiotic prophylactic guidelines for ocular surgeries in this tertiary hospital, and calls for prospective evaluation of incident SSIs post-ocular surgeries to guide specific management.\u003c/p\u003e","manuscriptTitle":"Prevalence and antimicrobial susceptibility patterns of bacteria colonizing the external ocular surfaces of patients undergoing ocular surgeries at Bugando Medical Center in Mwanza, Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-11 20:22:05","doi":"10.21203/rs.3.rs-4214866/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-07T08:23:03+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"c7b2db3d-2889-4d1c-8304-e75e1a53ff09_SNPRID","date":"2024-04-16T05:04:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-16T03:29:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8fd6f7ae-573f-4fb8-97f3-bab98e4d55bb","date":"2024-04-16T03:02:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-15T15:22:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-08T15:33:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-07T23:30:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-07T23:30:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2024-04-03T21:36:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"73249865-ae86-44f3-aa66-9a101f756be7","owner":[],"postedDate":"April 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-07-12T00:29:16+00:00","versionOfRecord":{"articleIdentity":"rs-4214866","link":"https://doi.org/10.1186/s13104-024-06851-3","journal":{"identity":"bmc-research-notes","isVorOnly":false,"title":"BMC Research Notes"},"publishedOn":"2024-07-11 00:29:16","publishedOnDateReadable":"July 11th, 2024"},"versionCreatedAt":"2024-04-11 20:22:05","video":"","vorDoi":"10.1186/s13104-024-06851-3","vorDoiUrl":"https://doi.org/10.1186/s13104-024-06851-3","workflowStages":[]},"version":"v1","identity":"rs-4214866","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4214866","identity":"rs-4214866","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}