**4. Discussion**

The prevalence of culture-positive ocular infections caused by bacteria found in this study was 88.6%, and the result is comparable with other previous study reports conducted in India (88%) [13] and Egypt (87.8%) [14]. Our finding is high compared with the report from Southern Ethiopia (74.7%) [15], Bangalore (34.5%) [16], Gondar (47.4%) [17] and Addis Ababa (54.9%) [18]. The difference can be attributed to geographic location, study period, study population, sanitary condition and laboratory method used. Gram-negative bacteria were predominant in our study unlike report from other countries [19]. In the current study, the predominant bacterial isolates were *H. influenzae* (29.5%) followed by *S. aureus* (27.3%). The finding of this study is not comparable with previous studies conducted in Ethiopia [20], Nigeria [21] and India. The proportion of Gram-negative bacteria isolated, (31.8%) in this study is high compared with the report from Ethiopia [22]. Among Gram-negative bacteria isolated in the present study, *H. influenzae* (29.5%) was the most prevalent followed by *P. aeruginosa* (26.1%), *K. pneumoniae* (8%) and *E. coli* (4.5%).

Conjunctivitis was the dominant type of clinical presentation (93.2%) observed in this study followed by dacryocystitis (4.5%) and blepharitis (2.3%). In this study, the majority of bacteria were resistant to ceftazidime and cloxacillin, while most of them were susceptible to ofloxacin. This finding is in agreement with the study conducted in Gondar, Ethiopia [17], Jimma, Ethiopia [23] and Uganda [24]. The reason for increased resistance to ceftazidime and cloxacillin may be prior exposure of the isolates to these antibiotics. Moreover, these antibiotics are common, and patients can access them easily with low price and often can be purchased without prescription over the counter in different pharmacies [16]. Most of the *S. aureus* were resistant to


## **Table 11.**

*Distribution of bacterial isolates in patients based on age gender and other socio-demographic data (N = 88).*

ceftazidime (95.8%) and cloxacillin (91.7%); however, 70.8% were susceptible to ceftriaxone. A similar finding was reported from other parts of Ethiopia [18]. However, low susceptibility (87.5%) to gentamicin was reported from other parts of Ethiopia [22]. Like *S. aureus, S. pneumoniae* (75%) were resistant to cloxacillin; similarly high resistance to penicillin was reported from Ethiopia [20]. *S. pneumoniae* isolated in this study were susceptible to erythromycin and gentamicin; this is not in line with other studies [22], in contrast to another study from Ethiopia [20].

*H. influenzae* and *P. aeroginosa* isolates in this study were susceptible to ciprofloxacin, ofloxacin and were resistant to gentamicin, nitrofurantoin and amoxicillin-clavulanic acid. *E. coli* isolates in this study were susceptible to

*Prevalence of Bacterial Ocular Infections among Patients Attending Eye Clinic of Aminu… DOI: http://dx.doi.org/10.5772/intechopen.108243*

ciprofloxacin, ofloxacin and gentamicin and were resistant to amoxicillinclavulanic acid, ceftazidime and cefuroxime. *K. pneumoniae* isolates in this study were susceptible to ciprofloxacin, ofloxacin and ceftazidime. All of them were resistant to amoxicillin-clavulanic acid; this is in partial agreement with the Getahun *et al.* report.

In the present study, the sensitivity to antibiotics was variable in bacterial ocular infections and increased resistance to most antibiotics. The fluoroquinolones (ciprofloxacin and ofloxacin) were highly effective against all bacterial isolates, followed by ceftriaxone.

In conclusion, in the current study, the most prevalent clinical presentation was conjunctivitis followed by dacryocystitis. From 88 study participants with ocular infections, 88.6% were culture-positive. Gram-negative bacteria were the most prevalent with *H. influenzae* taking the largest share. Most of the isolates are susceptible to ofloxacin and resistant to amoxicillin-clavulanic acid. And none of the factors were significantly associated with ocular infections (P > 0.05).

The following recommendations are made based on the findings of the study: To mitigate the burden of bacterial ocular infections, physicians should regard risk reduction and comply with etiologic approach of diagnosis. Antibiotic resistance among ocular pathogens is a challenge to the ophthalmologists. Resistance to most groups of antibiotics is increasing with resultant decline in the effectiveness of many commonly used topical antibiotics. It remains to be seen whether newer antibiotics such as besifloxacin will outlive the others before it, especially because of lack of systemic use. A strategy including judicious use of antibiotics in humans, animals and agriculture fields along with development of new products having lowresistance potential is required to end or at least reign in the current trend. Health education and personal hygiene should be practiced, and additional studies are needed in this study area.

## **4.1 Limitation of the study**

The limitation of the study was that the lack of reagents limited the diagnosis of Chlamydia infections.
