Complications of Pseudomonas Conjunctivitis in Premature Infants

Source: Shah SS, Gallagher PG. Complications of conjunctivitis caused by Pseudomonas aeruginosa in a newborn intensive care unit. Ped Inf Dis J 1998;17:97-102.

Pseudomonas conjunctivitis in infancy often leads to rapidly progressive, destructive eye infection-especially corneal ulceration and deep eye involvement. This extension is often associated with systemic complications and infections at other sites, including pneumonia and meningitis. Shah and Gallagher describe seven premature infants from their neonatal intensive care unit who developed systemic complications of localized Pseudomonas aeruginosa conjunctivitis without evidence of invasive ophthalmologic disease. During a 10-year period (1986-1996), there were 18 infants diagnosed with isolated conjunctivitis (conjunctival injection and discharge) proven by culture to be caused by P. aeruginosa. The average age at onset was 17 days. No infant had invasive eye disease. Systemic P. aeruginosa was diagnosed by culture of organisms with identical antibiotic susceptibilities from blood or other body fluids of a patient with a clinical picture consistent with meningitis, sepsis, or localized infection.

Systemic complications occurred in seven of 18 infants (39%). These systemic complications included sepsis, meningitis, brain abscess, and death. The seven infants who developed systemic complications of P. aeruginosa conjunctivitis had lower mean birth weights and lower mean gestational ages than the 11 infants with P. aeruginosa conjunctivitis who did not develop systemic complications. Six of seven infants weighing less than 1000 g developed systemic complications. Two of these infants died.

No infant received antibiotic therapy on the day that conjunctivitis was first observed and cultures were taken. Three of 18 infants received topical antibiotics alone; two of these developed systemic complications. Seven of 18 infants received parenteral antibiotic therapy appropriate for P. aeuginosa (gentamicin and tobramycin); two of these infants developed systemic complications. Eight of 18 infants were treated with other antibiotics that were not usually effective against P. aeruginosa; two of these infants developed systemic complications.

Combining their data with l9 cases from a literature review, Shah and colleagues estimate that 43% of infants with isolated P. aeruginosa conjunctivitis may subsequently develop systemic complications. In hospitalized premature infants, P. aeruginosa conjunctivitis may be complicated by systemic infections, with or without evidence of invasive eye infection. These observations emphasize the need for early detection and adequate treatment of this infection in this population. -rae