Evaluation of the relationship between causative organisms and clinical characteristics of infective endocarditis in dogs: 71 cases (1992-2005)

OBJECTIVE: To evaluate microbiologic findings in dogs with infective endocarditis (IE) and determine whether there were differences in clinical features of disease caused by different groups of infective agents. DESIGN: Retrospective case series. ANIMALS: 71 dogs with suspected or definite IE. PROCEDURES: Medical records were reviewed for results of bacterial culture and susceptibility testing, serologic assays for vector-borne disease, and PCR testing on vegetative growths. Cases were grouped by causative organism and relationships among infectious agent group, and various hematologic, biochemical, and clinical variables were determined. Survival analyses were used to determine associations between infecting organisms and outcome. RESULTS: Causative bacteria were identified in 41 of 71 (58%) dogs. Gram-positive cocci were the causative agents in most (21/41; 51%) infections, with Streptococcus canis associated with 24% of infections. Gram-negative organisms were detected in 9 of the 41 (22%) dogs. Infection with Bartonella spp was detected in 6 of 31 (19%) dogs with negative results for microbial growth on blood culture. Aortic valve involvement and congestive heart failure were more frequent in dogs with endocarditis from Bartonella spp infection, and those dogs were more likely to be afebrile. Infection with Bartonella spp was negatively correlated with survival. Mitral valve involvement and polyarthritis were more frequent in dogs with streptococcal endocarditis. CONCLUSIONS AND CLINICAL RELEVANCE: Streptococci were the most common cause of IE and were more likely to infect the mitral valve and be associated with polyarthritis. Dogs with IE secondary to Bartonella spp infection were often afebrile, more likely to develop congestive heart failure, rarely had mitral valve involvement, and had shorter survival times.     

Canine bacterial endocarditis: a review

Bacterial endocarditis is a disease of primarily middle-aged to older, large-breed dogs that is associated with high morbidity and mortality. It presents many challenges with respect to diagnosis and effective treatment. This paper reviews the pathogenesis, clinical presentation, progression, methods of diagnosis, and treatment of bacterial endocarditis in dogs. Methods for proper diagnosis, including echocardiographic findings and blood culture techniques, and recommendations for effective antimicrobial therapy are also provided.     

Polymerase chain reaction detection of Mycobacterium tuberculosis complex and Mycobacterium avium organisms in formalin-fixed tissues from culture-negative ruminants

In the US eradication program for bovine tuberculosis, a definitive diagnosis depends on the isolation of Mycobacterium bovis. However, in some cases bacterial culture is unsuccessful, even though the tissue is considered suspicious by histopathology because granulomatous lesions and acid-fast organisms are present. The purpose of this study was to determine if polymerase chain reaction (PCR) tests on formalin-fixed tissue would successfully identify the organisms observed in suspect lesions from culture-negative animals. Diagnostic laboratory records were used to select paraffin blocks of tissue from 102 ruminants that had suspect microscopic lesions but no bacterial isolation. Sections from these blocks were examined with PCR primers for IS6110 to detect Mycobacterium tuberculosis complex infection, or with 16S ribosomal RNA and IS900 primers for detection of Mycobacterium avium. The PCR tests successfully identified a mycobacterial infection in 58 of 102 tissues, including 41 M. tuberculosis complex and 17 M. avium (11 subspecies paratuberculosis). These results demonstrate that PCR testing of formalin-fixed tissue, in combination with bacterial culture, may increase the effectiveness of laboratory diagnostic efforts to detect and identify the most common mycobacterial diseases of ruminants.     

Detection of portal and systemic bacteremia in dogs with severe induced hepatic disease and multiple portosystemic shunts

OBJECTIVE: To determine existence of portal and systemic bacteremia in dogs with induced severe hepatic disease, compared with clinically normal dogs, before and after vena caval banding. ANIMALS: 6 control dogs and 10 dogs with induced severe hepatic disease and multiple portosystemic shunts (PSS). PROCEDURE: Dogs of the diseased group were given dimethylnitrosamine (2 mg/kg of body weight, PO) twice weekly until multiple PSS developed. Surgery was performed on dogs of both groups, and blood for baseline aerobic and anaerobic bacterial culture was collected from catheters placed in the portal and hepatic veins and caudal vena cava. All dogs underwent vena caval banding, and blood for aerobic and anaerobic bacterial culture was collected from the portal and hepatic venous catheters at 120, 240, and 360 minutes after banding. RESULTS: Compared with control dogs (16% gram-positive and 84% gram-negative bacteria), diseased dogs had significantly higher percentage of gram-positive bacteria (42% of positive culture results, P < or = 0.01) and significantly lower percentage of gram-negative bacteria (58% of positive culture results, P < or = 0.01) isolated. Pseudomonas aeruginosa was isolated most frequently from dogs of both groups; more than 1 organism was isolated from 5 dogs of each group. Antimicrobial susceptibility included that to aminoglycosides (particularly amikacin), fluorinated quinolones, and imipenem. CONCLUSION: Portal and systemic, predominantly gram-negative, bacteremia is present in catheterized, clinically normal dogs and dogs with dimethylnitrosamine-induced hepatic disease and multiple PSS.     

Isolation of obligate anaerobic bacteria from ulcerative keratitis in domestic animals

Objective To determine the frequency of obligate anaerobic bacterial isolation from corneal samples of domestic animals with ulcerative keratitis and to characterize the historical, clinical, cytological, and microbiological features of culture‐positive cases. Animals studied Three hundred and thirty domestic animals with ulcerative keratitis. Procedures Anaerobic bacteriologic culture and Gram stain were performed on corneal samples from consecutive animals examined with suspect septic ulcerative keratitis. Additional corneal diagnostics included: aerobic bacteriologic culture for all species; fungal culture for ungulates; Mycoplasma culture and virus isolation or feline herpesvirus‐1 (FHV‐1) polymerase chain reaction (PCR) for cats. Historical, clinical, and cytological findings were correlated with microbiologic data. Results Anaerobic bacteria were isolated from 13.0% of corneal samples (dogs: 14.0%; horses: 12.9%; cats: 7.9%; alpacas: 18.8%). The most frequent isolates were Clostridium, Peptostreptococcus, Actinomyces, Fusobacterium, and Bacteroides species. The majority of these infections were mixed anaerobic and aerobic bacteria, unless antimicrobial therapy had been administered prior to presentation. The clinical appearance of anaerobic bacterial culture‐positive cases was highly variable. Ocular trauma, pre‐existing corneal disease, previous corneal surgery, and chronic dermatological disease were significantly (P ≤ 0.05) correlated with positive anaerobic cultures in one or more species. Conclusions The results of the present study demonstrate that obligate anaerobic bacteria are present within the intralesional flora of ulcerative keratitis in domestic animals. In most species evaluated, these bacteria were identified infrequently. Anaerobic bacterial infection of the cornea most frequently occurs in association with other ocular pathogens and previous corneal abnormalities.     

The emergence of Mycobacterium paratuberculosis in farmed deer in New Zealand - a review of 619 cases

AIM: To review cases in which Mycobacterium paratuberculosis was identified in farmed deer in New Zealand. METHODS: Case histories were reviewed where M. paratuberculosis was identified in deer by either culture or a polymerase chain reaction (PCR) test using primers from IS900. RESULTS: Between 1986 and 2000, M. paratuberculosis was identified by bacterial culture and/or PCR in 619 farmed deer from 299 herds, representing approximately 6% of deer herds in New Zealand. Over 85% of cases were identified during the last 6 years. In 60% of the infected herds, only one infected animal was identified. The maximum number of cases identified in a single deer herd was 47, and these were identified over a period of 8 years. Only 36 (5.8%) cases came from clinically affected animals identified on farms by veterinarians. The majority (89.7%) of the 619 cases were identified from lesions in mesenteric lymph nodes, including the ileocaecal lymph nodes, identified at meat inspection as being macroscopically either typical or equivocal of bovine tuberculosis (M. bovis). While the overwhelming majority of lesions were identified in mesenteric lymph nodes, M. paratuberculosis was also identified in 27 lesions in lymph nodes of the head, especially the retropharyngeal lymph node. CONCLUSIONS: The figures presented underestimate the true prevalence of infection with M. paratuberculosis, especially since not all suspect cases were submitted for culture or PCR. However, they do show that M. paratuberculosis appears to be spreading in farmed deer in New Zealand and highlight the possibility that Johne's disease is emerging as a potential major problem affecting this species. Identification of the organism by bacterial culture or PCR is required in many cases to distinguish lesions in mesenteric lymph nodes and lymph nodes of the head caused by M. paratuberculosis from those caused by M. bovis and M. avium.     

Bacterial-associated diarrhea in the dog: a critical appraisal.

The clinical documentation of enteropathogenic bacteria causing diarrhea in dogs is clouded by the presence of many of these organisms existing as normal constituents of the indigenous intestinal flora. The diagnosis of a putative bacterial enteropathogen(s) in dogs should be made based on a combination of parameters, including signalment and predisposing factors, clinical signs, serologic assays for toxins, fecal culture, and PCR. Relying on results of fecal culture alone is problematic, because C perfringens, C difficile, Campylobacter spp, and pathogenic and non-pathogenic E coli are commonly isolated from apparently healthy dogs [10,13,33]. Nevertheless, culture may be useful in procuring isolates for the application of molecular techniques, such as PCR, for detection of specific toxin genes or molecular typing of isolated strains to establish clonality in suspected outbreaks. The oversimplistic attempt to characterize bacterially associated diarrhea by anatomic localization of clinical signs should be discouraged, because most of the previously mentioned bacteria have been associated with small and large intestinal diarrhea. Accurate diagnosis of infections may require diagnostic laboratories to incorporate PCR-based assays using genus- and species-specific primers to facilitate detection of toxin genes and differentiation of species that appear phenotypically and biochemically similar. There has been tremendous interest in the application of microarray technology for the simultaneous detection of thousands of genes or target DNA sequences on one glass slide. This powerful tool could be used for detection of specific pathogenic bacterial strains in fecal specimens obtained from dogs in the future.     

犬源贾第虫β-贾第素基因的克隆及序列分析

为了鉴定犬源贾第虫佛山分离株的基因型,根据GenBank中登录的贾第虫β-贾第素(bg)基因序列(X85958),设计2对引物GF1/GR、GF2/GR,采用套式PCR方法从贾第虫基因组DNA中扩增出目的片段;将扩增产物纯化并连接到质粒载体pMD18-T,克隆转入感受态细胞JM109,挑选阳性克隆测序,然后进行序列分析。结果显示,犬源贾第虫bg序列长为384 bp,与预期目的片段一致;分子进化树表明该犬源贾第虫分离株为蓝氏贾第虫D型。该基因型在我国为首次报道,为贾第虫的分子鉴定以及分子遗传学研究奠定了基础。     

Nested PCR for diagnosis of canine leishmaniosis in peripheral blood, lymph node and bone marrow aspirates

A nested polymerase chain reaction (PCR) assay was developed using primers selected from the genomic DNA of Leishmania infantum and applied to the diagnosis of leishmaniosis in peripheral blood in dogs. Blood of 39 dogs of different breeds, all sampled in Catalonia (Spain), were tested for leishmaniosis by enzyme linked immunosorbent assay (ELISA), western blotting (WB) and peripheral blood mononuclear cell (PBMC) culture and nested PCR. Twenty negative controls (healthy dogs less than 1-year-old that had not been exposed to a sandfly season) were also studied. Nineteen of the 39 dogs studied were positive by ELISA and/or WB, and 18 of these had a positive PBMC nested PCR. PBMC nested PCR was negative in all the remaining animals that were negative by serological examination, including the 20 negative controls. Parasitological examination and nested PCR of bone marrow and lymph node aspirate from the 19 dogs positive by serological examination, were also positive. These results indicate that PBMC nested PCR is a sensitive and specific tool to diagnose leishmaniosis in dogs. The use of PBMC has the advantage over bone marrow and lymph node aspirates in that it is a less invasive sample.     

Clinical and echocardiographic findings in 10 dogs with vegetative bacterial endocarditis

Ten cases of bacterial endocarditis in the dog were studied by retrospective analysis of case records. Diagnosis of bacterial endocarditis was based on either strict clinical criteria or post mortem examination. A wide spectrum of presenting signs was seen including pyrexia, lameness, epistaxis, haemoptysis and dyspnoea. Haematological and biochemical abnormalities were non-specific and were attributed to the effects of septicaemia, embolism or chronic inflammation. Haemostatic abnormalities and, or, severe dysrhythmias appeared to be associated with a significantly poorer prognosis. Blood cultures were positive in four cases of eight that were cultured. Lesions compatible with bacterial endocarditis were detected in all eight cases that underwent echocardiographic examination. Right-sided vegetations present in two dogs were not detected by echocardiography. Two-dimensional echocardiography is a useful technique for the detection of vegetative endocarditis in the dog and allows rapid therapeutic intervention while blood culture results are pending.     

A prospective study of canine infective endocarditis in northern California (1999-2001): emergence of Bartonella as a prevalent etiologic agent

A prospective study was performed (June 1999 to May 2001) to determine the incidence of infective endocarditis (IE) due to Bartonella in dogs in northern California and to compare these patients with other dogs with IE. IE was diagnosed antemortem based on clinical signs and echocardiography in 18 dogs. The etiologic agent was Bartonella sp. in 5 dogs (28%) and was diagnosed by high seroreactivity to Bartonella (titer > 1:512; range, 1:1,024-1:4,096); and confirmed postmortem by positive polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) from the infected valve and partial DNA sequencing of the citrate synthase gene (glt A). Conventional bacteria were causative agents in 7 dogs (39%). An etiologic agent was not identified in 6 dogs (33%). Bartonella vinsonii berkhoffii (n = 3), B clarridgeiae (n = 1), and a B clarridgeiae-like organism (n = 1) were identified. Blood culture was positive only for the IE case due to B clarridgeiae. All dogs with IE due to Bartonella were also seroreactive to Anaplasma phagocytophilum. All dogs with IE due to Bartonella had lesions only on the aortic valve. Of the cases of IE not due to Bartonella, 31% involved the aortic valve, 61% the mitral valve, and 8% both valves. Dogs with mitral valve IE lived longer than all dogs with aortic valve IE (P = .004) and dogs with IE of the aortic valve due to Bartonella (P = .002). In conclusion, Bartonella is a common cause of IE in dogs of northern California. A high Bartonella serologic titer (> 1:512) is useful antemortem to diagnose aortic valve IE due to Bartonella.     

Bacterial aortic valvular endocarditis associated with subaortic stenosis

The clinical and pathological findings in four young adult rottweiler dogs with subaortic stenosis and secondary bacterial endocarditis of the aortic valve are described. The four dogs, two males and two females, ranged in age from 18 months to three years. Three had three- to four-week histories of lethargy, anorexia, weight loss and intermittent coughing that progressively worsened. Bacterial aortic valvular endocarditis was diagnosed on the basis of physical examination and radiographic and ultrasound findings. Subaortic stenosis was not suspected clinically, but was found at necropsy. The fourth dog was known to have a subaortic stenotic ring at six months of age and developed clinical signs similar to the other dogs four weeks before euthanasia. Bacterial aortic valvular endocarditis and a subaortic stenotic ring were found at necropsy. It is suspected that the turbulence in blood flow caused by the stenotic rings damages the endocardium of the aortic valve, predisposing to the development of endocarditis.     

Diagnosis of Canine Brucellosis: Comparison between Serological and Microbiological Tests and a PCR Based on Primers to 16S-23S rDNA Interspacer

A pair of primers directed to 16S-23S rDNA interspacer (ITS) was designed directed to Brucella genetic sequences in order to develop a polymerase chain reaction (PCR) putatively capable of amplifying DNA from any Brucella species. Nucleic acid extracts from whole-blood from naive dogs were spiked with decreasing amounts of Brucella canis RM6/66 DNA and the resulting solutions were tested by PCR. In addition, the ability of PCR to amplify Brucella spp. genetic sequences from naturally infected dogs was evaluated using 210 whole-blood samples of dogs from 19 kennels. The whole-blood samples collected were subjected to blood culture and PCR. Serodiagnosis was performed using the rapid slide agglutination test with and without 2-mercaptoethanol. The DNA from whole blood was extracted using proteinase-K, sodium dodecyl sulphate and cetyl trimethyl ammonium bromide followed by phenol–chloroform purification. The PCR was capable of detecting as little as 3.8 fg of Brucella DNA mixed with 450 ng of host DNA. Theoretically, 3.8 fg of Brucella DNA represents the total genomic mass of fewer than two bacterial cells. The PCR diagnostic sensitivity and specificity were 100%. From the results observed in the present study, we conclude that PCR could be used as confirmatory test for diagnosis of B. canis infection.     

First isolation and molecular characterization of Ehrlichia canis in Costa Rica, Central America

The present study investigated Ehrlichia species in blood samples from dogs suspected of clinical ehrlichiosis, using molecular and isolation techniques in cell culture. From a total of 310 canine blood samples analyzed by 16S rRNA nested PCR, 148 (47.7%) were positive for Ehrlichia canis. DNA from Ehrlichia chaffeensis or Ehrlichia ewingii was not detected in any sample using species-specific primers in separated reactions. Leukocytes from five PCR-positive dogs were inoculated into DH82 cells; successful isolation of E. canis was obtained in four samples. Partial sequence of the dsb gene of eight canine blood samples (including the five samples for in vitro isolation) was obtained by PCR and their analyses through BLAST showed 100% of identity with the corresponding sequence of E. canis in GenBank. This study represents the first molecular diagnosis, isolation, and molecular characterization of E. canis in dogs from Costa Rica.     

Screening of bacterial DNA in bile sampled from healthy dogs and dogs suffering from liver- or gallbladder-associated disease

Although the biliary system is generally aseptic, gallbladder microbiota has been reported in humans and some animals apart from dogs. We screened and analyzed the bacterial deoxyribonucleic acid in canine gallbladders using bile sampled from 7 healthy dogs and 52 dogs with liver- or gallbladder-associated disease. PCR screening detected bacteria in 17.3% of diseased dogs (9/52) and none in healthy dogs. Microbiota analysis of PCR-positive samples showed that the microbial diversity differed between liver- and gallbladder-associated disease groups. Thus, a specific bacterial community appears to occur at a certain frequency in the bile of diseased dogs.     

Canine bacterial urinary tract infections: new developments in old pathogens

Uncomplicated bacterial urinary tract infections (UTIs) occur commonly in dogs. Persistent or recurrent infections are reported less frequently. They typically occur in dogs with an underlying disease and are sometimes asymptomatic, especially in dogs with predisposing chronic disease. Escherichia coli is the organism most frequently cultured in both simple and complicated UTIs. Organisms such as Enterococcus spp. and Pseudomonas spp. are less common in uncomplicated UTI, but become increasingly prominent in dogs with recurrent UTI. The ability of bacteria to acquire resistance to antimicrobials and/or to evade host immune defence mechanisms is vital for persistence in the urinary tract. Antimicrobial therapy limitations and bacterial strains with such abilities require novel control strategies. Sharing of resistant bacteria between humans and dogs has been recently documented and is of particular concern for E. coli O25b:H4-ST131 strains that are both virulent and multi-drug resistant. The epidemiology of complicated UTIs, pathogenic traits of uropathogens and new therapeutic concepts are outlined in this review.     

SYBR Green Ⅰ实时荧光PCR检测鉴定狮制品

为建立SYBR Green I实时荧光PCR检测鉴定狮（Panthera Leo）制品的方法,本文在豹属动物线粒体细胞色素b基因上设计狮特异性引物,建立并优化了SYBR Green I实时荧光PCR检测鉴定体系,采用17种血液、组织和骨粉类样品的DNA,通过扩增曲线和融解曲线分析检测的特异性和灵敏度,并用狮肉粉和牛肉骨粉系列百分比混合物进行抗干扰能力分析。结果显示,狮血液和组织DNA样品均出现特异性的实时扩增曲线,平均熔解温度在84±0.2℃。虎、豹、熊等14种哺乳动物DNA样本的检测结果均为阴性。灵敏度检测显示,本实验所建立的SYBRGreen I实时荧光PCR方法能够检测出10 pg/μL的狮组分DNA。抗干扰能力显示在骨粉中狮的成分最低检出含量为0.1%。这些结果说明,本文建立的SYBR Green I实时定量PCR方法具有方便、经济、灵敏度高和重复好等特性,可用于狮源性制品的检测鉴定。     

Fecal polymerase chain reaction with 16S ribosomal RNA primers can detect the presence of gastrointestinal Helicobacter in dogs

Questions about pathogenesis and therapy for Helicobacter infections in dogs could be answered with a simple, noninvasive, sensitive, and specific diagnostic test. We hypothesized that a fecal polymerase chain reaction (PCR) assay would detect Helicobacter and could be useful for assessing therapeutic responses. Paired gastric biopsies and fecal samples were obtained from 39 random source dogs (group 1). Gastric biopsies from each of these dogs had histologic evidence of gastric spiral bacteria, and paired gastric tissue and fecal samples produced a 375-base pair (bp) product when amplified by PCR with Helicobacter-specific primers. Specificity of the PCR product was confirmed by detection of expected 60-, 119-, and 196-bp products following Hinfl digestion. Direct sequencing of amplicons from paired PCR products from gastric biopsy and fecal samples from 8 group I dogs showed that gastric products had the highest homologies with known gastric Helicobacter species, whereas fecal products had the highest homologies with intestinal species. Healthy mixed-breed dogs (group II; n = 8) with histologically confirmed spiral bacteria infection were treated with a 21-day course of metronidazole, amoxicillin, and famotidine. Fecal samples were collected from group II dogs twice before and within 3 days of completion of treatment. The PCR results correctly identified 15/16 pretreatment samples as positive: 1 pretreatment sample was negative. PCR results identified 8/8 posttreatment samples as Helicobacter negative. Fecal PCR is a useful test for detecting Helicobacter infection in dogs. This assay may be useful as a screening test for infection and could be used to address questions relevant to pathogenesis and therapy.     

Use of closed-suction drains to treat generalized peritonitis in dogs and cats: 40 cases (1997-1999)

OBJECTIVE: To determine outcome of dogs and cats with generalized peritonitis treated by means of closed-suction drainage. DESIGN: Retrospective study. ANIMALS: 30 dogs and 10 cats with generalized peritonitis. PROCEDURE: Medical records were reviewed, and information on signalment, clinicopathologic abnormalities, contamination source, results of microbial culture, surgical procedure performed, postoperative management, complications, and outcome was obtained. RESULTS: The gastrointestinal tract was the most common source of contamination. Abdominal fluid collected from 34 patients at the time of surgery was submitted for bacterial culture; results were positive for 28 (82%). The most commonly isolated organism was Escherichia coli. Postoperative complications included anemia (n = 21), hypoproteinemia (21), vomiting (9), edema (7), and diarrhea (5). Total solids concentration did not decrease during the first 48 hours after surgery, and all drains remained functional until removal. Twenty-eight patients survived to the time of discharge; 8 of the 12 animals that died did so within 18 hours after surgery. The only factor significantly different between patients that survived and patients that died was postoperative systolic blood pressure. Factors that were not significantly associated with outcome included detection of bacteria in the abdominal fluid, number of organisms cultured from the abdominal fluid, selection of antimicrobials for empiric treatment, and source of contamination. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that closed-suction drainage may be a useful method for treating generalized peritonitis in dogs and cats. No clinically important complications were associated with their use.     

Evaluation of clinical characteristics and bacterial isolates in dogs with bacterial keratitis: 97 cases (1993-2003)

OBJECTIVE: To evaluate clinical characteristics and breeds affected with bacterial keratitis and compare patterns of resistance in bacterial isolates over time in dogs. DESIGN: Retrospective cross-sectional study. ANIMALS: 97 dogs with bacterial keratitis. PROCEDURE: Dogs with bacterial keratitis were identified from teaching hospital medical records at the Universities of Tennessee and Florida during the years 1993 to 2003. Data were collected pertaining to breed, Schirmer tear test results, treatments administered at the time of initial examination, bacterial species isolated, and resistance to selected antimicrobials. RESULTS: 66% of the dogs were brachycephalic, 54% had tear production < 15 mm/min, and 29% were receiving a corticosteroid at the time of initial examination. The most common bacteria isolated were Staphylococcus intermedius (29%), beta-hemolytic Streptococcus spp (17%), and Pseudomonas aeruginosa (21%). Staphylococcus intermedius isolates had limited resistance to certain antimicrobials. More than 80% of beta-hemolytic Streptococcus spp isolates were resistant to neomycin, polymyxin B, and tobramycin. Isolates of P aeruginosa were susceptible to tobramycin and gentamicin and had limited resistance to ciprofloxacin and enrofloxacin. Among bacterial species isolated, there was no evidence of development of antimicrobial resistance over time. CONCLUSIONS AND CLINICAL RELEVANCE: Data suggested that administration of ciprofloxacin or a combination of a first-generation cephalosporin and tobramycin may be used in the treatment of bacterial keratitis while awaiting results of bacterial culture and susceptibility testing. Evidence suggests that current methods of medical management of bacterial keratitis are not associated with increased antimicrobial resistance.