Pan-Antimicrobial Failure of Alexidine as a Contact Lens Disinfectant When Heated in Bausch Lomb Plastic Containers: Implications for the Worldwide Fusarium Keratitis Epidemic of 2004 to 2006

B. Laurel Elder; John D. Bullock; Ronald E. Warwar; Harry J. Khamis; Shaden Z. Khalaf

doi:10.1097/ICL.0b013e31824da9be

Pan-Antimicrobial Failure of Alexidine as a Contact Lens Disinfectant When Heated in Bausch Lomb Plastic Containers: Implications for the Worldwide Fusarium Keratitis Epidemic of 2004 to 2006

B. Laurel Elder, John D. Bullock, Ronald E. Warwar, Harry J. Khamis, Shaden Z. Khalaf

Statistical Consulting Center

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: ReNu with MoistureLoc (ReNuML), containing the antimicrobial agent alexidine 0.00045%, was associated with the Fusarium keratitis epidemic of 2004 to 2006. Although a single-point source contamination was ruled out, only Fusarium organisms were reported during the outbreak. This study investigated whether the reported loss of antimicrobial effectiveness toward Fusarium of ReNuML after exposure to heat in high-density polyethylene (HDPE) plastic containers could also be demonstrated with other common fungal and bacterial agents of keratitis. Methods: A buffered solution of alexidine 0.00045% was incubated in glass and ReNu HDPE plastic containers at room temperature (RT) and 56°C for 4 weeks, serially diluted, and tested for its ability to inhibit the growth of 20 bacterial isolates, 12 non- Fusarium fungal isolates, and 7 Fusarium isolates originally involved in the keratitis epidemic. Results: A statistically significant loss of antimicrobial capability was seen with all fungi, all gram-positive bacteria, and all isolates of Klebsiella when alexidine 0.00045% was incubated at 56°C in ReNu HDPE containers compared with RT or glass incubation ( P ≤0.0001). Conclusions: Heating of an alexidine solution in ReNu HDPE plastic (but not glass) containers results in the same loss of anti- Fusarium activity as reported when testing the original ReNuML solution. This loss of inhibitory activity is not specific to Fusarium and occurs with other fungi and bacteria that cause keratitis. The reasons for the lack of reports of bacterial and/or non- Fusarium fungal keratitis during the original Fusarium keratitis epidemic remain unclear at this time.

Original language	English
Pages (from-to)	222-226
Number of pages	5
Journal	Eye and Contact Lens
Volume	38
Issue number	4
DOIs	https://doi.org/10.1097/ICL.0b013e31824da9be https://doi.org/10.1097/ICL.0b013e31824da9be
State	Published - Jul 2012

ASJC Scopus Subject Areas

Ophthalmology

Keywords

Fusarium
Keratitis
Contact lens
Cornea
Plastic

Disciplines

Applied Mathematics
Applied Statistics
Mathematics
Physical Sciences and Mathematics
Statistics and Probability

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Elder, B. L., Bullock, J. D., Warwar, R. E., Khamis, H. J., & Khalaf, S. Z. (2012). Pan-Antimicrobial Failure of Alexidine as a Contact Lens Disinfectant When Heated in Bausch Lomb Plastic Containers: Implications for the Worldwide Fusarium Keratitis Epidemic of 2004 to 2006. Eye and Contact Lens, 38(4), 222-226. https://doi.org/10.1097/ICL.0b013e31824da9be, https://doi.org/10.1097/ICL.0b013e31824da9be

Pan-Antimicrobial Failure of Alexidine as a Contact Lens Disinfectant When Heated in Bausch Lomb Plastic Containers: Implications for the Worldwide Fusarium Keratitis Epidemic of 2004 to 2006. / Elder, B. Laurel; Bullock, John D.; Warwar, Ronald E. et al.
In: Eye and Contact Lens, Vol. 38, No. 4, 07.2012, p. 222-226.

Research output: Contribution to journal › Article › peer-review

Elder, BL, Bullock, JD, Warwar, RE, Khamis, HJ & Khalaf, SZ 2012, 'Pan-Antimicrobial Failure of Alexidine as a Contact Lens Disinfectant When Heated in Bausch Lomb Plastic Containers: Implications for the Worldwide Fusarium Keratitis Epidemic of 2004 to 2006', Eye and Contact Lens, vol. 38, no. 4, pp. 222-226. https://doi.org/10.1097/ICL.0b013e31824da9be, https://doi.org/10.1097/ICL.0b013e31824da9be

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title = "Pan-Antimicrobial Failure of Alexidine as a Contact Lens Disinfectant When Heated in Bausch Lomb Plastic Containers: Implications for the Worldwide Fusarium Keratitis Epidemic of 2004 to 2006",

abstract = " Objective: ReNu with MoistureLoc (ReNuML), containing the antimicrobial agent alexidine 0.00045%, was associated with the Fusarium keratitis epidemic of 2004 to 2006. Although a single-point source contamination was ruled out, only Fusarium organisms were reported during the outbreak. This study investigated whether the reported loss of antimicrobial effectiveness toward Fusarium of ReNuML after exposure to heat in high-density polyethylene (HDPE) plastic containers could also be demonstrated with other common fungal and bacterial agents of keratitis. Methods: A buffered solution of alexidine 0.00045% was incubated in glass and ReNu HDPE plastic containers at room temperature (RT) and 56°C for 4 weeks, serially diluted, and tested for its ability to inhibit the growth of 20 bacterial isolates, 12 non- Fusarium fungal isolates, and 7 Fusarium isolates originally involved in the keratitis epidemic. Results: A statistically significant loss of antimicrobial capability was seen with all fungi, all gram-positive bacteria, and all isolates of Klebsiella when alexidine 0.00045% was incubated at 56°C in ReNu HDPE containers compared with RT or glass incubation ( P ≤0.0001). Conclusions: Heating of an alexidine solution in ReNu HDPE plastic (but not glass) containers results in the same loss of anti- Fusarium activity as reported when testing the original ReNuML solution. This loss of inhibitory activity is not specific to Fusarium and occurs with other fungi and bacteria that cause keratitis. The reasons for the lack of reports of bacterial and/or non- Fusarium fungal keratitis during the original Fusarium keratitis epidemic remain unclear at this time. ",

keywords = "Fusarium, Keratitis, Contact lens, Cornea, Plastic",

author = "Elder, {B. Laurel} and Bullock, {John D.} and Warwar, {Ronald E.} and Khamis, {Harry J.} and Khalaf, {Shaden Z.}",

year = "2012",

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T2 - Implications for the Worldwide Fusarium Keratitis Epidemic of 2004 to 2006

AU - Elder, B. Laurel

AU - Bullock, John D.

AU - Warwar, Ronald E.

AU - Khamis, Harry J.

AU - Khalaf, Shaden Z.

PY - 2012/7

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N2 - Objective: ReNu with MoistureLoc (ReNuML), containing the antimicrobial agent alexidine 0.00045%, was associated with the Fusarium keratitis epidemic of 2004 to 2006. Although a single-point source contamination was ruled out, only Fusarium organisms were reported during the outbreak. This study investigated whether the reported loss of antimicrobial effectiveness toward Fusarium of ReNuML after exposure to heat in high-density polyethylene (HDPE) plastic containers could also be demonstrated with other common fungal and bacterial agents of keratitis. Methods: A buffered solution of alexidine 0.00045% was incubated in glass and ReNu HDPE plastic containers at room temperature (RT) and 56°C for 4 weeks, serially diluted, and tested for its ability to inhibit the growth of 20 bacterial isolates, 12 non- Fusarium fungal isolates, and 7 Fusarium isolates originally involved in the keratitis epidemic. Results: A statistically significant loss of antimicrobial capability was seen with all fungi, all gram-positive bacteria, and all isolates of Klebsiella when alexidine 0.00045% was incubated at 56°C in ReNu HDPE containers compared with RT or glass incubation ( P ≤0.0001). Conclusions: Heating of an alexidine solution in ReNu HDPE plastic (but not glass) containers results in the same loss of anti- Fusarium activity as reported when testing the original ReNuML solution. This loss of inhibitory activity is not specific to Fusarium and occurs with other fungi and bacteria that cause keratitis. The reasons for the lack of reports of bacterial and/or non- Fusarium fungal keratitis during the original Fusarium keratitis epidemic remain unclear at this time.

AB - Objective: ReNu with MoistureLoc (ReNuML), containing the antimicrobial agent alexidine 0.00045%, was associated with the Fusarium keratitis epidemic of 2004 to 2006. Although a single-point source contamination was ruled out, only Fusarium organisms were reported during the outbreak. This study investigated whether the reported loss of antimicrobial effectiveness toward Fusarium of ReNuML after exposure to heat in high-density polyethylene (HDPE) plastic containers could also be demonstrated with other common fungal and bacterial agents of keratitis. Methods: A buffered solution of alexidine 0.00045% was incubated in glass and ReNu HDPE plastic containers at room temperature (RT) and 56°C for 4 weeks, serially diluted, and tested for its ability to inhibit the growth of 20 bacterial isolates, 12 non- Fusarium fungal isolates, and 7 Fusarium isolates originally involved in the keratitis epidemic. Results: A statistically significant loss of antimicrobial capability was seen with all fungi, all gram-positive bacteria, and all isolates of Klebsiella when alexidine 0.00045% was incubated at 56°C in ReNu HDPE containers compared with RT or glass incubation ( P ≤0.0001). Conclusions: Heating of an alexidine solution in ReNu HDPE plastic (but not glass) containers results in the same loss of anti- Fusarium activity as reported when testing the original ReNuML solution. This loss of inhibitory activity is not specific to Fusarium and occurs with other fungi and bacteria that cause keratitis. The reasons for the lack of reports of bacterial and/or non- Fusarium fungal keratitis during the original Fusarium keratitis epidemic remain unclear at this time.

KW - Fusarium

KW - Keratitis

KW - Contact lens

KW - Cornea

KW - Plastic

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Pan-Antimicrobial Failure of Alexidine as a Contact Lens Disinfectant When Heated in Bausch Lomb Plastic Containers: Implications for the Worldwide Fusarium Keratitis Epidemic of 2004 to 2006

Abstract

ASJC Scopus Subject Areas

Keywords

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