Bacterial and fungal pathogens in adult dacryocystitis: a retrospective study from a tertiary medical center in southern Taiwan.

PURPOSE: To investigate the microbiological spectrum of dacryocystitis in southern Taiwan, with emphasis on polymicrobial and fungal infections, and to inform treatment based on regional susceptibility patterns.

METHODS

This retrospective study enrolled patients with culture-proven dacryocystitis who underwent lacrimal surgery at a tertiary medical center in southern Taiwan from 2014 to 2024. Routine fungal culture was implemented after July 2018. Only intraoperative specimens obtained under sterile conditions were analyzed to minimize contamination.

RESULTS

Among 216 dacryocystitis cases (102 acute and 114 chronic), 179 (82.9%) were culture-positive. Staphylococcus aureus and Cutibacterium acnes were commonly identified in acute cases, whereas Pseudomonas aeruginosa and S. epidermidis were more frequent in chronic cases. After routine fungal culture was implemented, fungi were detected in 19 of 154 cases (12.3%), predominantly in chronic cases. Oxacillin resistance was observed in 13 of 36 S. aureus isolates (36.1%), while most Gram-negative isolates remained susceptible to gentamicin, amikacin, and piperacillin-tazobactam.

CONCLUSION

Our findings demonstrate a diverse microbial spectrum in adult dacryocystitis, including Gram-negative, polymicrobial, and fungal involvement, particularly in chronic disease. The observed antimicrobial resistance patterns suggest that Gram-positive-focused empirical therapy may not provide adequate coverage. Comprehensive microbiological evaluation, including fungal culture, together with consideration of local susceptibility patterns may improve treatment selection, particularly in chronic or refractory dacryocystitis.