Antibiotic Resistance of Conjunctiva and Nasopharynx Evaluation Study: A Prospective Study of Patients Undergoing Intravitreal Injections

Kim, Stephen J.; Toma, Hassanain S.; Midha, Narinder K.; Cherney, Edward F.; Recchia, Franco M.; Doherty, Terrence J.

doi:10.1016/j.ophtha.2010.03.034

Cited by 85 publications

(55 citation statements)

References 43 publications

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“…Although a double point mutation was found for a few isolates in both studies, 38% to 41.6% of S. epidermidis isolates from conjunctival sacs preoperatively harbored at least one point mutation in the gyrA gene. Moreover, it has been demonstrated that prophylactic use of topical levofloxacin and moxifloxacin is associated with selection of fluoroquinolone-resistant S. epidermidis and others CoNS from the normal conjunctival and nasopharynx microbiota (4,18,25). The MSSE isolates resistant to 8-methoxyfluoroquinolones included in our study were recovered mostly from endophthalmitis cases following intraocular surgery and intravitreal injection.…”

Section: Discussionmentioning

confidence: 88%

“…Fluoroquinolone-resistant CoNS isolates from the normal conjunctiva microbiota have been recovered from patients undergoing intraocular surgery and intravitreal injection (4,5,(22)(23)(24). In addition, two studies found mutations within the QRDR in around 50% to 58% of S. epidermidis isolates from in the conjunctival sacs before preoperative instillation of antibiotic from patients undergoing intraocular surgeries (18,19).…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative endophthalmitis is the most common category and is caused predominantly by Gram-positive organisms originating from the normal conjunctiva and eyelid microflora (1)(2)(3). Coagulase-negative staphylococci (CoNS), including the most common species, Staphylococcus epidermidis, are the most frequently isolated organisms from culture-proven endophthalmitis cases (1,4,5). Topical fluoroquinolone agents (ciprofloxacin, ofloxacin, and levofloxacin) have been widely used as the first-line option for both prophylaxis and management of endophthalmitis and other ocular infections (6,7).…”

mentioning

confidence: 99%

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Emerging 8-Methoxyfluoroquinolone Resistance among Methicillin-Susceptible Staphylococcus epidermidis Isolates Recovered from Patients with Endophthalmitis

et al. 2013

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Fluoroquinolones remain the most commonly used antimicrobials for the prevention and management of bacterial endophthalmitis. Coagulase-negative staphylococci are the most frequently recovered pathogens. Increasing resistance among this group has paralleled the presence of methicillin resistance. From 2005 to 2010, we recovered 38 methicillin-susceptible Staphylococcus epidermidis (MSSE) isolates from endophthalmitis patients at our institute, including 15 (39.5%) isolates resistant to gatifloxacin and moxifloxacin, members of the C-8-methoxyfluoroquinolones family. Mutations in the quinolone resistance-determining regions (QRDR) of gyrA and parC were determined and correlated with fluoroquinolone MICs based on Etests of these 15 MSSE isolates. High-level resistance (MIC, >32 g/ml) to gatifloxacin and moxifloxacin was documented for 46.7% of the MSSE isolates, and low-level resistance (MIC, 2 to 4 g/ml) was determined for 53.3%. The MICs for ciprofloxacin, levofloxacin, and ofloxacin were >32 g/ml for all isolates. The amino acid substitution Ser84Phe in gyrA was found among all isolates. A second mutation in gyrA (Glu88Lys) resulted in high-level resistance to moxifloxacin and gatifloxacin. Almost all (92.8%) isolates presented double point mutations in the parC gene at codons 80 and 84 with different combinations. Eighty-seven percent of the patients had prior exposure to topical 8-methoxyfluoroquinolones. Prior exposure to the 8-methoxyfluoroquinolones may contribute to the selection of MSSE strains containing multiple mutations in the QRDRs of gyrA and parC that results in low-and high-level resistance to these agents.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Emerging 8-Methoxyfluoroquinolone Resistance among Methicillin-Susceptible Staphylococcus epidermidis Isolates Recovered from Patients with Endophthalmitis

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“…Acorde con la literatura científica, las bacterias más frecuentes en la microbiota conjuntival, identificadas mediante el sistema automatizado VI-TEK, fueron del género Staphylococcus, con un porcentaje similar (55,6 %) al reportado en varios estudios (9,12,14,24). Los estafilococos coagulasa negativos fueron las bacterias más representativas (95 %), dentro de los cuales S. epidermidis fue la especie más aislada (50 %), junto con otras -S. warneri, S. haemolyticus, S. auricularis, S. hominis y S. capitas-previamente reportadas en la microbiota conjuntiva (7,24).…”

Section: Discussionunclassified

“…Los estafilococos coagulasa negativos fueron las bacterias más representativas (95 %), dentro de los cuales S. epidermidis fue la especie más aislada (50 %), junto con otras -S. warneri, S. haemolyticus, S. auricularis, S. hominis y S. capitas-previamente reportadas en la microbiota conjuntiva (7,24). La alta frecuencia de identificación de este género en las dos muestras de conjuntiva de cada sujeto corrobora que es el principal constituyente de la microbiota residente en el ojo.…”

Section: Discussionunclassified

Caracterización de la microbiota conjuntival transitoria y residente de adultos jóvenes

Algarra¹,

Niño²,

Rodríguez³

2017

Cienc. Tecnol. Salud Vis. Ocul.

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Cómo citar este artículo: Martin Algarra V, Jaimes Niño V, Rodríguez MF. Caracterización de la microbiota conjuntival transitoria y residente de adultos jóvenes. Cienc Tecnol Salud Vis Ocul. 2017;15(1):37-45. doi: http://dx.doi.org/10.19052/sv.3994 RESUMEN La microbiota ocular se encuentra principalmente en la conjuntiva y está constituida por bacterias de los géneros Staphylococcus corynebacterium spp., Bacillus spp., Neisseria spp., Moraxella spp. y Streptococcus spp. Esta diversidad puede variar según las condiciones estacionales, la temperatura, la edad y la exposición ambiental. Objetivo: caracterizar la diversidad de la microbiota residente y transitoria de la conjuntiva en adultos jóvenes. Metodología: estudio observacional descriptivo de corte transversal en 67 adultos jóvenes, hombres y mujeres entre 18 y 25 años de edad, que cumplieron con los criterios de inclusión y aceptaron firmar el consentimiento informado. A cada sujeto se le tomaron dos muestras del saco conjuntival, con un intervalo de una semana. Estas se cultivaron en agar sangre y agar chocolate a 37 °C por 24 horas. Las colonias aisladas se identificaron mediante el sistema automatizado VITEK. Resultados: se determinaron 16 géneros y 29 especies diferentes. El género más frecuente fue Staphylococcus (55,6 %), seguido de Acinetobacter (12,0 %), Bacillus (7,0 %), Pasterella (4,6 %) y Escherichia (3,7 %). La microbiota residente estuvo constituida principalmente por el género Staphylococcus y sus especies más representativas fueron S. epidermidis (50,0 %) y S. lentus (13,3 %). Conclusión: existe gran diversidad de bacterias en la microbiota conjuntival, mayor en la microbiota transitoria que en la residente; probablemente, esto depende del ambiente en el que se encuentra el individuo.

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Antimicrobial Resistance and Ophthalmic Antibiotics

Kim¹

2011

Arch Ophthalmol

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103

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Objective: To determine antibiotic susceptibility patterns of conjunctival flora from patients undergoing intraocular injection for choroidal neovascularization after repeated exposure to ophthalmic antibiotics. Methods: We conducted a randomized, controlled, longitudinal study of 48 eyes of 24 patients undergoing unilateral intraocular injection for choroidal neovascularization. Bilateral conjunctival cultures from the treated eye and untreated (control) fellow eye were taken at baseline and after each injection (before the application of povidone-iodine). Patients were randomized to ofloxacin, 0.3%; azithromycin, 1%; gatifloxacin, 0.3%; or moxifloxacin hydrochloride, 0.5% and used only their assigned antibiotic after each injection. Bacterial isolates were tested for antibiotic susceptibility to 16 different antibiotics, and analysis of bacteria DNA was performed using pulse-field gel electrophoresis. Main outcome measures included changes in antibiotic susceptibility patterns of conjunctival flora after 1 year. Results: Coagulase-negative staphylococci (CNS) cultured from eyes repeatedly exposed to fluoroquinolone antibiotics demonstrated significantly increased rates of resistance to older-generation (P = .002) and newergeneration (PϽ.01) fluoroquinolones. In contrast, CNS isolated from azithromycin-exposed eyes demonstrated significantly increased resistance to macrolides (95%; P Ͻ .001) and decreased resistance to older-generation (P =.03) and newer-generation (PϽ .001) fluoroquinolones. There were significant increases in multiple-drug resistance of CNS isolated from treated eyes, with 81.8% and 67.5% of isolates resistant to at least 3 (P =.01) and at least 5 (P =.009) antibiotics, respectively. Conclusion: Repeated exposure of conjunctival flora to ophthalmic antibiotics selects for resistant strains. Application to Clinical Practice: Repeated use of ophthalmic antibiotics after intraocular injection promotes the emergence of antimicrobial resistance.

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Antibiotic Resistance of Conjunctiva and Nasopharynx Evaluation Study: A Prospective Study of Patients Undergoing Intravitreal Injections

Cited by 85 publications

References 43 publications

Emerging 8-Methoxyfluoroquinolone Resistance among Methicillin-Susceptible Staphylococcus epidermidis Isolates Recovered from Patients with Endophthalmitis

Emerging 8-Methoxyfluoroquinolone Resistance among Methicillin-Susceptible Staphylococcus epidermidis Isolates Recovered from Patients with Endophthalmitis

Caracterización de la microbiota conjuntival transitoria y residente de adultos jóvenes

Antimicrobial Resistance and Ophthalmic Antibiotics

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