Antimicrobial Resistance and Ophthalmic Antibiotics

Abstract

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.

Ocular surface microbiome in diabetes mellitus

“…40 Hence, several studies reported the emergence of antibioticresistant organisms after multiple sessions of intravitreal drug injection using prophylactic antibiotics. [40][41][42] The NGS analysis showed that the top four most common phyla in both non-DM and DM groups were Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes, which were consistent with previous studies. 29,30 At the class level, we found that Alphaproteobacteria was predominated in the non-DM group, and Gammaproteobacteria was predominated in the DM group, similar to the reported from Ham B. et al 29 Prior studies have demonstrated the abundance of potentially pathogenic bacteria in the DM group, using NGS technique.…”

Ocular surface microbiome in diabetes mellitus

“…40 Hence, several studies reported the emergence of antibioticresistant organisms after multiple sessions of intravitreal drug injection using prophylactic antibiotics. [40][41][42] The NGS analysis showed that the top four most common phyla in both non-DM and DM groups were Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes, which were consistent with previous studies. 29,30 At the class level, we found that Alphaproteobacteria was predominated in the non-DM group, and Gammaproteobacteria was predominated in the DM group, similar to the reported from Ham B. et al 29 Prior studies have demonstrated the abundance of potentially pathogenic bacteria in the DM group, using NGS technique.…”

Trends in Fluoroquinolone Nonsusceptibility Among Coagulase-Negative Staphylococcus Isolates Causing Endophthalmitis, 1995-2016

“…In another study, nonsusceptibility to these antibiotics was shown to rapidly occur with repeated exposure of conjunctival Staphylococcus epidermidis to fluoroquinolones or azithromycin . Increase in the resistance among all of conjunctival flora with repeated exposure to topical antibiotics (ofloxacin, 0.3%; azithromycin, 1%; gatifloxacin, 0.3%; or moxifloxacin hydrochloride, 0.5%) has been reported . Similarly, in a prospective study, CoNS resistant to fluoroquinolones were also reported to have resistance to multiple other antibiotics.…”

Fluoroquinolone Treatment and Susceptibility of Isolates From Bacterial Keratitis

“…Although there were too few cases caused by organisms other than S pneumoniae, P aeruginosa , and Nocardia species to draw significant conclusions for other organisms, previous surveillance and longitudinal studies have observed emerging resistance in Staphylococcus species of ocular flora. 15–18 Results reported here suggest that fluoroquinolone use may select for growth of certain less susceptible species and also selects for resistant strains within a species.…”

Ocular surface microbiome in diabetes mellitus

“…40 Hence, several studies reported the emergence of antibioticresistant organisms after multiple sessions of intravitreal drug injection using prophylactic antibiotics. [40][41][42] The NGS analysis showed that the top four most common phyla in both non-DM and DM groups were Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes, which were consistent with previous studies. 29,30 At the class level, we found that Alphaproteobacteria was predominated in the non-DM group, and Gammaproteobacteria was predominated in the DM group, similar to the reported from Ham B. et al 29 Prior studies have demonstrated the abundance of potentially pathogenic bacteria in the DM group, using NGS technique.…”

Trends in Fluoroquinolone Nonsusceptibility Among Coagulase-Negative Staphylococcus Isolates Causing Endophthalmitis, 1995-2016

“…In another study, nonsusceptibility to these antibiotics was shown to rapidly occur with repeated exposure of conjunctival Staphylococcus epidermidis to fluoroquinolones or azithromycin . Increase in the resistance among all of conjunctival flora with repeated exposure to topical antibiotics (ofloxacin, 0.3%; azithromycin, 1%; gatifloxacin, 0.3%; or moxifloxacin hydrochloride, 0.5%) has been reported . Similarly, in a prospective study, CoNS resistant to fluoroquinolones were also reported to have resistance to multiple other antibiotics.…”

Fluoroquinolone Treatment and Susceptibility of Isolates From Bacterial Keratitis

“…Although there were too few cases caused by organisms other than S pneumoniae, P aeruginosa , and Nocardia species to draw significant conclusions for other organisms, previous surveillance and longitudinal studies have observed emerging resistance in Staphylococcus species of ocular flora. 15–18 Results reported here suggest that fluoroquinolone use may select for growth of certain less susceptible species and also selects for resistant strains within a species.…”

Ocular surface microbiome in diabetes mellitus

“…40 Hence, several studies reported the emergence of antibioticresistant organisms after multiple sessions of intravitreal drug injection using prophylactic antibiotics. [40][41][42] The NGS analysis showed that the top four most common phyla in both non-DM and DM groups were Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes, which were consistent with previous studies. 29,30 At the class level, we found that Alphaproteobacteria was predominated in the non-DM group, and Gammaproteobacteria was predominated in the DM group, similar to the reported from Ham B. et al 29 Prior studies have demonstrated the abundance of potentially pathogenic bacteria in the DM group, using NGS technique.…”

Trends in Fluoroquinolone Nonsusceptibility Among Coagulase-Negative Staphylococcus Isolates Causing Endophthalmitis, 1995-2016

“…In another study, nonsusceptibility to these antibiotics was shown to rapidly occur with repeated exposure of conjunctival Staphylococcus epidermidis to fluoroquinolones or azithromycin . Increase in the resistance among all of conjunctival flora with repeated exposure to topical antibiotics (ofloxacin, 0.3%; azithromycin, 1%; gatifloxacin, 0.3%; or moxifloxacin hydrochloride, 0.5%) has been reported . Similarly, in a prospective study, CoNS resistant to fluoroquinolones were also reported to have resistance to multiple other antibiotics.…”

Fluoroquinolone Treatment and Susceptibility of Isolates From Bacterial Keratitis

“…Although there were too few cases caused by organisms other than S pneumoniae, P aeruginosa , and Nocardia species to draw significant conclusions for other organisms, previous surveillance and longitudinal studies have observed emerging resistance in Staphylococcus species of ocular flora. 15–18 Results reported here suggest that fluoroquinolone use may select for growth of certain less susceptible species and also selects for resistant strains within a species.…”