Emerging
            <i>Enterococcus</i>
            isolates in postoperative endophthalmitis by selection pressure of fluoroquinolones: an 11-year multicenter and experimental study

Kim, Jiyeun Kate; Nam, Ki Yup; Chung, In Young; Jeung, Woo Jin; Kwon, Yoon Hyung; Park, Jung Min; Han, Yong Seop; Lee, Ji Eun; Byon, Ik Soo; Park, Sung Hu; Kim, Hyun Wong; Park, Kang Yun; Yoon, Hyong Seo; Park, Indal; Kim, Han Woo; Lee, Sang Joon

doi:10.1080/22221751.2020.1810134

Cited by 6 publications

(5 citation statements)

References 29 publications

(45 reference statements)

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“…The incidence of enterococcal endophthalmitis after cataract surgery tends to increase recently. Enterococci are more resistant to the fourth-generation fluoroquinolones than coagulase-negative Staphylococci [ 26 , 42 ]. Aminoglycoside inactivating enzyme encoded by the aac(6’)-aph(2’’) gene can confer resistance to high concentrations of gentamicin [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of gentamicin in surgical perfusion solution on cataract postoperative endophthalmitis

Hou

Wang

et al. 2022

BMC Ophthalmol

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Objective To evaluate the effect of gentamicin in surgical perfusion solution on endophthalmitis incidence after cataract surgery. Methods A retrospective analysis of endophthalmitis incidence was conducted in two groups of patients who underwent cataract surgery, with (Group B) or without gentamicin (Group A) in the surgical perfusion solution. Endophthalmitis incidence, the isolated pathogenic bacteria strains and their antibiotic sensitivity, and the drug-resistant genotype of the pathogens were examined. Results The incidence of endophthalmitis in patients of group A was 0.8‰. Thirteen pathogenic bacterial strains were isolated from the patient samples in group A, including 8 strains of Staphylococcus epidermidis, 1 Staphylococcus aureus, 1 Streptococcus pneumoniae, 1 Streptococcus bovis, 1 Enterococcus faecium and 1 Morganella sp. The incidence of endophthalmitis in group B patients was 0.2‰, which was significantly lower than that in group A (P<0.05). Five strains of pathogenic bacteria were successfully isolated, including 2 strains of Enterococcus faecium, 1 Enterococcus faecalis, 1 Staphylococcus epidermidis and 1 Staphylococcus aureus. There was no significant difference in the proportion of Staphylococcus strains in all isolated bacteria between the two groups (P > 0.05). However, the proportion of Enterococci isolated in group B samples was higher than that in group A (P < 0.05). There were more gentamicin-sensitive strains than levofloxacin-sensitive strains identified (P < 0.05). Interestingly, aminoglycoside-inactivating enzyme resistance gene was detected in Enterococcus strains. Conclusion Our data suggest that gentamicin-containing perfusion solution can reduce the incidence of postoperative endophthalmitis in cataract patients. However, the selective pressure imposed by gentamicin may facilitate the development of aminoglycoside-resistant Enterococcos strains.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the effect of gentamicin in surgical perfusion solution on cataract postoperative endophthalmitis

Hou

Wang

et al. 2022

BMC Ophthalmol

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“…Because the most prevalent bacteria in the conjunctiva are CNS, including S. epidermidis , they have been the major causative agent of PE after surgery. On the other hand, several recent reports on PE in Korea, Sweden, and Taiwan indicated that E. faecalis has become the top causative agent of PE ( 6 , 9 – 11 ). Enterococcus spp.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, it has been reported that the distribution of the causative bacteria of postoperative PE changed in Korea, Sweden, and Taiwan ( 9 – 11 ). These changes may reflect alterations of conjunctival microflora in the PE patients.…”

Section: Introductionmentioning

confidence: 99%

“…Such a shift may occur in response to increased use of topical antibiotics intended to prevent ocular infection. Previous studies reporting that the distribution of isolates causing PE is changing from coagulase-negative staphylococci (CNS) to enterococci suggest that external factors have altered the relationship between the two most common bacterial taxa in the conjunctiva ( 9 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

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Establishing in vitro and in vivo Co-culture Models of Staphylococcus epidermidis and Enterococcus faecalis to Evaluate the Effect of Topical Fluoroquinolone on Ocular Microbes

Kim

Park

et al. 2021

Front. Med.

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Purpose: To establish in vitro and in vivo ocular co-culture models of Staphylococcus epidermidis and Enterococcus faecalis and to study how various concentrations of moxifloxacin affect the survival of these two endophthalmitis-causing bacteria.Methods: Standard strains of S. epidermidis and E. faecalis were used. Color detection agar plates were employed to distinguish their colonies. To establish the in vitro and in vivo co-culture models, S. epidermidis and E. faecalis were co-cultivated at different ratios for various periods. For the in vivo model, various volumes and concentrations of either a mono-culture or co-culture were inoculated into the lower conjunctival sac of rabbits. Finally, the newly developed in vitro and in vivo co-culture models were subjected to the moxifloxacin treatment to access its effect on S. epidermidis and E. faecalis.Results: When S. epidermidis and E. faecalis were cultured separately in tryptic soy broth, their growth peaked and plateaued at approximately 16 and 6 h, respectively. When they were co-cultured, the growth peak of S. epidermidis got delayed, whereas the growth peak of E. faecalis did not change. The number of E. faecalis was significantly higher in the co-culture than that in the mono-culture. Treatment with moxifloxacin in the in vitro co-culture model rapidly decreased the number of S. epidermidis cells at doses ≥ 0.125 μg/ml. In contrast, the number of E. faecalis did not change significantly up to 16 μg/ml moxifloxacin. In in vivo co-culture (at 1:1), the S. epidermidis count decreased in a pattern similar to that seen in in vivo mono-culture and was barely detectable at 24 h after inoculation. In contrast, the of E. faecalis count increased up to 16 h and then decreased. When moxifloxacin was applied (zero, one, or two times) to this model, the S. epidermidis count decreased in proportion to the number of treatments. In contrast, the E. faecalis count increased with moxifloxacin treatment.Conclusions: The in vitro and in vivo co-culture models of S. epidermidis and E. faecalis were established to determine the influence of moxifloxacin eye drops on these bacteria. The results clearly show that the moxifloxacin eye drops can make E. faecalis dominant on the ocular surface.

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“…Enterococci are important pathogens causing hospital-and community-acquired abdominal infections, with Enterococcus faecalis and Enterococcus faecium accounting for most enterococcal infections in humans, including urinary tract infections, surgical site infections, bacteremia, endocarditis and tissue damage [1,2]. Enterococcus species are of clinical importance because they lead to a fulminant and destructive disease course [3]. A recent report showed that Enterococcus accounted for 20% of bloodstream infections in China, with a mortality rate of 24% [4].…”

Section: Introductionmentioning

confidence: 99%

Identification of two novel type II topoisomerase mutations in Enterococcus spp. isolated from a hospital in China

Peng

Wang

et al. 2021

ARCH BIOL SCI BELGRA

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Type II topoisomerases, including DNA gyrase (GyrA) and topoisomerase IV (ParC), contribute to fluoroquinolone resistance in Enterococcus spp. This study investigated the mutational status of the quinolone resistance-determining regions (QRDRs) of GyrA and ParC in the clinical isolates of enterococci from a hospital in Baotou, China. We analyzed 110 enterococcal isolates, including 57 Enterococcus faecalis and 53 Enterococcus faecalis faecium. The resistance rates of E. faecalis and E. faecium to ciprofloxacin were 63.16% and 84.91%, respectively. We found that 32 samples of E. faecalis and 42 of E. faecium had single or combined mutations in gyrA and/or parC, which were all resistant to ciprofloxacin. Only two ciprofloxacin-resistant E. faecalis isolates had no mutation. No mutations in gyrA and parC genes in all ciprofloxacin-susceptible isolates were found. Ciprofloxacin minimal inhibitory concentrations (MICs) in the mutation group were significantly higher than those of the nonmutation group, indicating that mutations in the QRDRs of gyrA and parC were correlated with MIC elevation. Two novel substitutions (GyrA Ser83Phe and ParC Ser80Leu) of E. faecalis were identified herein. Three-dimensional modeling revealed that these novel amino acid substitutions could disrupt the water/metal-ion bridge and decrease the interaction between the enzymes and ciprofloxacin. The data showed a diversity of mutation types in QRDRs of type II topoisomerases whose association with fluoroquinolone resistance in clinical isolates of enterococci warrants further investigation.

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Emerging Enterococcus isolates in postoperative endophthalmitis by selection pressure of fluoroquinolones: an 11-year multicenter and experimental study

Cited by 6 publications

References 29 publications

Evaluation of the effect of gentamicin in surgical perfusion solution on cataract postoperative endophthalmitis

Evaluation of the effect of gentamicin in surgical perfusion solution on cataract postoperative endophthalmitis

Establishing in vitro and in vivo Co-culture Models of Staphylococcus epidermidis and Enterococcus faecalis to Evaluate the Effect of Topical Fluoroquinolone on Ocular Microbes

Identification of two novel type II topoisomerase mutations in Enterococcus spp. isolated from a hospital in China

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