Moxifloxacin Susceptibility Mediates the Relationship between Causative Organism and Clinical Outcome in Bacterial Keratitis

Oldenburg, Catherine E.; Lalitha, Prajna; Srinivasan, Muthiah; Palanisamy, M.; Bharathi, M Jayahar; Rajaraman, Revathi; Ravindran, Meenakshi; Mascarenhas, Jeena; Nardone, Natalie; Ray, Kathryn J.; Glidden, David V.; Acharya, Nisha R.; Lietman, Thomas M.

doi:10.1167/iovs.12-11246

Cited by 25 publications

(19 citation statements)

References 21 publications

(25 reference statements)

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“…Although our ultimate goal in treatment of corneal ulcers is ulcer healing, our immediate objective of therapy is to eliminate the infection. Baseline culture positivity despite antibiotic therapy has been associated with poor outcomes in bacterial and fungal keratitis 8,9,12,14 Similarly, positive fungal donor rim cultures have also been shown to predict increased risk of fungal endophthalmitis after corneal transplant. 15 By contrast in our fungal smear positive population, baseline culture status did not predict clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Repeat Culture in Fungal Corneal Ulcer Management: A Secondary Analysis of the MUTT-I Randomized Clinical Trial

Ray

Lalitha

Prajna

et al. 2017

American Journal of Ophthalmology

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PURPOSE To determine whether patients who had a positive repeated culture was predictive of worse clinical outcome than those who achieved microbiological cure at 6 days in the Mycotic Ulcer Treatment Trial I (MUTT-I). DESIGN Secondary analysis from a multicenter, double-masked, randomized clinical trial. METHODS Setting Multiple hospital sites of the Aravind Eye Care System, India. Study Population Patients with culture-positive filamentous fungal ulcers and visual acuity of 20/40 to 20/400 re-examined 6 days after initiation of treatment Intervention Corneal scraping and cultures were obtained from study participants at day-6 after enrollment. Main outcome Measures We assess 3-month best spectacle corrected visual acuity (BSCVA), 3-month infiltrate/scar size, corneal perforation and re-epithelialization rates stratified by culture positivity at day 6. RESULTS Of the 323 patients with smear positive ulcers enrolled in MUTT-I, 299 (92.6%) were scraped and cultured six days after enrollment. Repeat culture positivity was 31% (92/299). Among patients who tested positive at enrollment, those with positive 6-day cultures had significantly worse 3-month BSCVA (0.39 LogMAR; 95% CI: 0.24 to 0.44; P<0.001), larger 3-month scar-size (0.39 mm; 95% CI: 0.06 to 0. 73; P=0.02), were more likely to perforate or require therapeutic penetrating keratoplasty (OR: 6.27; 95% CI: 2.73 to 14.40; P<0.001), and were slower to re-epithelialize (HR: 0.33; 95% CI: 0.21 to 0.50; P<0.001) than those with a negative 6-day culture result. CONCLUSIONS Early microbiological cure on culture is a predictor of clinical response to treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT00996736

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Section: Discussionmentioning

confidence: 99%

The Utility of Repeat Culture in Fungal Corneal Ulcer Management: A Secondary Analysis of the MUTT-I Randomized Clinical Trial

Ray

Lalitha

Prajna

et al. 2017

American Journal of Ophthalmology

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“…36–38 In the Steroids for Corneal Ulcer Trial (SCUT), in-vitro susceptibility was correlated with clinical outcomes. 39,40,41 Therefore, corneal culture and sensitivity testing is recommended for all corneal ulcers. Assessing response to treatment is critical and if the patient appears to be worsening on treatment one can consider switching to fortified broad-spectrum antibiotics if the initial therapy was fluoroquinolone monotherapy.…”

Section: Bacterial Keratitismentioning

confidence: 99%

Update on the Management of Infectious Keratitis

2017

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Infectious keratitis is a major global cause of visual impairment and blindness, often affecting marginalized populations. Proper diagnosis of the causative organism is critical, and while culture remains the prevailing diagnostic tool, newer techniques such as in vivo confocal microscopy are helpful for diagnosing fungal keratitis and Acanthameoba. Next generation sequencing holds the potential for early and accurate diagnosis even for organisms that are difficult to culture by conventional methods. Topical antibiotics remain the best treatment for bacterial keratitis, and a recent review found all commonly prescribed topical antibiotics to be equally effective. However outcomes remain poor secondary to corneal melting, scarring and perforation. Adjuvant therapies aimed at reducing the immune response responsible for much of the morbidity associated with keratitis include topical corticosteroids. The large, randomized controlled Steroids for Corneal Ulcers trial found that while steroids provided no significant improvement overall, they did appear beneficial for ulcers that were central, deep or large, non-Nocardia or classically invasive P. aeruginosa, patients with low baseline vision, and when started early after the initiation of antibiotics. Fungal ulcers often have worse clinical outcomes than bacterial ulcers, with no new treatments since the 1960’s when topical natamycin was introduced. The randomized controlled Mycotic Ulcer Treatment Trial showed a benefit of topical natamycin over topical voriconazole for fungal keratitis, particularly among those caused by Fusarium. The second Mycotic Ulcer Treatment Trial showed that oral voriconazole did not improve outcomes overall although there may have been some effect among Fusarium ulcers. Given an increase in non-serious adverse events the authors concluded that they could not recommend oral voriconazole at this time. Viral keratitis differs from bacterial and fungal cases in that is often recurrent and is common in developed countries. The first Herpetic Eye Disease Study (HEDS) showed a significant benefit of topical corticosteroids and oral acyclovir for stromal keratitis. HEDS II showed that oral acyclovir decreased the recurrence of any type of HSV keratitis by approximately half. Future strategies to reduce the morbidity associated with infectious keratitis are likely to be multidimensional with adjuvant therapies aimed at modifying the immune response to infection holding the greatest potential to improve clinical outcomes.

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“…En cuanto a las bacterias Gram negativas, 32,3 % era resistente a la moxifloxacina y 10,8 %, a la tobramicina (14). Recientemente, en Italia, Blanco, et al, estudiaron Staphylococcus spp.…”

Section: En El Estudio Antibiotic Resistance Monitoring In Ocular Micunclassified

Sensibilidad antibiótica de bacterias obtenidas de queratitis e infecciones intraoculares en la Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia

et al. 2013

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Acuña: redacción del artículo. Todos los autores participaron en el análisis de los datos y la revisión crítica del artículo. ARTÍCULO ORIGINAL Biomédica 2014;34(Supl. Introducción. La resistencia bacteriana es crítica para la selección de los antibióticos en el tratamiento de las infecciones, por ello es vital conocer su estado actual en nuestro medio. Objetivo. Determinar la sensibilidad antibiótica bacteriana in vitro obtenida de los cultivos de queratitis e infecciones intraoculares. Materiales y métodos. Se llevó a cabo un estudio retrospectivo en la Fundación Oftalmológica de Santander (FOSCAL), entre junio de 2011 y enero de 2012. Resultados. Se examinaron 92 muestras. Se identificaron 110 bacterias, 27 hongos y 12 amebas de vida libre. Del total de bacterias Gram positivas, 1,1 %, 0 %, 1,1 %, 16,9 %, 29,3 % y 85 % fue resistente a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina, respectivamente, mientras que la resistencia a estos mismos fármacos se presentó, respectivamente, en 0 %, 8,3 %, 0 %, 0 %, 18,2 % y 27,3 % de las bacterias Gram negativas. Los porcentajes de resistencia de los estafilococos positivos para coagulasa resistentes a la meticilina fueron 0 %, 0 %, 0 %, 7 %, 17 % y 100 %, respectivamente, y los porcentajes de los estafilococos negativos para coagulasa resistentes a la meticilina fueron 3 %, 0 %, 0 %, 24 %, 44 % y 100 %, respectivamente. Los porcentajes de resistencia bacteriana globales (tanto para bacterias Gram positivas como para Gram negativas) a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina fueron 1 %, 1 %, 1 %, 15,1 %, 28 % y 64,5 %, respectivamente. Conclusiones. Los niveles de resistencia bacteriana para imipenem, moxifloxacina y gatifloxacina fueron menores que para levofloxacina, ciprofloxacina y tobramicina. Los niveles de resistencia para la tobramicina fueron muy altos, lo que pone en duda su utilidad clínica en las infecciones oculares en nuestro medio.Palabras clave: bacterias, farmacorresistencia microbiana, antibacterianos, infecciones del ojo, queratitis, endoftalmitis.

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Moxifloxacin Susceptibility Mediates the Relationship between Causative Organism and Clinical Outcome in Bacterial Keratitis

Cited by 25 publications

References 21 publications

The Utility of Repeat Culture in Fungal Corneal Ulcer Management: A Secondary Analysis of the MUTT-I Randomized Clinical Trial

The Utility of Repeat Culture in Fungal Corneal Ulcer Management: A Secondary Analysis of the MUTT-I Randomized Clinical Trial

Update on the Management of Infectious Keratitis

Sensibilidad antibiótica de bacterias obtenidas de queratitis e infecciones intraoculares en la Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia

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