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

Abstract

Coagulase-negative Staphylococcus (CoNS) is the most common cause of acute-onset post-cataract surgery endophthalmitis. 1 Fluoroquinolones are frequently used prophylactically (either topical or intracameral) in an attempt to reduce the rates of postoperative endophthalmitis. In this study, the susceptibilities of CoNS-causing endophthalmitis to fluoroquinolones over a 22-year period at the Bascom Palmer Eye Institute, Miami, Florida, are reported. Methods | This study was a retrospective, consecutive case series of microbiology isolates, with no identifying patient information. Microbiology studies were used to obtain sensitivities for second-generation (ciprofloxacin), third-generation (levofloxacin), and fourth-generation (moxifloxacin) fluoroquinolones derived from E-test and VITEK testing of vitreous CoNS isolates causing endophthalmitis between January 1, 1995, and December 31, 2016, at Bascom Palmer Eye Institute, Miami, Florida. In the earlier period, all isolates were not tested for levofloxacin and moxifloxacin. This study did not require informed consent and the University of Miami Miller School of Medicine institutional review board waived approval because samples were taken as part of routine medical care unrelated to this study and no patient-identifying information was collected. For the same reasons, the Health Insurance Portability and Accountability Act compliance did not apply to this study. We used a 2-sided P value of .05 at 95% confidence interval significance level. Results | In this study of coagulase-negative Staphylococcus from patients with endophthalmitis, susceptibility rates among fluoroquinolones (ciprofloxacin, levofloxacin, and moxifloxacin) were reviewed between January 1, 1995, and December 31, 2016 (Figure).

Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis

“…Expedient intravitreal administration of broad-spectrum antibiotics remains the main objective of early management. Increasing rates of resistance have been reported [ 21 , 22 , 23 ], and in this study, we showed 16.7% resistance across all isolates. Fourth-generation fluoroquinolones, such as delafloxacin, demonstrate promising MIC effects in in-vitro studies and may be considered as adjunctive treatment in the future [ 24 ].…”

Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis

“…Expedient intravitreal administration of broad-spectrum antibiotics remains the main objective of early management. Increasing rates of resistance have been reported [ 21 , 22 , 23 ], and in this study, we showed 16.7% resistance across all isolates. Fourth-generation fluoroquinolones, such as delafloxacin, demonstrate promising MIC effects in in-vitro studies and may be considered as adjunctive treatment in the future [ 24 ].…”

Endophthalmitis caused by gram-positive bacteria resistant to vancomycin: Clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes

“…In a retrospective data analysis of endophthalmitis isolates reported that non-susceptibility of CoNS to all three generations of fluoroquinolones increased over the time-period of 22 years significantly. 20 Non-susceptibility to amikacin was reported in 7/14 (50%) of isolates in the current study. Antimicrobial susceptibility test for linezolid was performed for 5/14 patients and all were susceptible to linezolid.…”

Surveillance of post-cataract endophthalmitis at a tertiary referral center: a 10-year critical evaluation

“…For example, 1 out of 4 strains of Staphylococcus aureus (25.0%) was found to be MRSA. (1995)(1996)(1997)(1998)(1999) to 57% (2010-2016) (p = 0.003) [21].…”

Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis

“…Expedient intravitreal administration of broad-spectrum antibiotics remains the main objective of early management. Increasing rates of resistance have been reported [ 21 , 22 , 23 ], and in this study, we showed 16.7% resistance across all isolates. Fourth-generation fluoroquinolones, such as delafloxacin, demonstrate promising MIC effects in in-vitro studies and may be considered as adjunctive treatment in the future [ 24 ].…”

Endophthalmitis caused by gram-positive bacteria resistant to vancomycin: Clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes

“…In a retrospective data analysis of endophthalmitis isolates reported that non-susceptibility of CoNS to all three generations of fluoroquinolones increased over the time-period of 22 years significantly. 20 Non-susceptibility to amikacin was reported in 7/14 (50%) of isolates in the current study. Antimicrobial susceptibility test for linezolid was performed for 5/14 patients and all were susceptible to linezolid.…”

Surveillance of post-cataract endophthalmitis at a tertiary referral center: a 10-year critical evaluation

“…For example, 1 out of 4 strains of Staphylococcus aureus (25.0%) was found to be MRSA. (1995)(1996)(1997)(1998)(1999) to 57% (2010-2016) (p = 0.003) [21].…”

Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis

“…Expedient intravitreal administration of broad-spectrum antibiotics remains the main objective of early management. Increasing rates of resistance have been reported [ 21 , 22 , 23 ], and in this study, we showed 16.7% resistance across all isolates. Fourth-generation fluoroquinolones, such as delafloxacin, demonstrate promising MIC effects in in-vitro studies and may be considered as adjunctive treatment in the future [ 24 ].…”

Endophthalmitis caused by gram-positive bacteria resistant to vancomycin: Clinical settings, causative organisms, antimicrobial susceptibilities, and treatment outcomes

“…In a retrospective data analysis of endophthalmitis isolates reported that non-susceptibility of CoNS to all three generations of fluoroquinolones increased over the time-period of 22 years significantly. 20 Non-susceptibility to amikacin was reported in 7/14 (50%) of isolates in the current study. Antimicrobial susceptibility test for linezolid was performed for 5/14 patients and all were susceptible to linezolid.…”

Surveillance of post-cataract endophthalmitis at a tertiary referral center: a 10-year critical evaluation

“…For example, 1 out of 4 strains of Staphylococcus aureus (25.0%) was found to be MRSA. (1995)(1996)(1997)(1998)(1999) to 57% (2010-2016) (p = 0.003) [21].…”