Antibiotic Resistance Trends Among Ocular Pathogens in the US—Cumulative Results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study

BACKGROUND Antibiotic prophylaxis in cataract surgery is intended to minimize endophthalmitis. We describe pathogenic organisms, antibiotic sensitivities, and antibiotic prophylaxis in culture-proven endophthalmitis cases. DESIGN Retrospective consecutive case series, community-based setting. SAMPLES 215 cases of endophthalmitis after cataract surgery performed during 2007–2012 in Kaiser Permanente, California. METHODS AND MAIN OUTCOME MEASURES Descriptive analysis of isolated organisms and antibiotic sensitivities in relation to antibiotic prophylaxis in culture-proven endophthalmitis cases. RESULTS The majority of culture-confirmed organisms (N=83) were Gram-positive (96%), most notably coagulase-negative Staphylococci (CoNS) (N=34, 52%), of which all that underwent testing were sensitive to vancomycin (N=32). Among 19 cases that had received only topical antibiotic prophylaxis, 7 (37%) were resistant to the antibiotic given: 50% of cases (5 of 10 isolates) that had received ofloxacin were resistant to this antibiotic, 40% (2 of 5 isolates) that had received gatifloxacin were resistant. In contrast, 100% of cases (N=4) that had received aminoglycosides were susceptible. Few culture-confirmed cases occurred in patients who received intracameral antibiotic (N=4). CONCLUSIONS In cases where fluoroquinolones were administered as antibiotic prophylaxis, isolates demonstrated a degree of bacterial resistance. The majority of endophthalmitis cases isolated following topical antibiotic prophylaxis only and were attributed to Gram-positive organisms, while few occurred in association with intracameral antibiotic.

Section: Discussionsupporting

confidence: 90%

Pathogens and antibiotic sensitivities in endophthalmitis

Slean

Shorstein

Liu

et al. 2017

“…Monitoring of AMR in bacterial keratitis despite the limitations in antimicrobial susceptibility testing methods in ocular infections, is critical in an era of AMR. These limitations include the use of systemic breakpoints to interpret minimum inhibitory concentration data and the choice of antibiotics tested …”

Section: Introductionmentioning

confidence: 99%

“…These limitations include the use of systemic breakpoints to interpret minimum inhibitory concentration data and the choice of antibiotics tested. 12 Whilst we recognize the limits of antimicrobial susceptibility data for topical ocular therapy, more contemporary data are required to benchmark the current status of AMR in eye samples; to guide empirical antimicrobial therapy; to increase the efficacy of treatment; to reduce the side effects from inappropriate therapy; and to gather data for worldwide AMR surveillance. In the United States, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOUR) study has been annually publishing the susceptibility data for ocular pathogens since 2008.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance trends in bacterial keratitis over 5 years in Sydney, Australia

Cabrera‐Aguas

Khoo

George

et al. 2019

Importance Antimicrobial resistance (AMR) patterns in bacterial keratitis may fluctuate in a geographic location over time. Background To investigate any change in AMR patterns in Sydney, Australia. Design Retrospective case series. Participants All patients with microbial keratitis who underwent a corneal scrape and culture from 2012 to 2016 at the Sydney Eye Hospital. Methods Matrix‐assisted laser desorption ionization‐time of flight (MALDI‐TOF) mass spectrometry identified organisms. The Calibrated Dichotomous Susceptibility method determined antibiotic susceptibilities. Main Outcome Measures Isolated organisms and antibiotic susceptibilities. Results There were 1084 corneal scrapes from 957 patients. The mean age was 54 years (range 18‐100) and 52% were male. Cultures were positive in 711 of 1084 scrapes (66%), with 884 organisms identified. Of the bacteria isolated, 685 of 884 (78%) were Gram‐positive and 199 of 884 (22%) were Gram‐negative. Overall, the most common bacteria were coagulase‐negative Staphylococci (CoNS) (405/884, 46%). Methicillin‐resistance was detected in 7% of Staphylococcus aureus isolates (7/103). Methicillin‐resistance in CoNS (ie, also cefalotin resistance) was reported in 19% of isolates and ciprofloxacin 8%. For methicillin‐sensitive S aureus (MSSA), 5% of isolates were resistant to ciprofloxacin. For Corynebacterium spp., 34% of isolates were resistant to chloramphenicol and 9% to ciprofloxacin. The most common Gram‐negative bacteria was Pseudomonas aeruginosa (109/199, 55%). One case was resistant to ciprofloxacin. Conclusions and Relevance Coagulase‐negative staphylococcal species were the most frequently suspected of causing bacterial keratitis. Increased resistance to cefalotin was identified for CoNS and to ciprofloxacin for Corynebacterium spp., MSSA and P aeruginosa compared to a previous study in Sydney in 2002 to 2003.

“…Rising rates of antibiotic resistance have been a concern especially among S. aureus and CoNS . Five years results of the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study conducted in United States showed high rates of methicillin resistance among S aureus 42.2% and CoNS 49.7%. These bacteria would be resistant to cefazolin and cefuroxime of course.…”

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwementioning

confidence: 99%

“…These bacteria would be resistant to cefazolin and cefuroxime of course. Moreover, methicillin resistant staphylococci were more likely to be resistant to other classes of antibiotics including fluoroquinolones, macrolides and aminoglycosides . Sensitivity to moxifloxacin was 88% and 26% in methicillin sensitive and resistant S. aureus respectively, and 86% and 49% in methicillin sensitive and resistant CoNS, respectively.…”

Section: Microbial Spectrum Of Endophthalmitis Samples Isolated Betwementioning

confidence: 99%

Intracameral antibiotics for prophylaxis of postoperative endophthalmitis in Australia: a review

Lipsky

Barrett

2018

Postoperative endophthalmitis is a severe complication which may result in loss of vision. Intracameral antibiotics have been shown to reduce the risk of this complication and are extensively used worldwide, with vancomycin, cefuroxime and moxifloxacin most commonly used. Choices in Australia are currently limited to vancomycin and cefazolin, since cefuroxime and moxifloxacin are not available. Vancomycin has been safely and effectively used in our department for more than two decades. Recent publications have risen concerns regarding the association of haemorrhagic occlusive retinal vasculitis a potentially blinding complication with intracameral vancomycin. This concern has driven us to review the safety and efficacy of currently available antibiotics in the context of Australian practice.