Multidrug-Resistant Pseudomonas aeruginosa Keratitis

Vazirani, Jayesh; Wurity, Siva; Ali, Hasnat

doi:10.1016/j.ophtha.2015.06.007

Cited by 85 publications

(47 citation statements)

References 15 publications

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“…For example, Staphylococcus species and Pseudomonas aeruginosa have demonstrated resistance to fluoroquinolones, macrolides, and β-lactams [2, 3, 6, 8]. Haemophilus influenzae , a common Gram-negative bacterium, has also shown increased resistance to trimethoprim [9–12].…”

Section: Introductionmentioning

confidence: 99%

Retrospective report of antimicrobial susceptibility observed in bacterial pathogens isolated from ocular samples at Mount Sinai Hospital, 2010 to 2015

Oydanich

Dingle

Hamula

et al. 2017

Antimicrob Resist Infect Control

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BackgroundAntimicrobial resistance has emerged as a major threat to global public health. Thus, the surveillance of changes in antimicrobial resistance in local and global settings is a paramount necessity. While many studies have tracked antimicrobial resistance, only a small percentage surveyed ocular isolates. The purpose of this study was to report the in vitro susceptibility of bacterial pathogens isolated from ocular samples in New York, NY from 2010 to 2015.MethodsA retrospective review of ocular isolates was conducted. All organisms were collected by 25 separate inpatient wards and outpatient clinics, and were analyzed by the clinical microbiology laboratory at Mount Sinai Hospital. Clinical Laboratory and Standards Institute (CLSI) guidelines were followed for susceptibility testing and breakpoint interpretations.ResultsA total of 549 bacterial organisms were isolated from 1664 cultures (33%) during the 6-year study period. Of these, 358 isolates (65.2%) underwent susceptibility testing. 182 (50.8%) isolates were Gram-positive. The most common Gram-positive bacterium was Staphylococcus aureus (62.1%). Methicillin-resistance decreased in S. aureus isolates (31.3% in 2010, 14.1% in 2015) but was without significant change (p = 0.25). When analyzing all S. aureus isolates recovered during the study period, there were significantly more methicillin-resistant S. aureus (MRSA) isolates resistant to fluoroquinolones (p <0.0001), erythromycin (p <0.0001), and trimethoprim/sulfamethoxazole (TMP/SMZ; p <0.05). Overall, Streptococcus pneumoniae isolates showed reduced susceptibility to erythromycin, but were otherwise susceptible to the other antimicrobials tested. Haemophilus influenzae (26.1%) and Pseudomonas aeruginosa (23.9%) were the most common Gram-negative bacteria isolated. Resistance to ampicillin and TMP/SMZ was observed in several of the H. influenzae isolates. P. aeruginosa isolates did not show high resistance overall, however, it was noted that isolates resistant to meropenem were also resistant to other antimicrobials (p < 0.01).ConclusionOverall, antimicrobial resistance was infrequent for the Gram-negative and Gram-positive bacteria analyzed. While the MRSA isolates demonstrated increased resistance to multiple antimicrobial classes, this is expected for this pathogen. Due to the continued use of broad-spectrum oral and systemic antimicrobials to treat ocular infections, findings of this study and other surveillance studies specific to ocular isolates should be used as resources in effective decision making in the treatment of ocular disease.

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Section: Introductionmentioning

confidence: 99%

Retrospective report of antimicrobial susceptibility observed in bacterial pathogens isolated from ocular samples at Mount Sinai Hospital, 2010 to 2015

Oydanich

Dingle

Hamula

et al. 2017

Antimicrob Resist Infect Control

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“…Antibiotic susceptibility was detected in only 10 of the 23 eyes with MDR-PA keratitis (43.38%), all of which were susceptible to colistin and imipenem. 42 In another 15 eyes with MDR-PA keratitis, Fernandes et al 43 detected susceptibility to imipenem in eight eyes, colistin in four eyes, neomycin in two eyes, and no susceptibility to any drug in one eye.…”

Section: Antibiotics In Multidrug Resistancementioning

confidence: 96%

“…Among gram-negative bacteria, susceptibility to imipenem was highest (24/29, 82.75%) while susceptibility to ceftazidime was just 50.81% (31/61). Vazirani et al 42 reported less than 15% susceptibility to aminoglycosides, cephalosporins, and fluoroquinolones in their series of 23 patients with multidrug resistant P. aeruginosa (MDR-PA) keratitis. Antibiotic susceptibility was detected in only 10 of the 23 eyes with MDR-PA keratitis (43.38%), all of which were susceptible to colistin and imipenem.…”

Section: Antibiotics In Multidrug Resistancementioning

confidence: 99%

“…It is effective against both gram-positive and gram-negative bacteria, including extended-spectrum betalactamase-producing (ESBL) bacteria and enterobacteria. 45 In addition to being the other antibiotic (besides colistin) for which high susceptibility has been reported in MDR-PA, [41][42][43][46][47][48] imipenem is also effective in atypical keratitis (nocardia 32,49 nontuberculosis mycobacteria 29,50,51 ) and it has also been a preferred antibiotic in resistant and polymicrobial keratitis due to its broad spectrum of suitability for empirical monotherapy. 52 Jain et al 53 treated eight patients with MDR-PA with ciprofloxacin and 5% cefazolin in the first 48 hrs, before antibiotic susceptibility test results were reported, then with topical colistin 0.19%.…”

Section: Antibiotics In Multidrug Resistancementioning

confidence: 99%

See 1 more Smart Citation

<p>Treatment-Resistant Bacterial Keratitis: Challenges and Solutions</p>

Eğrilmez¹,

Yildirim-Theveny²

2020

OPTH

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Bacterial keratitis is an important ophthalmic emergency and one of the most common causes of corneal blindness. The main causes of treatment resistance in bacterial keratitis are failure to eliminate predisposing factors, misdiagnosis and mistreatment. At first, exogenous, local and systemic predisposing factors that disturbing ocular surface must be eliminated to improve corneal ulcers and to prevent recurrences. Smears and scrapings for staining and culture are indispensable diagnostic tools for cases of sight-threatening keratitis (centrally located, multifocal, characterized by melting, painful). Main treatment agents in bacterial keratitis treatment are topical antibiotics. Until the results of culture antibiograms reach the ophthalmologist, empirical antibiotic selections based on direct microscopic examination and gram stain findings are the most appropriate initial treatment approach currently. S. aureus and coagulase-negative staphylococci (CoNS), the most common gram-positive agents, have resistance rates of more than 30% for fluoroquinolone and methicillin. Multidrug resistance rates are similarly high in these microorganisms. P. aeruginosa is the most common gram-negative micro-organism, in case of multidrug-resistant isolates, both functional and anatomical prognosis of the eyes are very poor. In cases of sight-threatening and resistant keratitis, antibiotic susceptibility testing containing imipenem, colistin, and linezolid is seeming to be an important requirement. Despite its efficiency limited to superficial cases, a nonpharmaceutical anti-infective treatment option such as corneal crosslinking for bacterial keratitis is an emerging hope, while antibiotic resistance increases.

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“…Infections caused by P. aeruginosa are further complicated by the fact that multidrug resistant (MDR) variants of this species are on the rise worldwide34, which are difficult to treat by conventional therapy, the empirical but intensive topical treatment with commonly used ophthalmic antibiotics, such as the fluoroquinolones ciprofloxacin and ofloxacin, the aminoglycosides gentamicin and tobramycin, and the 1 st generation cephalosporin cefazolin, respectively56. Many risk factors, such as contact lens use, compromised ocular surface and preservative-free lubricant ointment use, can predispose patients to P. aeruginosa keratitis7. P. aeruginosa may also cause keratitis after keratoplasty, which often leads to a very poor outcome8.…”

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confidence: 99%

Chlorin e6 mediated photodynamic inactivation for multidrug resistant Pseudomonas aeruginosa keratitis in mice in vivo

Deichelbohrer

Tschernig

et al. 2017

Sci Rep

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Following corneal epithelium scratches, mouse corneas were infected with the multidrug resistant (MDR) P. aeruginosa strain PA54. 24 hours later, 0% (for control group), 0.01%, 0.05% or 0.1% Chlorin e6 (Ce6), a second generation photosensitizer derived from chlorophyll, was combined with red light, for photodynamic inactivation (PDI). 1 hour or 2 days later, entire mouse eyes were enucleated and homogenized for counting colony forming units (CFU) of P. aeruginosa. For comparison, 0.1% Ce6 mediated PDI was started at 12 hours post infection, and 0.005% methylene blue mediated PDI 24 hours post infection. Clinical scores of corneal manifestation were recorded daily. Compared to the control, CFU 1 hour after PDI started 24 hours post infection in the 0.01% Ce6 and 0.05% Ce6 groups were significantly lower (more than one log10 reduction), the CFU 2 days post PDI higher in the 0.1% Ce6 group, clinical score lower in the 0.1% Ce6 group at 1 day post PDI. These findings suggest that PDI with Ce6 and red light has a transient efficacy in killing MDR-PA in vivo, and repetitive PDI treatments are required to fully resolve the infection. Before its clinical application, the paradoxical bacterial regrowth post PDI has to be further studied.

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Multidrug-Resistant Pseudomonas aeruginosa Keratitis

Cited by 85 publications

References 15 publications

Retrospective report of antimicrobial susceptibility observed in bacterial pathogens isolated from ocular samples at Mount Sinai Hospital, 2010 to 2015

Retrospective report of antimicrobial susceptibility observed in bacterial pathogens isolated from ocular samples at Mount Sinai Hospital, 2010 to 2015

<p>Treatment-Resistant Bacterial Keratitis: Challenges and Solutions</p>

Chlorin e6 mediated photodynamic inactivation for multidrug resistant Pseudomonas aeruginosa keratitis in mice in vivo

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