Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018

Abstract

IMPORTANCE Antibiotic resistance in ocular infections can affect treatment outcomes. Surveillance data on evolving antibacterial susceptibility patterns inform the treatment of such infections. OBJECTIVE To assess overall antibiotic resistance profiles and trends among bacterial isolates from ocular sources collected during 10 years. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of longitudinal data from the ongoing, nationwide, prospective, laboratory-based surveillance study, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study, included clinically relevant isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae cultured from patients with ocular infections at US centers from January 1, 2009, to December 31, 2018.MAIN OUTCOMES AND MEASURES Minimum inhibitory concentrations were determined for various combinations of antibiotics and species. Odds ratios (ORs) were determined for concurrent antibiotic resistance; analysis of variance and χ 2 tests were used to evaluate resistance rates by patient age and geographic region; Cochran-Armitage tests identified changing antibiotic susceptibility trends over time.RESULTS A total of 6091 isolates (2189 S aureus, 1765 CoNS, 590 S pneumoniae, 767 P aeruginosa, and 780 H influenzae) from 6091 patients were submitted by 88 sites. Overall, 765 S aureus (34.9%) and 871 CoNS (49.3%) isolates were methicillin resistant and more likely to be concurrently resistant to macrolides

Characterization of baseline polybacterial versus monobacterial infections in three randomized controlled bacterial conjunctivitis trials and microbial outcomes with besifloxacin ophthalmic suspension 0.6%

“…In conjunction with its in vitro potency, clinical microbiological eradication rates with besifloxacin were similarly robust against both polybacterial and monobacterial infections attesting to the efficacy of this chlorinated fluoroquinolone necessary for empiric use. While eradications rates with besifloxacin were also similar to those with moxifloxacin (evaluated in the active comparator study), the lower MICs of besifloxacin against methicillin-resistant staphylococci compared to that of moxifloxacin, reported here and elsewhere [25,27] bears consideration and may result in differential treatment outcomes in populations of subjects with either poly-or monobacterial conjunctivitis infections due to more resistant strains.…”

“…In conjunctivitis infections where a mixture of bacterial pathogens may be present, the broad-spectrum, potent activity of besifloxacin should be more than ample to eradicate these organisms. Besifloxacin is a fluoroquinolone with structural modifications intended to increase its inhibition of bacterial DNA gyrase and topoisomerase IV [ 65 ] and has been reported to be highly bactericidal with potent activity against a wide range of Gram-positive and Gram-negative organisms, including drug-resistant pathogens [ 25 – 28 , 30 , 66 ]. In this post-hoc analysis, the in vitro activity of besifloxacin was similar to or exceeded that of comparator fluoroquinolone agents against most isolates regardless of infection type.…”

“…the treatment of bacterial conjunctivitis. A chlorinated fluoroquinolone, besifloxacin has potent activity against both Gram-positive and Gram-negative bacteria, including multidrugresistant strains [25][26][27], and is rapidly bactericidal [28][29][30]. Besifloxacin is formulated with DuraSite 1 (Sun Pharma Global FZE), which helps increase retention on the ocular surface, and has demonstrated effectiveness in several bacterial conjunctivitis clinical trials [31][32][33][34][35][36].…”

Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance

“…(15) 2018 Peng et al [ 26 ] 1996–2015 San Francisco, US 2203 – – 23.7 100 0 0 S. aureus (20.1); S. viridans (13.2); Pseudomonas (10.9) 2019 Kowalski et al [ 27 ] c 1993–2018 Pittsburgh, US 1387 – – 100 72.1 6.7 5.2 S. aureus (20.3); Pseudomonas (18.0); Streptococci . (8.5) 2020 Asbell et al [ 28 ] d 2009–2018 US 6091 – 46.8 100 100 0 0 S. aureus (35.9); CoNS (29); H. influenza (13) South America 2011 Cariello et al [ 29 ] 1975–2007 Brazil 6804 42.1 ± 21.4 40 48.6 78.9 11.0 3.6 CoNS (41.2); S. aureus (33.1); Pseudomonas (18.5) 2013 Marujo et al [ 30 ] 2005–2009 Brazil 2049 45 45 71.6 80.3 7.0 6 Staphylococci (52.5); Corynebacterium (14.3); Streptococci (10.1) 2015 Hernandez-Camarena et al [ 31 ] 2002–2011 Mexico 1638 45 51.4 38.0 88 12 0 ...…”

Hybrid Derivative of Cathelicidin and Human Beta Defensin-2 Against Gram-Positive Bacteria: A Novel Approach for the Treatment of Bacterial Keratitis

“…resistant to ≥ 3 antibiotic classes). 4 More compellingly, the increased level of AMR of the causative microorganism has been shown to negatively influence the corneal healing time and final visual outcome. 14, vital roles in the innate immune system.…”