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E.W. Fitz, M. Shaw, R.B. Rosen, R.C. Gentile; Bacterial Sensitivity to Fourth Generation Fluoroquinolones in Infectious Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5278.
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Endophthalmitis remains one of the most devastating complications of ophthalmic surgery. Systemic administration of fourth generation fluoroquinolones is used as adjunctive therapy for infectious endophthalmitis. This study evaluates the antibiotic sensitivities of culture positive cases of endophthalmitis to gatifloxacin and moxifloxacin.
All positive vitreous cultures in the microbiology records at the New York Eye and Ear Infirmary since the onset of sensitivity testing for fourth generation fluoroquinolones were reviewed. These records spanned from April 2004 to September 2005. The endopthalmitis cases were classified as post–operative in patients that had undergone intraocular surgery within 6 weeks, as bleb–related in patients who had a filtering bleb, or as other in patients with trauma or a corneal abscess.
42 positive vitreous cultures from 38 patients were identified. Overall, Staph and Strep species were the most common pathogens; 76% of all isolates were gram positive. 79%(14/18) of the gram postitives tested were sensitive to gatifloxacin, 76% (19/25) to moxifloxacin. All of the gram negatives were sensitive to the fourth generation fluoroquinolones. The sensitivity rates for the different clinical situations are summarized in Table 1. Additionally, ten isolates were tested for sensitivity to both antibiotics: 6 isolates were sensitive to both, two were resistant to both, and two were resistant to gatifloxacin and intermediate to moxifloxacin.
Overall, approximately 80% of tested isolates were sensitive to either gatifloxacin or moxifloxacin. While this rate does not support use of systemic antibiotics as a monotherapy, the fourth generation quinolones may be beneficial in some clinical situations. Patients with bleb associated endopthalmitis may be most likely to benefit from adjunctive treatment given the typically poor outcomes in that disease with current therapy.
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