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John C. Moffitt; Systemic Antimicrobial Resistance Following Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1497.
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To assess the risk of developing systemic resistance to fluoroquinolones after administration levofloxacin for prophylaxis of endophthalmitis in open globe injuries during Operation Iraqi Freedom or Operation Enduring Freedom.
Retrospective, non-comparative, interventional study of 76 patients with combined open globe/perforating globe injuries and an amputation. The current US military medical policy is that all patients with suspected perforating injuries are treated with a seven day course of oral or intravenous levofloxacin in order to prevent endophthalmitis. Patients with both open globe injury status post repair and an amputation were identified and non-ocular cultures with antibiotic sensitivities recorded in the inpatient record. Patients with two sets of cultures with sensitivities 1-3 weeks from initial injury and also 2-6 weeks after that were compared to assess for any changes in resistance to ciprofloxacin or levofloxacin.
Thirteen patients met the requirements of combined open globe injury and appropriate culture with sensitivities. Of the thirteen patients, 14 (82%) were resistant to either ciprofloxacin or levofloxacin on the first culture. Of the remaining 3 (18%), all three developed resistance to ciprofloxacin and/or levofloxacin during the course of treatment. Resistance developed each in Staphylococcus epidermidis, Acinetobacter baumannii, and Klebsiella pneumoniae. The time between the first and the 2nd culture was eight days in two of the patients, and twenty-one days in the third.
Although a majority of patients with non-ocular bacterial infections that were already resistant to levofloxacin and ciprofloxacin, the three patients with bacterial infections that initially were sensitive to these antibiotics became resistant to them shortly after the completion of their antibiotic course. Additional data should be gathered over a larger scale and in a prospective manner to confirm this finding.
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