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Daniela Diaz-Robles, Blanca B. Figueroa-Magana, Tania N. Adabache-Guel; In Vivo Antimicrobial Susceptibility And Shifting Trends In Antibiotic Resistance Of Acute Bacterial Endophthalmitis Isolates In A Training Hospital In Mexico. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2970.
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To identify the microbial profile, antibiotic susceptibility and resistance patterns in a teaching hospital in Mexico that commonly manages acute bacterial endophthalmitis
Retrospective, observational and transversal study. We reviewed hospital and microbiology records of all patients diagnosed with acute bacterial endophthalmitis from january 2006 to february 2010 and the following variables were captured: age, sex, presumed cause of endophthalmitis, infectious agent and antimicrobial susceptibility
There were a total of 50 cases of acute bacterial endophthalmitis, 30 male (60%) and 20 female (20%) with a mean age of 50.98 years (3-86 years). The prevalent presumed cause of endophthalmitis was penetrating trauma with the 30% of the cases, followed by vitrectomy with 14% and intravitreal injections and phacoemulsification surgery with 8% each. The principal bacterial agent isolated was Staphylococcus epidermidis with 38.2% of the cases, followed by Pseudomonas aeruginosa and Streptococcus pneumoniae with 11.8% each and 13 other pathogens with one case each. There was a decrease of the incidence of S. epidermidis isolates (61.5% of isolates in 2006 vs 33% in 2009, p= 0.018) with no other trend observed. 24% of all pathogens were resistant to vancomycin, 18% to ceftazidime and 14% to ciprofloxacin and ofloxacin, only 6% was resistant to fourth-generation fluoroquinolones (moxifloxacin, gatifloxacin). When analyzing resistance according to pathogen, 10.5% of all S. epidermidis were vancomycin-resistant and 15.8% were ceftazidime-resistant, 60% of such cases observed in 2009 (p=0.032); 100% of P. aeruginosa were vancomycin-resistant and 25% ceftazidime-resistant with no trend observed and with S.pneumoniae no antimicrobial resistance to vancomycin or ceftazidime was observed, only to Amikacin (25% of all cases).
Although there is a decrease of incidence of S. epidermidis as a causative agent it still is the principal bacterial agent recovered from endophthalmitis isolates, seconded by P. aeruginosa. Both of these agents presented an increased and marked resistance to the most commonly used intravitreal antibiotics, becoming an important therapeutic challenge that remarks the importance of finding an alternative therapy for such pathology.
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