April 2011
Volume 52, Issue 14
Free
ARVO Annual Meeting Abstract  |   April 2011
Ophthalmic Antibiotics and Antimicrobial Resistance: A Randomized, Controlled Study of Patients Undergoing Intravitreal Injections
Author Affiliations & Notes
  • Stephen J. Kim
    Ophthalmology, Vanderbilt University, Nashville, Tennessee
  • Hassanain S. Toma
    Ophthalmology, Vanderbilt University, Nashville, Tennessee
  • Footnotes
    Commercial Relationships  Stephen J. Kim, None; Hassanain S. Toma, None
  • Footnotes
    Support  Unrestricted grant from Research to Prevent Blindness
Investigative Ophthalmology & Visual Science April 2011, Vol.52, 5925. doi:
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      Stephen J. Kim, Hassanain S. Toma; Ophthalmic Antibiotics and Antimicrobial Resistance: A Randomized, Controlled Study of Patients Undergoing Intravitreal Injections. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5925.

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Abstract

Purpose: : To determine whether repeated exposure of ocular and nasopharyngeal flora to ophthalmic antibiotics promotes antimicrobial resistance in patients undergoing intravitreal injections for choroidal neovascularization (CNV).

Methods: : This was a prospective, randomized, controlled, clinical trial involving 48 eyes of 24 patients undergoing unilateral intravitreal injections for CNV. Subjects were randomly assigned to 1 of 4 ophthalmic antibiotics (azithromycin 1%, ofloxacin 0.3%, gatifloxacin 0.3%, moxifloxacin 0.5%) to be used after each injection in the treatment eye only. Bilateral conjunctival and unilateral nasopharyngeal cultures on the treatment side were taken at baseline and repeated at each subsequent visit for 1 year. All bacterial isolates were tested for antibiotic susceptibility to 16 different antibiotics using the Kirby-Bauer disc diffusion technique. Genomic analysis of bacteria strains was performed using pulse-field gel electrophoresis. Main outcome measures were changes in antibiotic susceptibility patterns of conjunctival and nasopharyngeal flora over time and emergence of resistant strains.

Results: : Eight subjects (33%) grew Staphylococcus aureus from the nasopharynx and one subject (13%) showed emergence of a resistant strain. Coagulase-negative staphylococci(CNS) cultured from eyes repeatedly exposed to fluoroquinolone antibiotics demonstrated significantly increased rates of resistance to 3rd and 4th generation fluoroquinolones compared to untreated eyes. Resistance to ofloxacin and levofloxacin was roughly 85% (P = 0.003) and resistance to gatifloxacin and moxifloxacin approached 67% (P = 0.009) and 77% (P < 0.001) respectively. In contrast, CNS isolated from eyes repeatedly exposed to azithromycin demonstrated significantly increased resistance (94%) to erythromycin and azithromycin when compared to control eyes (P = 0.009) and decreased resistance to 3rd (P < 0.03) and 4th (P < 0.001) generation fluoroquinolones when compared to eyes exposed to fluoroquinolones.

Conclusions: : Repeated exposure of ocular and nasopharyngeal flora to ophthalmic antibiotics selects for resistant strains.

Clinical Trial: : http://www.clinicaltrials.gov NCT00831961

Keywords: endophthalmitis • age-related macular degeneration • antibiotics/antifungals/antiparasitics 
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