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Anne L Kunkler, Jesse Sengillo, Nicolas A. Yannuzzi, Darlene Miller, Harry W Flynn; Trends in Moxifloxacin Nonsusceptibility Among Coagulase-Negative Staphylococcus Isolates Causing Endophthalmitis, 2005-2020. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1361.
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Coagulase-negative Staphylococcus (CoNS) is the most common cause of acute-onset post-cataract surgery endophthalmitis. Moxifloxacin, a fourth-generation fluoroquinolone, is frequently used prophylactically to prevent infection after cataract surgery, either topically or intracamerally. The purpose of this study is to report the trends in moxifloxacin resistance of CoNS isolates causing endophthalmitis over a 16-year period.
This study was a retrospective, consecutive case series of vitreous CoNS isolates causing endophthalmitis between January 1, 2005, and December 31, 2020, at Bascom Palmer Eye Institute, Miami, Florida. The study was deemed exempt from IRB approval as no identifying patient information was collected. Microbiology testing was used to determine the sensitivities for moxifloxacin derived by the E-test and VITEK testing of isolates. Statistical analysis was performed using two-tailed Fisher’s exact test.
The moxifloxacin sensitives of 236 CoNS endophthalmitis isolates were reviewed. The nonsusceptibility rates of 68 CoNS isolates to moxifloxacin from 2005-2009 were 78.8% for methicillin-resistant Staphylococcus epidermidis (MRSE, 23/33), 41.4% for methicillin-sensitive Staphylococcus epidermidis (MSSE, 18/49), and 0% for other CoNS (0/6). The nonsusceptibility rates of 100 CoNS isolates to moxifloxacin from 2010-2015 were 84.6% for MRSE (44/52), 41.9% for MSSE (13/31), and 11.8% for other CoNS (2/17). The nonsusceptibility rates of 68 CoNS isolates to moxifloxacin from 2016-2020 were 50.0% for MRSE (10/20), 25.9% for MSSE (7/27), and 9.5% for other CoNS (2/21). The average nonsusceptibility of all CoNS isolates to moxifloxacin decreased from 59.0% (n=59/100) between 2010 and 2015 to 27.9% (n=19/68) between 2016 and 2020 (P <0.0001).
In the current study, the nonsusceptibility of CoNS to moxifloxacin has decreased over the last 5 years. Moxifloxacin resistance remains higher among MRSE isolates. Further investigation is needed to determine the clinical implications of these findings.
This is a 2021 ARVO Annual Meeting abstract.
Figure 1. Trends moxifloxacin nonsusceptibility among coagulase-negative Staphylococcus (CoNS) isolates causing endophthalmitis at the Bascom Palmer Eye Institute from 2005-2020. Data are divided by methicillin-resistantStaphylococcus epidermidis (MRSE), methicillin-sensitive Staphylococcus epidermidis (MSSE), and other CoNS.
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