Korean J Ophthalmol.  2015 Feb;29(1):7-13. 10.3341/kjo.2015.29.1.7.

Risk Factors for Fluoroquinolone Resistance in Ocular Cultures

• Lee J
• Choi S

• KMID: 2360132
• DOI: http://doi.org/10.3341/kjo.2015.29.1.7

Abstract

PURPOSE
To identify the risk factors associated with fluoroquinolone resistance in patients undergoing cataract surgery.
METHODS
A total of 1,125 patients (1,125 eyes) who underwent cataract surgery at Veterans Health Service Medical Center from May 2011 to July 2012 were enrolled in this study. Conjunctival cultures were obtained from the patients on the day of surgery before instillation of any ophthalmic solutions. The medical records of patients with positive coagulase negative staphylococcus (CNS) and Staphylococcus aureus (S. aureus) cultures were reviewed to determine factors associated with fluoroquinolone resistance.
RESULTS
Of 734 CNS and S. aureus cultures, 175 (23.8%) were resistant to ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin. Use of fluoroquinolone within 3 months and within 1 year before surgery, topical antibiotic use other than fluoroquinolone, systemic antibiotic use, recent hospitalization, ocular surgery, intravitreal injection and use of eyedrops containing benzalkonium chloride were significantly more frequent in resistant isolates than in susceptible isolates. In multivariable logistic regression analysis, ocular surgery (odds ratio [OR], 8.457), recent hospitalization (OR, 6.646) and use of fluoroquinolone within 3 months before surgery (OR, 4.918) were significant predictors of fluoroquinolone resistance, along with intravitreal injection (OR, 2.976), systemic antibiotic use (OR, 2.665), use of eyedrops containing benzalkonium chloride (OR, 2.323), use of fluoroquinolone within 1 year before surgery (OR, 1.943) and topical antibiotic use other than fluoroquinolone (OR, 1.673).
CONCLUSIONS
Recent topical fluoroquinolone use, hospitalization and ocular surgery were significantly associated with fluoroquinolone resistance in CNS and S. aureus isolates from ocular culture.

Keyword

Benzalkonium compounds; Cataract extraction; Fluoroquinolones; Staphylococcus; Staphylococcus aureus

MeSH Terms

Aged
Anti-Bacterial Agents/*administration & dosage
*Drug Resistance, Bacterial
Eye Infections, Bacterial/drug therapy/*microbiology
Female
Fluoroquinolones/*administration & dosage
Humans
Male
Ophthalmic Solutions
Retrospective Studies
Risk Factors
Staphylococcal Infections/drug therapy/*microbiology
Staphylococcus aureus/drug effects/*isolation & purification
Anti-Bacterial Agents
Fluoroquinolones
Ophthalmic Solutions

Reference

1. Endophthalmitis Study Group. European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007; 33:978–988. PMID: 17531690.

2. Liesegang TJ. Use of antimicrobials to prevent postoperative infection in patients with cataracts. Curr Opin Ophthalmol. 2001; 12:68–74. PMID: 11150084.

3. Ou JI, Ta CN. Endophthalmitis prophylaxis. Ophthalmol Clin North Am. 2006; 19:449–456. PMID: 17067900.

4. Speaker MG, Menikoff JA. Prophylaxis of endophthalmitis with topical povidone-iodine. Ophthalmology. 1991; 98:1769–1775. PMID: 1775308.

5. Gordon-Bennett P, Karas A, Flanagan D, et al. A survey of measures used for the prevention of postoperative endophthalmitis after cataract surgery in the United Kingdom. Eye (Lond). 2008; 22:620–627. PMID: 17173008.

6. Chung JL, Seo KY, Yong DE, et al. Antibiotic susceptibility of conjunctival bacterial isolates from refractive surgery patients. Ophthalmology. 2009; 116:1067–1074. PMID: 19395038.

7. Asbell PA, Colby KA, Deng S, et al. Ocular TRUST: nationwide antimicrobial susceptibility patterns in ocular isolates. Am J Ophthalmol. 2008; 145:951–958. PMID: 18374299.

8. Chang DF, Braga-Mele R, Mamalis N, et al. Prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2007 ASCRS member survey. J Cataract Refract Surg. 2007; 33:1801–1805. PMID: 17889779.

9. Ta CN, Chang RT, Singh K, et al. Antibiotic resistance patterns of ocular bacterial flora: a prospective study of patients undergoing anterior segment surgery. Ophthalmology. 2003; 110:1946–1951. PMID: 14522770.

10. Park SH, Lim JA, Choi JS, et al. The resistance patterns of normal ocular bacterial flora to 4 fluoroquinolone antibiotics. Cornea. 2009; 28:68–72. PMID: 19092409.

11. Hori Y, Nakazawa T, Maeda N, et al. Susceptibility comparisons of normal preoperative conjunctival bacteria to fluoroquinolones. J Cataract Refract Surg. 2009; 35:475–479. PMID: 19251140.

12. Olson R, Donnenfeld E, Bucci FA Jr, et al. Methicillin resistance of Staphylococcus species among health care and nonhealth care workers undergoing cataract surgery. Clin Ophthalmol. 2010; 4:1505–1514. PMID: 21191448.

13. Alabiad CR, Miller D, Schiffman JC, Davis JL. Antimicrobial resistance profiles of ocular and nasal flora in patients undergoing intravitreal injections. Am J Ophthalmol. 2011; 152:999–1004.e2. PMID: 21861973.

14. Hsu HY, Lind JT, Tseng L, Miller D. Ocular flora and their antibiotic resistance patterns in the midwest: a prospective study of patients undergoing cataract surgery. Am J Ophthalmol. 2013; 155:36–44.e2. PMID: 22995030.

15. Haas W, Pillar CM, Torres M, et al. Monitoring antibiotic resistance in ocular microorganisms: results from the Antibiotic Resistance Monitoring in Ocular micRorganisms (ARMOR) 2009 surveillance study. Am J Ophthalmol. 2011; 152:567–574.e3. PMID: 21652021.

16. Hartman BJ, Tomasz A. Low-affinity penicillin-binding protein associated with beta-lactam resistance in Staphylococcus aureus. J Bacteriol. 1984; 158:513–516. PMID: 6563036.

17. Ito T, Katayama Y, Hiramatsu K. Cloning and nucleotide sequence determination of the entire mec DNA of pre-methicillin-resistant Staphylococcus aureus N315. Antimicrob Agents Chemother. 1999; 43:1449–1458. PMID: 10348769.

18. Barberis-Maino L, Berger-Bachi B, Weber H, et al. IS431, a staphylococcal insertion sequence-like element related to IS26 from Proteus vulgaris. Gene. 1987; 59:107–113. PMID: 2830163.

19. Rogues AM, Dumartin C, Amadeo B, et al. Relationship between rates of antimicrobial consumption and the incidence of antimicrobial resistance in Staphylococcus aureus and Pseudomonas aeruginosa isolates from 47 French hospitals. Infect Control Hosp Epidemiol. 2007; 28:1389–1395. PMID: 17994520.

20. Fintelmann RE, Hoskins EN, Lietman TM, et al. Topical fluoroquinolone use as a risk factor for in vitro fluoroquinolone resistance in ocular cultures. Arch Ophthalmol. 2011; 129:399–402. PMID: 21482865.

21. Chenia HY, Pillay B, Pillay D. Analysis of the mechanisms of fluoroquinolone resistance in urinary tract pathogens. J Antimicrob Chemother. 2006; 58:1274–1278. PMID: 17040923.

22. Juarez-Verdayes MA, Parra-Ortega B, Hernandez-Rodriguez C, et al. Identification and expression of nor efflux family genes in Staphylococcus epidermidis that act against gatifloxacin. Microb Pathog. 2012; 52:318–325. PMID: 22426170.

23. Lautenbach E, Fishman NO, Bilker WB, et al. Risk factors for fluoroquinolone resistance in nosocomial Escherichia coli and Klebsiella pneumoniae infections. Arch Intern Med. 2002; 162:2469–2477. PMID: 12437407.

24. Richard P, Delangle MH, Merrien D, et al. Fluoroquinolone use and fluoroquinolone resistance: is there an association. Clin Infect Dis. 1994; 19:54–59. PMID: 7948558.

25. Weber DJ, Rutala WA. Use of germicides in the home and the healthcare setting: is there a relationship between germicide use and antibiotic resistance? Infect Control Hosp Epidemiol. 2006; 27:1107–1119. PMID: 17006819.

26. Braoudaki M, Hilton AC. Adaptive resistance to biocides in Salmonella enterica and Escherichia coli O157 and cross-resistance to antimicrobial agents. J Clin Microbiol. 2004; 42:73–78. PMID: 14715734.

27. Mc Cay PH, Ocampo-Sosa AA, Fleming GT. Effect of subinhibitory concentrations of benzalkonium chloride on the competitiveness of Pseudomonas aeruginosa grown in continuous culture. Microbiology. 2010; 156:30–38. PMID: 19815578.

28. Buffet-Bataillon S, Tattevin P, Bonnaure-Mallet M, Jolivet-Gougeon A. Emergence of resistance to antibacterial agents: the role of quaternary ammonium compounds: a critical review. Int J Antimicrob Agents. 2012; 39:381–389. PMID: 22421329.

29. Vincent C, Boerlin P, Daignault D, et al. Food reservoir for Escherichia coli causing urinary tract infections. Emerg Infect Dis. 2010; 16:88–95. PMID: 20031048.