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Comparative activity of antimicrobials against Pseudomonas aeruginosa, Achromobacter xylosoxidans and Stenotrophomonas maltophilia keratitis isolates
  1. Oriel Spierer1,2,
  2. Darlene Miller1,
  3. Terrence P O’Brien1
  1. 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2Ophthalmology Department, Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
  1. Correspondence to Dr Oriel Spierer, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Coral Gables, FL 33146, USA; spierero{at}


Background/aims Achromobacter xylosoxidans and Stenotrophomonas maltophilia are emerging corneal pathogens, which are closely related to Pseudomonas aeruginosa, and have intrinsic resistance to many commonly available antimicrobials. The purpose of this study is to compare the in vitro efficacy of 12 antimicrobial agents against A. xylosoxidans, S. maltophilia and P. aeruginosa isolates recovered from clinical cases of keratitis.

Methods Recovered corneal isolates (n=58) were identified and extracted from the Microbiology Data Bank of the Bascom Palmer Eye Institute. Comparative in vitro minimum inhibitory concentration (MIC) susceptibility profiles for fluoroquinolones, aminoglycosides, beta-lactams and miscellaneous antibiotics were recorded using the E-test methodology. Pharmacodynamic indices (Cmax/MIC) were calculated.

Results A. xylosoxidans and S. maltophilia isolates were resistant to fluoroquinolones, aminoglycosides and ceftazidime (susceptibility rate ranging from 0% to 30%) while P. aeruginosa isolates showed a susceptibility rate of 95%–100% to these antimicrobials (P<0.00001 for the various antimicrobials). Exception was moxifloxacin with 80% of susceptibility rate to S. maltophilia isolates and Cmax/MIC=10.19. Ninety to 100% susceptibility rates were found for minocycline and trimethoprim/sulfamethoxazole for both A. xylosoxidans and S. maltophilia. One hundred per cent of the A. xylosoxidans isolates were susceptible to piperacillin/tazobactam and ticarcillin/clavulanic acid.

Conclusions There is a significant difference in susceptibility patterns between A. xylosoxidans, S. maltophilia and P. aeruginosa. Fluoroquinolones and aminoglycosides may not be effective against A. xylosoxidans and S. maltophilia. Antibiotics that are not commercially available as eye drops, such as beta-lactams for A. xylosoxidans, and trimethoprim/sulfamethoxazole and minocycline for both A. xylosoxidans and S. maltophilia should be considered.

  • cornea
  • contact lens
  • experimental laboratory
  • infection
  • microbiology

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  • Contributors Conception or design of the work: OS, DM, TPOB. Acquisition, analysis or interpretation of data: OS, DM, TPOB. Drafting of the work: OS. Revising the work critically: DM, TPOB. Final approval of the version published: OS, DM, TPOB.

  • Funding DM and TPOB were supported by NIH Center Core Grant P30EY014801, Research to Prevent Blindness unrestricted grant.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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