Elsevier

Ophthalmology

Volume 106, Issue 1, 1 January 1999, Pages 80-85
Ophthalmology

In vitro susceptibility of bacterial keratitis pathogens to ciprofloxacin: Emerging resistance1,

https://doi.org/10.1016/S0161-6420(99)90008-8Get rights and content

Abstract

Objective

To examine in vitro susceptibility of bacterial keratitis pathogens to ciprofloxacin.

Design

Retrospective review.

Participants

The authors examined in vitro susceptibility of 1558 corneal isolates from 1303 patients with culture-proven bacterial keratitis seen at the LV Prasad Eye Institute in Hyderabad, India, during the 6-year period between March 1, 1991, and June 30, 1997.

Results

Of 1558 corneal isolates, 478 (30.7%) were not sensitive to ciprofloxacin. Among the isolates, 355 (32.5%) of the 1091 gram-positive cocci were not sensitive to ciprofloxacin, and 2 (10%) of the 20 gram-positive bacilli, 22 (13.3%) of the 165 gram-negative organisms, and 99 (35.1%) of the 282 Actinomycetes and related organisms were not sensitive to ciprofloxacin. Results from chi-square for trends analysis showed a trend of significantly increasing ciprofloxacin insensitivity in bacteria between 1992 and 1997 (P = 0.011).

Conclusion

This is the first report of significantly increasing ciprofloxacin insensitivity among corneal pathogens. Although the lowered cost and convenience of dispensing a single, commercially available antibiotic such as ciprofloxacin in the initial treatment of bacterial keratitis is desirable, the emergence of ciprofloxacin resistance is a significant finding in this series, and the clinician should proceed with caution in the initial empiric treatment of bacterial keratitis with ciprofloxacin.

Section snippets

Materials and methods

A retrospective review of a corneal ulcer database at the LV Prasad Eye Institute in Hyderabad, India, identified 1633 bacterial isolates from 1353 patients of culture-proven bacterial keratitis seen between March 1, 1991, and June 30, 1997.

Corneal scrapings were obtained using a sterile Bard Parker blade (#15) and were inoculated directly onto sheep blood agar, chocolate agar, thioglycolate, and brain heart infusion broth. These media were incubated at 37° C. Blood agar plates were incubated

Results

A total of 1558 bacterial isolates from 1303 patients were examined in this series. Gram-positive cocci accounted for 1091 (70%) of all bacterial isolates, gram-positive bacilli for 20 (1.3%), gram-negative organisms for 165 (10.6%), and Actinomycetes and related organisms for 282 (18.1%).

Of the 1558 isolates, 478 (30.7%) were not sensitive to ciprofloxacin (defined as either resistant [R] or intermediate sensitivity [I] by the Kirby-Bauer disc diffusion method). One or more

Discussion

Control of fulminant forms of bacterial keratitis requires potent antimicrobial agents. Until recent years, the concentration of commercially available antibiotics was inadequate to control such infections, necessitating the usage of fortified antibiotics. More recently, the use of ocular ciprofloxacin as monotherapy for bacterial keratitis has been discussed.1, 2, 3, 4, 5, 9, 10 Greater efficacy, low ocular toxicity, and dispensing convenience have made it a reasonable alternative to

References (18)

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    It has been demonstrated amply in the available randomized clinical trials that topical corticosteroids may not help in enhancing the rate of healing in cases of resolving keratitis.33,34 The argument against fluoroquinolone monotherapy is that although these agents are considered very effective and safe, resistance is bound to occur if they are used indiscriminately, and a few cases of moxifloxacin and gatifloxacin resistance already are emerging, especially in cases of infectious keratitis occurring after refractive surgery35–40; however, their judicious use in an appropriate setting may be justified. Furthermore, poor patients from rural areas often are uneducated and have poor access to tertiary care hospitals or pharmacy.

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Supported by Hyderabad Eye Research Foundation.

1

The authors have no proprietary interest in any aspect of this study.

2

Derek Y. Kunimoto is on a fellowship from Harvard Medical School, Department of Ophthalmology.

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