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Trends in antibiotic resistance in bacterial keratitis isolates from South India
  1. Prajna Lalitha1,
  2. Geetha Manoharan1,
  3. Rajaram Karpagam1,
  4. Namperumalsamy V Prajna2,
  5. Muthiah Srinivasan2,
  6. Jeena Mascarenhas2,
  7. Manoranjan Das2,
  8. Travis C Porco3,4,5,
  9. Thomas M Lietman3,4,5,
  10. Vicky Cevallos3,
  11. Jeremy D Keenan3,4
  1. 1Department of Ocular Microbiology, Aravind Eye Care System, Madurai, Tamil Nadu, India
  2. 2Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, Tamil Nadu, India
  3. 3Francis I. Proctor Foundation, University of California, San Francisco, California, USA
  4. 4Department of Ophthalmology, University of California, San Francisco, California, USA
  5. 5Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
  1. Correspondence to Dr Jeremy Keenan, Francis I. Proctor Foundation, University of California 513 Parnassus Avenue, Med Sci S334B, San Francisco, CA 94143, USA; jeremy.keenan{at}


Aims To report trends in antibiotic resistance in cases of bacterial keratitis from a large eye hospital in South India.

Methods In this retrospective cross-sectional study, the microbiology laboratory records of patients with infectious keratitis diagnosed at an eye hospital in South India from 2002 to 2013 were reviewed to determine the proportion with antibiotic non-susceptibility.

Results 3685 bacterial isolates had susceptibility testing performed over the 12-year period. The two most common organisms with resistance were Streptococcus pneumoniae (n=1204) and Pseudomonas aeruginosa (n=894). Antibiotic non-susceptibility was generally uncommon for these two organisms and no significant trends were detected over the course of the study. In contrast, Staphylococcus aureus (N=211) isolates demonstrated a significant increase in fluoroquinolone non-susceptibility over the 12-year study period. This coincided with a significant increase in methicillin-resistant S. aureus (MRSA) during the study period, though the increase in fluoroquinolone resistance was likewise seen in methicillin-sensitive S. aureus (MSSA). For example, ofloxacin resistance in MSSA increased from 11.1% in 2002 to 66.7% in 2013 (p=0.002). No trends were apparent for the aminoglycosides, cefazolin or vancomycin, for which in vitro non-susceptibility generally appeared to be low.

Conclusion Resistance to antibiotics was generally stable for infectious keratitis isolates from a large eye hospital in South India, except for S. aureus, which experienced a significant increase in fluoroquinolone resistance from 2002 to 2013. Fluoroquinolone antibiotics currently have poor in vitro activity against both MRSA and MSSA in South India and are therefore not the ideal therapy for Staphylococcal corneal ulcers.

  • Cornea
  • Infection

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  • Contributors Designed study: PL, NVP, VC and JDK; collected data: PL, GM, RK, MS, JM and MD; analysed data: PL, TCP, TML and JDK; wrote manuscript: PL and JDK; edited manuscript: PL, GM, RK, NVP, MS, JM, MD, TCP, TML, VC and JDK.

  • Funding JDK was supported by career development awards from the National Eye Institute (K23 EY019071) and Research to Prevent Blindness.

  • Competing interests None declared.

  • Ethics approval Aravind Institutional Review Board.

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

  • Data sharing statement All data from the study are being published.

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