Emerging fluoroquinolone resistance in bacterial keratitis - A 5-year review
Emerging fluoroquinolone resistance in bacterial keratitis - A 5-year review
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DOI：
10.1016/s0161-6420(99)00716-2
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发表时间：
1999-07-01
期刊：
影响因子：
13.7
通讯作者：
Gordon, YJ
中科院分区：
文献类型：
--
作者：
Goldstein, MH;Kowalski, RP;Gordon, YJ
目的：确定细菌性角膜炎患者对氟喹诺酮类药物的耐药模式。 设计：回顾性观察病例系列，参与者：对 1993 年 1 月至 1997 年 12 月在匹兹堡眼耳研究所 Charles T. Campbell 眼科微生物实验室就诊的所有细菌性角膜炎病例进行回顾性分析，对 825 例细菌性角膜炎病例中总共 1053 例眼部分离株进行了回顾性分析。确定，主要结果指标：采用Kirby-Bauer纸片扩散法测定眼部分离菌对环丙沙星和氧氟沙星的体外实验室药敏试验，并采用国家临床实验室标准委员会血清标准品判读。结果：每年细菌性角膜炎病例数从1993年的284例下降到1997年的75例，革兰氏阳性菌与革兰氏阴性菌的比例从1993年的81.8%:18.2%增加到1997年的51.4%:48.6%(卡方,66.00;自由度,4;P<0.000001),金黄色葡萄球菌对环丙沙星的耐药性逐年显着增加,从1993年的5.8%增加到1997年的35.0% （卡方，19.80；自由度，4；P < 0.0001），氧氟沙星同期从 4.7% 升至 35.0%（卡方，21.32；自由度，4；P < 0.001）。链球菌属和凝固酶阴性葡萄球菌属对两种氟喹诺酮类药物均表现出显着的耐药性，但在研究期间耐药性没有变化。革兰氏阴性菌对氟喹诺酮类药物表现出良好的敏感性。结论：这项体外研究表明，从 1993 年到 1997 年，金黄色葡萄球菌对氟喹诺酮类药物的耐药性显着增加。此外，链球菌和链球菌的氟喹诺酮类药物覆盖率存在差距。凝固酶阴性葡萄球菌引起了对使用单一疗法治疗细菌性角膜炎的担忧。与预期相反，革兰氏阳性菌向革兰氏阴性菌的分布发生了变化，鉴定出的革兰氏阳性菌数量减少，而革兰氏阴性菌株的数量保持稳定。
Objective: To identify resistance patterns to the fluoroquinolones for patients with bacterial keratitis.Design: Retrospective observational case series,Participants: All cases of bacterial keratitis presenting to the Charles T. Campbell Ophthalmic Microbiology Laboratory at the Eye and Ear Institute of Pittsburgh from January 1993 to December 1997 were reviewed, A total of 1053 ocular isolates from 825 cases of bacterial keratitis were identified,Main Outcome Measures: In vitro laboratory susceptibility testing of ocular isolates to ciprofloxacin and ofloxacin was determined by the Kirby-Bauer disk diffusion method and interpreted using the National Committee for Clinical Laboratory Standards serum standards.Results: The number of cases of bacterial keratitis per year decreased from 284 in 1993 to 75 in 1997, The ratio of gram-positive to gram-negative organisms changed from 81.8%:18.2% in 1993 to 51.4%:48.6% in 1997 (chi-square, 66.00; degrees of freedom, 4; P < 0.000001), Resistance of Staphylococcus aureus to ciprofloxacin significantly increased annually from 5.8% in 1993 to 35.0% in 1997 (chi-square, 19.80; degrees of freedom, 4; P < 0.0001) and for ofloxacin from 4.7% to 35.0% over the same period (chi-square, 21.32; degrees of freedom, 4; P < 0.001). Streptococcus species and coagulase-negative Staphylococcus species showed significant resistance to both fluoroquinolones but no change in resistance over the study period, The gram-negative organisms showed good susceptibility to the fluoroquinolones.Conclusions: This in vitro study shows a significant increased resistance of S. aureus to the fluoroquinolones from 1993 to 1997, In addition, gaps in fluoroquinolone coverage for Streptococcus and coagulase-negative Staphylococcus species raise concern for the use of monotherapy in treating bacterial keratitis, Contrary to what might be expected, the distribution of gram-positive to gram-negative organisms has shifted, with a decrease in the number of gram-positive organisms identified, while the number of gram-negative isolates has remained stable.