Antibiotic Susceptibility of Conjunctival Bacterial Isolates from Refractive Surgery Patients

Jae Lim Chung, KyoungYul Seo, DongEun Yong, Francis S. Mah, Tae-im Kim, Eungkweon Kim, Jin Kook Kim

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Abstract

Purpose: To determine the in vitro antibiotic susceptibility patterns of conjunctival bacterial flora isolated before surgery from patients undergoing refractive surgery. Design: In vitro laboratory investigation. Participants: One hundred five eyes from 105 patients scheduled for refractive surgery at Balgensesang Ophthalmology Clinic between September 2005 and January 2006 were studied. Among 105 patients, 71 (67.6%) underwent LASIK using a femtosecond laser, 24 (22.9%) underwent LASIK using an automated microkeratome, 8 (7.6%) underwent LASEK, and 2 (1.9%) patients underwent phakic intraocular lens implantation. Methods: Preoperative conjunctival swab samples were inoculated directly in culture media at the bedside before topical anesthetic or antibiotic application. Blood agar, chocolate agar, thioglycolate broth, Sabouraud dextrose agar, and Ogawa media were used for bacterial, fungal, and mycobacterial cultures. Main Outcome Measures: Minimum inhibitory concentrations (MICs) of ofloxacin (OFX), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX), gemifloxacin (GEM), and other commonly used antibiotics were determined using an E test. Results: From 105 patients, 73 (85%) coagulase-negative staphylococci (CNS), 2 (2.3%) Staphylococcus aureus, 1 (1.2%) Streptococcus pneumoniae, and 5 (4.8%) gram-negative bacilli were isolated. No fungi or mycobacteria were isolated. The MIC that would inhibit the growth of 90% of the tested bacterial isolates (MIC 90 ) of OFX, LEV, GAT, MOX, and GEM for methicillin-susceptible CNS (n = 46) were 0.5 μg/ml, 0.19 μg/ml, 0.094 μg/ml, 0.047 μg/ml, and 0.023 μg/ml, respectively. The MIC 90 values for methicillin-resistant CNS (n = 27) were 32 μg/ml, 4 μg/ml, 1 μg/ml, 0.5 μg/ml, and 0.25 μg/ml, respectively (P<0.001). Conclusions: The most effective against conjunctival bacteria isolated from refractive surgery patients were GEM, MOX, and GAT; however, resistance to earlier-generation fluoroquinolones (OFX and LEV) is increasing among methicillin-resistant CNS. It may be a therapeutic option to use newer fluoroquinolones in patients undergoing refractive eye surgery to reduce such infections as methicillin-resistant CNS. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Original languageEnglish
Pages (from-to)1067-1074
Number of pages8
JournalOphthalmology
Volume116
Issue number6
DOIs
Publication statusPublished - 2009 Jun 1

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Refractive Surgical Procedures
Coagulase
Staphylococcus
Anti-Bacterial Agents
Microbial Sensitivity Tests
Levofloxacin
Methicillin Resistance
Ofloxacin
Agar
Laser In Situ Keratomileusis
Fluoroquinolones
Laser-Assisted Subepithelial Keratectomy
Phakic Intraocular Lenses
Thioglycolates
Intraocular Lens Implantation
Methicillin
Disclosure
Ophthalmology
Mycobacterium
Streptococcus pneumoniae

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

@article{da81434a78f9432e877e29bec945e680,
title = "Antibiotic Susceptibility of Conjunctival Bacterial Isolates from Refractive Surgery Patients",
abstract = "Purpose: To determine the in vitro antibiotic susceptibility patterns of conjunctival bacterial flora isolated before surgery from patients undergoing refractive surgery. Design: In vitro laboratory investigation. Participants: One hundred five eyes from 105 patients scheduled for refractive surgery at Balgensesang Ophthalmology Clinic between September 2005 and January 2006 were studied. Among 105 patients, 71 (67.6{\%}) underwent LASIK using a femtosecond laser, 24 (22.9{\%}) underwent LASIK using an automated microkeratome, 8 (7.6{\%}) underwent LASEK, and 2 (1.9{\%}) patients underwent phakic intraocular lens implantation. Methods: Preoperative conjunctival swab samples were inoculated directly in culture media at the bedside before topical anesthetic or antibiotic application. Blood agar, chocolate agar, thioglycolate broth, Sabouraud dextrose agar, and Ogawa media were used for bacterial, fungal, and mycobacterial cultures. Main Outcome Measures: Minimum inhibitory concentrations (MICs) of ofloxacin (OFX), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX), gemifloxacin (GEM), and other commonly used antibiotics were determined using an E test. Results: From 105 patients, 73 (85{\%}) coagulase-negative staphylococci (CNS), 2 (2.3{\%}) Staphylococcus aureus, 1 (1.2{\%}) Streptococcus pneumoniae, and 5 (4.8{\%}) gram-negative bacilli were isolated. No fungi or mycobacteria were isolated. The MIC that would inhibit the growth of 90{\%} of the tested bacterial isolates (MIC 90 ) of OFX, LEV, GAT, MOX, and GEM for methicillin-susceptible CNS (n = 46) were 0.5 μg/ml, 0.19 μg/ml, 0.094 μg/ml, 0.047 μg/ml, and 0.023 μg/ml, respectively. The MIC 90 values for methicillin-resistant CNS (n = 27) were 32 μg/ml, 4 μg/ml, 1 μg/ml, 0.5 μg/ml, and 0.25 μg/ml, respectively (P<0.001). Conclusions: The most effective against conjunctival bacteria isolated from refractive surgery patients were GEM, MOX, and GAT; however, resistance to earlier-generation fluoroquinolones (OFX and LEV) is increasing among methicillin-resistant CNS. It may be a therapeutic option to use newer fluoroquinolones in patients undergoing refractive eye surgery to reduce such infections as methicillin-resistant CNS. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.",
author = "Chung, {Jae Lim} and KyoungYul Seo and DongEun Yong and Mah, {Francis S.} and Tae-im Kim and Eungkweon Kim and Kim, {Jin Kook}",
year = "2009",
month = "6",
day = "1",
doi = "10.1016/j.ophtha.2008.12.064",
language = "English",
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Antibiotic Susceptibility of Conjunctival Bacterial Isolates from Refractive Surgery Patients. / Chung, Jae Lim; Seo, KyoungYul; Yong, DongEun; Mah, Francis S.; Kim, Tae-im; Kim, Eungkweon; Kim, Jin Kook.

In: Ophthalmology, Vol. 116, No. 6, 01.06.2009, p. 1067-1074.

Research output: Contribution to journalArticle

TY - JOUR

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AU - Chung, Jae Lim

AU - Seo, KyoungYul

AU - Yong, DongEun

AU - Mah, Francis S.

AU - Kim, Tae-im

AU - Kim, Eungkweon

AU - Kim, Jin Kook

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Y1 - 2009/6/1

N2 - Purpose: To determine the in vitro antibiotic susceptibility patterns of conjunctival bacterial flora isolated before surgery from patients undergoing refractive surgery. Design: In vitro laboratory investigation. Participants: One hundred five eyes from 105 patients scheduled for refractive surgery at Balgensesang Ophthalmology Clinic between September 2005 and January 2006 were studied. Among 105 patients, 71 (67.6%) underwent LASIK using a femtosecond laser, 24 (22.9%) underwent LASIK using an automated microkeratome, 8 (7.6%) underwent LASEK, and 2 (1.9%) patients underwent phakic intraocular lens implantation. Methods: Preoperative conjunctival swab samples were inoculated directly in culture media at the bedside before topical anesthetic or antibiotic application. Blood agar, chocolate agar, thioglycolate broth, Sabouraud dextrose agar, and Ogawa media were used for bacterial, fungal, and mycobacterial cultures. Main Outcome Measures: Minimum inhibitory concentrations (MICs) of ofloxacin (OFX), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX), gemifloxacin (GEM), and other commonly used antibiotics were determined using an E test. Results: From 105 patients, 73 (85%) coagulase-negative staphylococci (CNS), 2 (2.3%) Staphylococcus aureus, 1 (1.2%) Streptococcus pneumoniae, and 5 (4.8%) gram-negative bacilli were isolated. No fungi or mycobacteria were isolated. The MIC that would inhibit the growth of 90% of the tested bacterial isolates (MIC 90 ) of OFX, LEV, GAT, MOX, and GEM for methicillin-susceptible CNS (n = 46) were 0.5 μg/ml, 0.19 μg/ml, 0.094 μg/ml, 0.047 μg/ml, and 0.023 μg/ml, respectively. The MIC 90 values for methicillin-resistant CNS (n = 27) were 32 μg/ml, 4 μg/ml, 1 μg/ml, 0.5 μg/ml, and 0.25 μg/ml, respectively (P<0.001). Conclusions: The most effective against conjunctival bacteria isolated from refractive surgery patients were GEM, MOX, and GAT; however, resistance to earlier-generation fluoroquinolones (OFX and LEV) is increasing among methicillin-resistant CNS. It may be a therapeutic option to use newer fluoroquinolones in patients undergoing refractive eye surgery to reduce such infections as methicillin-resistant CNS. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

AB - Purpose: To determine the in vitro antibiotic susceptibility patterns of conjunctival bacterial flora isolated before surgery from patients undergoing refractive surgery. Design: In vitro laboratory investigation. Participants: One hundred five eyes from 105 patients scheduled for refractive surgery at Balgensesang Ophthalmology Clinic between September 2005 and January 2006 were studied. Among 105 patients, 71 (67.6%) underwent LASIK using a femtosecond laser, 24 (22.9%) underwent LASIK using an automated microkeratome, 8 (7.6%) underwent LASEK, and 2 (1.9%) patients underwent phakic intraocular lens implantation. Methods: Preoperative conjunctival swab samples were inoculated directly in culture media at the bedside before topical anesthetic or antibiotic application. Blood agar, chocolate agar, thioglycolate broth, Sabouraud dextrose agar, and Ogawa media were used for bacterial, fungal, and mycobacterial cultures. Main Outcome Measures: Minimum inhibitory concentrations (MICs) of ofloxacin (OFX), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX), gemifloxacin (GEM), and other commonly used antibiotics were determined using an E test. Results: From 105 patients, 73 (85%) coagulase-negative staphylococci (CNS), 2 (2.3%) Staphylococcus aureus, 1 (1.2%) Streptococcus pneumoniae, and 5 (4.8%) gram-negative bacilli were isolated. No fungi or mycobacteria were isolated. The MIC that would inhibit the growth of 90% of the tested bacterial isolates (MIC 90 ) of OFX, LEV, GAT, MOX, and GEM for methicillin-susceptible CNS (n = 46) were 0.5 μg/ml, 0.19 μg/ml, 0.094 μg/ml, 0.047 μg/ml, and 0.023 μg/ml, respectively. The MIC 90 values for methicillin-resistant CNS (n = 27) were 32 μg/ml, 4 μg/ml, 1 μg/ml, 0.5 μg/ml, and 0.25 μg/ml, respectively (P<0.001). Conclusions: The most effective against conjunctival bacteria isolated from refractive surgery patients were GEM, MOX, and GAT; however, resistance to earlier-generation fluoroquinolones (OFX and LEV) is increasing among methicillin-resistant CNS. It may be a therapeutic option to use newer fluoroquinolones in patients undergoing refractive eye surgery to reduce such infections as methicillin-resistant CNS. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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