Department of Microbiology, William Harvey Hospital, East Kent Hospitals University NHS Trust, Ashford, Kent, UK.
Ophthalmology. 2011 Nov;118(11):2161-5. doi: 10.1016/j.ophtha.2011.04.021. Epub 2011 Jul 18.
To determine the scale of antibiotic resistance in microbial keratitis in East Kent, United Kingdom.
Retrospective, observational case series.
Corneal scrapes over a 10-year period to December 2008 were identified using the local microbiology database, which provided culture results and antibiotic sensitivity-resistance profiles.
Isolate sensitivity to chloramphenicol, cefuroxime, gentamicin, and ciprofloxacin was determined by microdilution using the Microscan System (Siemens Diagnostics, Dearfield, IL).
Isolates were graded as sensitive, intermediate, or resistant to the tested antibiotics, with minimal inhibitory concentrations interpreted against breakpoints from the Clinical and Laboratory Standards Institute.
There were 476 scrapes from 440 patients (female, 57.6%; mean age, 53.5 years). All samples were cultured. Culture was positive in 163 samples (34.2%), growing 172 organisms. Bacterial keratitis accounted for 162 isolates (94.2%), of which 99 (61.1%) were gram-negative. There was a general increase in the number of gram-negative isolates with time (P=0.003). In vitro testing showed widespread gram-negative resistance to chloramphenicol (74.1%), with reducing sensitivity over the study period (P=0.004). There was 97.3% sensitivity to combination gentamicin and cefuroxime, and 94.4% sensitivity to ciprofloxacin. Ciprofloxacin resistance was found in 8 (17.0%) of 47 gram-positive isolates tested, with no trend toward increasing resistance.
This study has documented the highest levels of gram-negative keratitis in any open retrospective survey to date and highlights a trend of increasing gram-negative infection. We have demonstrated reducing chloramphenicol sensitivity, with high sensitivity to combination gentamicin and cefuroxime, as well as ciprofloxacin. Gram-positive fluoroquinolone resistance was higher than previously reported in the United Kingdom, but showed no evidence of increasing resistance. Second-generation fluoroquinolone monotherapy remains the recommended empirical treatment in microbial keratitis in the United Kingdom, and a change to fourth-generation compounds is not advised. Continued testing is essential to monitor for increasing resistance.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
确定英国东肯特微生物角膜炎的抗生素耐药程度。
回顾性观察性病例系列。
使用当地微生物学数据库确定了 10 年来（截至 2008 年 12 月）的角膜刮片，该数据库提供了培养结果和抗生素敏感性-耐药性图谱。
使用 Microscan 系统（Siemens Diagnostics，Dearfield，IL）通过微量稀释法测定氯霉素、头孢呋辛、庆大霉素和环丙沙星的分离敏感性。
根据临床和实验室标准协会的临界点，将分离物分为对测试抗生素敏感、中介或耐药的等级，最小抑菌浓度解释。
440 名患者中有 476 例刮片（女性占 57.6%；平均年龄为 53.5 岁）。所有样本均进行培养。163 例样本（34.2%）培养阳性，培养出 172 株菌。细菌性角膜炎占 162 株（94.2%），其中 99 株（61.1%）为革兰氏阴性菌。随着时间的推移，革兰氏阴性菌的数量普遍增加（P=0.003）。体外试验显示，革兰氏阴性菌对氯霉素的耐药性普遍较高（74.1%），且在研究期间敏感性降低（P=0.004）。组合庆大霉素和头孢呋辛的敏感性为 97.3%，环丙沙星的敏感性为 94.4%。在 47 株革兰氏阳性菌中，有 8 株（17.0%）对环丙沙星产生耐药性，但没有耐药性增加的趋势。
本研究记录了迄今为止任何开放性回顾性调查中革兰氏阴性角膜炎的最高水平，并强调了革兰氏阴性感染增加的趋势。我们已经证明，氯霉素敏感性降低，联合庆大霉素和头孢呋辛以及环丙沙星的敏感性较高。革兰氏阳性菌氟喹诺酮类药物耐药性高于英国以往报道，但没有证据表明耐药性增加。第二代氟喹诺酮类药物单药治疗仍被推荐用于英国微生物性角膜炎的经验性治疗，不建议使用第四代化合物。继续检测对于监测耐药性的增加至关重要。
作者没有与本文讨论的任何材料有关的专有或商业利益。
