Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, North Carolina.
Vita Eye Clinic, Shelby, North Carolina.
Optom Vis Sci. 2021 Sep 1;98(9):1113-1121. doi: 10.1097/OPX.0000000000001768.
This study aimed to report on in vitro susceptibility patterns among corneal isolates collected in the Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study.
Each year, from 2009 to 2019, Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates cultured from patients with ocular infections at participating ARMOR sites were submitted to a central laboratory for species confirmation and antibiotic susceptibility testing. In this analysis of corneal isolates, odds ratios for concurrent resistance were based on sample proportions, one-way ANOVA was used to evaluate resistance by patient age, and Cochran-Armitage tests were used to examine changes in antibiotic resistance over time.
A total of 1499 corneal isolates were collected from 61 sites over the 11-year period. Overall, 34.5% (148 of 429) of S. aureus and 41.9% (220 of 525) of CoNS isolates were methicillin resistant and had higher odds ratios for concurrent resistance to azithromycin (17.44 and 5.67), ciprofloxacin (39.63 and 12.81), and tobramycin (19.56 and 19.95), respectively, relative to methicillin-susceptible isolates (P < .001, all); also, a high proportion of methicillin-resistant S. aureus (85.1%) and methicillin-resistant CoNS (81.8%) were multidrug resistant (at least three classes of antibiotics). Resistance among S. pneumoniae isolates was highest for azithromycin (33.1%), whereas P. aeruginosa and H. influenzae isolates demonstrated low resistance overall. Among staphylococci, antibiotic resistance differed by patient age (S. aureus: F = 6.46, P < .001; CoNS: F = 4.82, P < .001), and few small changes in resistance (≤3.60% per year), mostly decreases, were observed over time.
Although rates of in vitro antibiotic resistance among presumed keratitis isolates obtained in ARMOR seemed stable between 2009 and 2019, resistance among staphylococci and pneumococci remains high (and should be considered when treating keratitis).
本研究旨在报告 ARMOR 研究中收集的角膜分离株的体外药敏模式。
每年（2009 年至 2019 年），从参与 ARMOR 计划的各地点培养的眼部感染患者中分离出金黄色葡萄球菌、凝固酶阴性葡萄球菌（CoNS）、肺炎链球菌、铜绿假单胞菌和流感嗜血杆菌，然后将这些分离株送至中央实验室进行种属确认和药敏试验。在本项角膜分离株分析中，基于样本比例计算并发耐药的比值比，采用单向方差分析评估患者年龄的耐药情况，采用 Cochran-Armitage 检验检测抗生素耐药性随时间的变化。
在 11 年期间，从 61 个地点共采集了 1499 例角膜分离株。总体而言，34.5%（429 例中的 148 例）金黄色葡萄球菌和 41.9%（525 例中的 220 例）凝固酶阴性葡萄球菌分离株为耐甲氧西林株，且对阿奇霉素（17.44 和 5.67）、环丙沙星（39.63 和 12.81）和妥布霉素（19.56 和 19.95）的并发耐药比值比更高，均显著高于甲氧西林敏感株（均 P <.001）；此外，耐甲氧西林金黄色葡萄球菌（85.1%）和耐甲氧西林凝固酶阴性葡萄球菌（81.8%）的多重耐药比例较高（至少对 3 类抗生素耐药）。肺炎链球菌分离株对阿奇霉素的耐药率最高（33.1%），而铜绿假单胞菌和流感嗜血杆菌分离株的耐药率总体较低。在葡萄球菌中，不同患者年龄的抗生素耐药性存在差异（金黄色葡萄球菌：F = 6.46，P <.001；凝固酶阴性葡萄球菌：F = 4.82，P <.001），且随着时间的推移，耐药性变化（每年≤3.60%）很小，主要是减少。
尽管 ARMOR 研究中获得的疑似角膜炎分离株的体外抗生素耐药率在 2009 年至 2019 年期间似乎保持稳定，但葡萄球菌和肺炎链球菌的耐药率仍然很高（在治疗角膜炎时应予以考虑）。
