Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America.
Ocular Microbiology Laboratory, Bascom Palmer Eye Institute, Anne Bates Leach Eye Center, University of Miami Miller School of Medicine, McKnight Research Pavilions, Miami, FL, United States of America.
PLoS One. 2024 Nov 22;19(11):e0314366. doi: 10.1371/journal.pone.0314366. eCollection 2024.
To assess the in vitro efficacy of common antimicrobial agents used empirically for methicillin- resistant and sensitive Staphylococcus aureus (MRSA and MSSA) infections of the lacrimal system.
A retrospective review of culture-proven S. aureus isolates retrieved from lacrimal system samples collected between January 2013-December 2022 was performed. Microbiologic characteristics such as in vitro susceptibility as well as clinical characteristics including history of recent ocular surgery, presence of lacrimal biomaterial implant, anti-microbial regimen, and treatments outcome were collected.
One hundred and sixteen S. aureus isolates (patients = 116) were identified. Thirty-one (27.4%) and 22 (19.5%) patients had recent ocular procedure and lacrimal intubation, respectively. Fifty (44.2%) patients received a combination of oral and topical antibiotics as first line of treatment. The most common empirically utilized antibiotics were β-lactams (38.9%) and polymyxin B/ trimethoprim (31.0%). The antibiotic regimen was changed at least once in 20.5% of patients due to ineffectiveness. Of the patients with positive cultures from the lacrimal excretory apparatus, 37.3% underwent surgery as part of the treatment approach. Of all isolates identified 44.8% were MRSA. Among the fluoroquinolones, the resistance rate was 38.8% for ciprofloxacin and 30.4% for moxifloxacin, with significantly higher resistance rates in MRSA (P-value <0.0001). The resistance rates for trimethoprim/sulfamethoxazole (TMP/SXT) and gentamicin were 8.6% and 3.4%, retrospectively.
There is low in vitro efficacy of commonly used antimicrobials such as β-lactams and fluoroquinolones in our study population; thus, we recommend opting for trimethoprim/sulfamethoxazole and gentamicin for systemic and topical single-agent treatments.
评估常用于治疗耐甲氧西林金黄色葡萄球菌（MRSA 和 MSSA）和敏感金黄色葡萄球菌（MRSA 和 MSSA）眼部感染的经验性抗菌药物的体外疗效。
对 2013 年 1 月至 2022 年 12 月期间从泪液系统样本中分离出的培养证实的金黄色葡萄球菌分离株进行了回顾性研究。收集了微生物学特征，如体外药敏性以及临床特征，包括近期眼部手术史、是否存在泪道生物材料植入物、抗菌药物治疗方案和治疗结果。
共鉴定出 116 株金黄色葡萄球菌分离株（患者=116）。31 例（27.4%）和 22 例（19.5%）患者分别有近期眼部手术和泪管插管史。50 例（44.2%）患者接受口服和局部抗生素联合治疗作为一线治疗。经验性使用最常见的抗生素是β-内酰胺类（38.9%）和多粘菌素 B/甲氧苄啶（31.0%）。由于无效，20.5%的患者至少更换过一次抗生素治疗方案。在有泪液分泌物培养阳性的患者中，37.3%的患者接受了手术治疗。在所有鉴定的分离株中，44.8%为 MRSA。氟喹诺酮类药物中，环丙沙星和莫西沙星的耐药率分别为 38.8%和 30.4%，MRSA 的耐药率明显更高（P 值<0.0001）。回顾性分析显示，甲氧苄啶/磺胺甲恶唑（TMP/SXT）和庆大霉素的耐药率分别为 8.6%和 3.4%。
在我们的研究人群中，常用抗菌药物如β-内酰胺类和氟喹诺酮类药物的体外疗效较低；因此，我们建议选择甲氧苄啶/磺胺甲恶唑和庆大霉素进行全身和局部单一药物治疗。
