Transcript Methicillin Resistant Staphylococcus aureus prevalence in

Ocular infections due to
pseudomonas resistant to fourthgeneration fluoroquinolones
The authors have no financial interest in the subject matter of this poster
Heloisa Nascimento, Aline Silveira Moriyama, Denise de Freitas, Ana Luisa Höfling-Lima
Departmet of Ophthalmology
Federal University of São Paulo
São Paulo, Brazil
Background
Pseudomonas aeruginosa
•
•
•
•
•
Gram negative bacillus
Important keratitis agent
Traditionally associated to CL wear
Aggressive infection
P. aeruginosa
– Increasing rates of fluoroquinolone resistance
– More virulent than fluoroquinolone sensible strains
– More prevalent among non-CL weares Pseudomonas
infections
Purpose
To report the prevalence of fourth-generation
fluoroquinolones resistance among Pseudomonas
aeruginosa isolates from patients with keratitis at the
Laboratory of Ocular Microbiology of the Federal
University of São Paulo.
Methods
• Retrospective review of data from patients with keratitis who had
cornea specimen sent to microbiological analysis at the Laboratory
of Ocular Microbiology of the Federal University of São Paulo
(UNIFESP) during the seven years period between July, 2002 and
July, 2009
• Patients whose exam confirmed P. aeruginosa were included in
the study. Cases with identification of other Pseudomonas species
or Pseudomonas spp were not included
• P. aeuruginosa isolates with resistance to any of the tested fourthgeneration fluoroquinolone were selected and evaluated
regarding antimicrobial susceptibility profile
Results
Rates of culture proven P. aeruginosa keratitis per year and proportion of
cases with resistance to fourth-generation fluoroquinolones
Year
P. aeruginosa keratitis
P. aeruginosa fourth-generation
fluoroquinolone resistant keratits
2002
6
0
2003
28
0
2004
10
0
2005
12
1 (8,33%)
2006
8
1 (12,5%)
2007
11
1 (9,09%)
2008
12
1 (8,33%)
2009
13
6 (46,15%)
Overall
100
10 (10%)
Results
Profile and associated ocular and systemic conditions of the P.
aeruginosa isolates resistant to fourth-generation fluoroquinolones
Case #
Year
Gender
Age
Associated conditions
1
2005
M
2
2006
F
67
Carcinomatosis
3
2007
F
63
Sepsis - ICU
4
2008
M
5
2009
F
40
Respiratory Insufficiency - ICU
6
2009
M
37
Chemical ocular injury
7
2009
M
47
Previous PPV
8
2009
M
9
2009
M
10
2009
F
Contact Lens Wear
Contact Lens Wear
Corneal Ulcer
39
Corneal FB removal and TCL+ofloxacyn use
Corneal ulcer
Results
Antimicrobial susceptibility profile of the P. aeruginosa isolates resistant to
fourth-generation fluoroquinolones
#
Ciprofloxacin
Moxifloxacin
Gatifloxacin
Amikacin
Ofloxacin
Gentamicin
Polymixin
1
R
R
R
R
R
R
R
2
R
R
R
S
R
R
S
3
R
R
R
R
R
R
S
4
R
R
R
R
R
R
R
5
R
R
R
R
R
R
S
6
R
R
R
R
R
R
S
7
R
R
R
S
S
R
S
8
S
R
S
S
R
S
S
9
S
R
S
S
R
R
S
10
S
R
R
S
R
S
S
Total resistance
cases
7 (70%)
10 (100%)
8 (80%)
5 (50%)
9 (90%)
8 (80%)
2 (20%)
Conclusion
• It is the first time Pseudomonas aeruginosa resistance to
fourth-generation fluoroquinolone is noted in Brazil
• Increasing rates of fourth-generation fluoroquinolones
resistance in Brazil after moxifloxacin and gatifloxacin eye
drops became commercially available (2004)
• Pick prevalence of 46,15% P. aeruginosa strains resistant to
fourth-generation fluoroquinolones among P. aeruginosa
keratitis is alarming, with practical implications on empiric
treatment to Pseudomonas keratits suspects
• Continued microbiological surveillance is essential
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