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JAMA Ophthalmol. 2013 Mar;131(3):310-3. doi: 10.1001/jamaophthalmol.2013.1718.

Fluoroquinolone treatment and susceptibility of isolates from bacterial keratitis.

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  • 1Francis I. Proctor Foundation, University of California, San Francisco, CA 94143-0412, USA.

Abstract

OBJECTIVE:

To analyze the relationship between fluoroquinolone use at presentation and minimum inhibitory concentration in bacterial keratitis.

METHODS:

The Steroids for Corneal Ulcers Trial was a randomized, double-masked, placebo-controlled trial assessing the effect of adjunctive topical corticosteroid treatment on outcomes in bacterial keratitis. After presentation, all patients were treated with moxifloxacin hydrochloride, 0.5%. We compare antibiotic use at presentation with minimum inhibitory concentration against moxifloxacin for all isolates. Separate analyses accounted for organism species and fluoroquinolone generation.

RESULTS:

Topical fluoroquinolone use at presentation was reported in 92 of 480 cases (19.2%). Causative organisms in the 480 cases included Streptococcus pneumoniae (247 cases [51.5%]), Pseudomonas aeruginosa (109 cases [22.7%]), and Nocardia species (55 cases [11.5%]). Isolates from patients who reported fluoroquinolone use at presentation had a 2.01-fold-higher minimum inhibitory concentration (95% CI, 1.39-fold to 2.91-fold; P < .001). Fourth-generation fluoroquinolones were associated with a 3.48-fold-higher minimum inhibitory concentration than those isolates that were not exposed to pretreatment at enrollment (95% CI, 1.99-fold to 6.06-fold; P < .001).

CONCLUSION:

This study provides evidence that prior use of fluoroquinolones is associated with antibiotic resistance.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00324168.

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