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. 2018 Oct 18;13(10):e0205814.
doi: 10.1371/journal.pone.0205814. eCollection 2018.

Antibiotic resistance among bacterial conjunctival pathogens collected in the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study

Penny A Asbell  1 , Heleen H DeCory  2
Affiliations

Antibiotic resistance among bacterial conjunctival pathogens collected in the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study

Penny A Asbell et al. PLoS One. .

Abstract

The Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study evaluates in vitro antibiotic resistance among Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates from ocular infections. Here we report resistance rates and trends among conjunctival-sourced ocular isolates collected across the US from 2009 through 2016. A total of 1198 conjunctival isolates (483 S. aureus, 305 CoNS, 208 H. influenzae, 118 S. pneumoniae, and 84 P. aeruginosa) were collected from patients with presumed bacterial conjunctivitis from 57 sites across 40 states. A large proportion of staphylococci demonstrated resistance to oxacillin and azithromycin, while resistance was low against the majority of antibiotics tested for S. pneumoniae, P. aeruginosa, and H. influenzae. Multidrug resistance (≥3 antibiotic classes) was found in 30.2% of S. aureus and 39.0% of CoNS isolates, and methicillin resistance more than doubled the rate of multi-drug resistance (methicillin-resistant S. aureus [MRSA], 76.5%; methicillin-resistant CoNS isolates, 72.8%). There was a pattern of increasing mean percent resistance with increasing age by decade of life among S. aureus, MRSA, and CoNS (P≤0.038). Over the eight-year study period, there were small yet significant decreases in resistance rates among S. aureus to azithromycin, ciprofloxacin, tobramycin, trimethoprim, and oxacillin (P≤0.003), and among CoNS and P. aeruginosa (both P<0.05) to ciprofloxacin. These data indicate that antibiotic resistance is high, but did not increase, among conjunctival-sourced isolates collected in the US from 2009 through 2016. For certain antibiotic/pathogen combinations, there was a trend of decreased resistance, including a decrease in oxacillin resistance among S. aureus.

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Conflict of interest statement

We have read the journal's policy and the authors of this manuscript have the following competing interests: PA Asbell has received: grants from Bausch + Lomb, the National Eye Institute, the Office of Dietary Supplements (NIH), Novartis, MC2 Therapeutics, Rtech, and Miotech; speaker fees from Santen, Medscape, ScientiaCME, Oculus, and Vindico; advisory board/consultancy fees from Bausch + Lomb, Shire, Novartis, MC2 Therapeutics, Allergan, Rtech, Miotech; non-financial support from Bausch + Lomb, CLAO, Santen, and Shire. HH DeCory is an employee of Bausch + Lomb. This does not alter our adherence to PLOS ONE policies on sharing data and materials related to this analysis.

Figures

Fig 1
Fig 1. Proportion of conjunctival isolates collected in the ARMOR study, stratified by patient age.
Missing: n = 187 (15.6%).
Fig 2
Fig 2. Multidrug resistance (MDR)a among conjunctival S. aureus and coagulase-negative staphylococci.
Isolates were tested against ciprofloxacin, azithromycin, clindamycin, chloramphenicol, tobramycin, oxacillin, tetracycline, vancomycin, and trimethoprim. Percent resistance includes intermediate resistance. a Multidrug resistance defined as resistance to 3 or more classes of antibiotics. Abbreviations: MRSA, methicillin-resistant S. aureus; CoNS, coagulase-negative staphylococci; MRCoNS, methicillin-resistant coagulase-negative staphylococci.
Fig 3
Fig 3. Resistance among staphylococcal isolates from the conjunctiva by patient age.
Data are expressed by decade of life for (A) mean ± SE percentage of resistance for S. aureus (black circles) and MRSA (blue circles); (B) mean ± SE percentage of resistance for CoNS (black squares) and MRCoNS (blue squares). P-values are from ANOVAs. Abbreviations: MRSA, methicillin-resistant S. aureus; CoNS, coagulase-negative staphylococci; MRCoNS, methicillin-resistant coagulase-negative staphylococci.
Fig 4
Fig 4. Oxacillin resistance among conjunctival isolates of staphylococci by patient age.
Data are expressed by decade of life for percentage of oxacillin resistance among S. aureus and CoNS; P-values are from Chi-Square test. Horizontal lines represent significant pairwise differences (P<0.05). Abbreviations: CoNS, coagulase-negative staphylococci.
Fig 5
Fig 5. Resistance among ocular S. aureus, coagulase-negative staphylococci, P. aeruginosa, and S. pneumoniae from patients with presumed conjunctivitis by antibiotic class over the 8-year study period.
Abbreviations: CoNS, coagulase-negative staphylococci; MRCoNS, methicillin-resistant coagulase-negative staphylococci; MRSA, methicillin-resistant S. aureus.
See this image and copyright information in PMC

References

    1. American Academy of Ophthalmology Cornea/External Disease Panel. Preferred Practice Pattern® Guidelines. Conjunctivitis. San Francisco, CA: American Academy of Ophthalmology; 2013. Available at: https://www.aao.org/preferred-practice-pattern/conjunctivitis-ppp—2013. Accessed January 16, 2017.
    1. Azari AA, Barney NP. Conjunctivitis: A systematic review of diagnosis and treatment. JAMA. 2013;310(16): 1721–1729. 10.1001/jama.2013.280318 - DOI - PMC - PubMed
    1. Høvding G. Acute bacterial conjunctivitis. Acta Ophthalmol. 2008;86(1): 5–17. 10.1111/j.1600-0420.2007.01006.x - DOI - PubMed
    1. Adebayo A, Parikh JG, McCormick SA, Shah MK, Huerto RS, Yu G, et al. Shifting trends in in vitro antibiotic susceptibilities for common bacterial conjunctival isolates in the last decade at the New York Eye and Ear Infirmary. Graefes Arch Clin Exp Ophthalmol. 2011;249(1): 111–119. 10.1007/s00417-010-1426-6 - DOI - PubMed
    1. Epling J. Bacterial conjunctivitis. BMJ Clin Evid. 2012;2012:704. - PMC - PubMed

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