Topical Fluoroquinolone Use as a Risk Factor for In Vitro Fluoroquinolone Resistance in Ocular Cultures | Allergy and Clinical Immunology | JAMA Ophthalmology | JAMA Network
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Clinical Sciences
April 11, 2011

Topical Fluoroquinolone Use as a Risk Factor for In Vitro Fluoroquinolone Resistance in Ocular Cultures

Author Affiliations

Author Affiliations: Francis I. Proctor Foundation for Research in Ophthalmology (Drs Fintelmann, Hoskins, Lietman, Keenan, Gaynor, Cevallos, and Acharya), Departments of Ophthalmology (Drs Fintelmann, Hoskins, Lietman, Keenan, Gaynor, and Acharya) and Epidemiology & Biostatistics (Dr Lietman), and Institute for Global Health (Dr Lietman), University of California, San Francisco.

Arch Ophthalmol. 2011;129(4):399-402. doi:10.1001/archophthalmol.2011.45

Objective  To determine whether recent use of topical fluoroquinolones is a risk factor for in vitro fluoroquinolone resistance in Staphylococcus aureus ocular isolates.

Methods  Disk diffusion susceptibility testing for ciprofloxacin, moxifloxacin, and gatifloxacin was performed for all ocular isolates of S aureus at the Francis I. Proctor Foundation microbiology laboratory from January 1, 2005, to December 31, 2008. The medical records of patients with positive S aureus cultures were reviewed to determine topical or systemic fluoroquinolone use within the 3 months prior to culture. The Fisher exact test was used to compare the proportion of patients who used topical fluoroquinolones in the past 3 months among fluoroquinolone-sensitive and -resistant cases. Logistic regression was used to determine risk factors for fluoroquinolone resistance.

Results  Of 200 S aureus cultures, 41 were resistant to ciprofloxacin, moxifloxacin, and gatifloxacin (20.5%). Fluoroquinolone-resistant S aureus isolates were from older patients (mean [SD] age, 65.5 [25.0] years) compared with fluoroquinolone-susceptible isolates (mean [SD] patient age, 52.1 [22.1] years) (P = .003). Use of fluoroquinolones within the 3 months before testing was more frequent in resistant isolates (29%) than in susceptible isolates (11%) (P = .005), as was recent hospitalization (22% of resistant isolates, 0% of susceptible isolates) (P < .001). In the multivariate regression analysis, topical fluoroquinolone use within 3 months was a significant predictor of fluoroquinolone resistance (P = .046), along with age, systemic immunosuppression, and topical fluoroquinolone use between 3 and 6 months before testing.

Conclusion  Recent topical fluoroquinolone use is significantly associated with fluoroquinolone resistance in S aureus isolates from ocular cultures.