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Repeated antibiotic exposure after intraocular injection may promote antimicrobial resistance

Arch Ophthalmol. 2011;129(9):1180-1188.

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Repeated use of ophthalmic antibiotics after intraocular injection promotes the development of antimicrobial resistance, a study found.

"Our results demonstrate that macrolide- and fluoroquinolone-resistant conjunctival [coagulase-negative staphylococci] emerge rapidly after exposure to their respective antibiotic and are maintained by periodic re-exposure," the authors said.

In a randomized, controlled, longitudinal analysis, 48 eyes of 24 patients underwent injection for choroidal neovascularization and received either ofloxacin 0.3%, azithromycin 1%, gatifloxacin 0.3% or moxifloxacin HCl 0.5%. Bacterial isolates were tested for susceptibility to 16 different antibiotics, and pulse-field gel electrophoresis evaluated bacteria DNA.

Coagulase-negative staphylococci repeatedly exposed to fluoroquinolone antibiotics demonstrated increased resistance to older-generation and newer-generation fluoroquinolones (P = .002 and P < .01, respectively). Coagulase-negative staphylococci isolated from azithromycin-exposed eyes showed increased resistance to macrolides (P < .001) and decreased resistance to older-generation (P = .03) and newer-generation (P < .001) fluoroquinolones.

Increased resistance to multiple drugs also occurred among repeatedly exposed conjunctival flora, with 81.8% of isolates resistant to at least three antibiotics (P = .01) and 67.5% resistant to at least five (P = .009).