Antibiotics Susceptibility in Bacterial Keratitis and Proper Initial Treatment

Je Hwan Yoon; Jee Woong Jung; Hyun Seung Moon; Ho Seok Moon; Kyung Hwan Shyn; Kyun Hyung Kim

doi:10.3341/jkos.2013.54.1.38

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Yoon, Jung, Moon, Moon, Shyn, and Kim: Antibiotics Susceptibility in Bacterial Keratitis and Proper Initial Treatment

Original Article

J Korean Ophthalmol Soc 2013;54(1):38-45.

Published online: 25 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.1.38

Antibiotics Susceptibility in Bacterial Keratitis and Proper Initial Treatment

Je Hwan Yoon, MD¹, Jee Woong Jung, MD², Hyun Seung Moon, MD³, Ho Seok Moon, MD¹, Kyung Hwan Shyn, MD, PhD⁴, Kyun Hyung Kim, MD^1,

¹Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea

²Bright Eye Clinic, Osan, Korea

³Bright Eye World Clinic, Seoul, Korea

⁴Kim's Eye Clinic, Incheon, Korea

Address reprint requests to Kyun Hyung Kim, MD Department of Ophthalmology, Gachon University Gil Medical Center #21 Namdong-daero774beon-gil, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: balance@gilhospital.com

Received 8 November 2011 Accepted 17 May 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The present study aims to determine the common pathogens involved in the etiology of bacterial keratitis and to analyze not only the antibiotic susceptibility of bacterial isolates from patients with bacterial keratitis but also the propriety of initial treatment.

Methods

A retrospective study of 161 eyes in 161 patients with bacterial keratitis, who were diagnosed by cultures from 2000 to 2011, was performed. Causative bacteria and antibiotic susceptibility were evaluated in consecutive 6-year periods.

Results

The most common bacteria was the pseudomonas species in the 2 time periods tested and cefazolin with tobramycin was the most commonly used antibiotic (125 cases, 77.6%) for initial treatment of bacterial keratitis. In vitro testing showed gram-negative susceptibility to tobramycin and ciprofloxacin was over 70%, gram-positive susceptibility to cephalothin and vancomycin was 100% and there was no significant difference between the 2 time periods tested. Eight cases had resistance to the initial treatment, but only 1 case showed treatment failure.

Conclusions

Antibiotics used for initial treatment of bacterial keratitis were able to obtain a proper effect but several cases showed bacterial resistance to antibiotics. Thus, continued testing is essential to monitor for antibiotic resistance.

Keywords: Antibiotics, Antibiotic susceptibility, Bacterial keratitis, Resistance

References

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Table 1.

Total number of bacteria isolates, and prevalence percentage of the different bacterial groups in bacterial keratitis cases

	Organism	2000–2005 No. (%)	2006–2011 No. (%)	Total No. (%)
Gram(+)cocci
	CNS	6 (9.7)	26 (18.8)	32 (16.0)
	Streptococcus pneumoniae	4 (6.5)	6 (4.3)	10 (5.0)
	Staphylococcus aureus	5 (8.1)	4 (2.9)	9 (4.5)
	Streptococcus group G	0 (0.0)	1 (0.7)	1 (0.5)
	Streptococcus oralis	1 (1.6)	0 (0.0)	1 (0.5)
	Viridans streptococcus	0 (0.0)	3 (2.2)	3 (1.5)
Gram(−)rod
	Pseudomonas species
	Pseudomonas putida	0 (0.0)	22 (15.9)	22 (11.0)
	Pseudomonas aeruginosa	14 (22.6)	10 (7.2)	24 (12.0)
	Pseudomonas fluorescens	3 (4.8)	9 (6.5)	12 (6.0)
	Stenotrophomonas maltophilia	7 (11.3)	21 (15.2)	28 (14.0)
	Serratia marcescens	8 (12.9)	7 (5.1)	15 (7.5)
	Enterobacter species
	Enterobacter aerogenes	0 (0.0)	3 (2.2)	3 (1.5)
	Enterobacter asburiae	0 (0.0)	2 (1.4)	2 (1.0)
	Enterobacter cloacae	1 (1.6)	9 (6.5)	10 (5.0)
	Alcaligenes xylosoxidans	1 (1.6)	3 (2.2)	4 (2.0)
	Acinetobacter species	3 (4.8)	2 (1.4)	5 (2.5)
	Achromobacter denitrificans	0 (0.0)	3 (2.2)	3 (1.5)
	Comamonas acidovorans	4 (6.5)	0 (0.0)	4 (2.0)
	Chryseobacterium meningosepticum	4 (6.5)	0 (0.0)	4 (2.0)
	Nonferment gram negative bacilli	0 (0.0)	3 (2.2)	3 (1.5)
	Others	1 (1.6)	4 (2.9)	5 (2.5)
Total		62 (100.0)	138 (100.0)	200 (100.0)

No = number of patients; CNS = coagulase-negative staphylococcus.

Table 2.

The susceptibility of Pseudomonas species to each antibiotic tested from bacterial keratitis cases

	2000 to 2005			2006 to 2011			2000 to 2011			p-value
	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	p-value
Gentamicin	18	16 (88.9)	2 (11.1)	41	40 (97.6)	1 (2.4)	59	56 (94.9)	3 (5.1)	0.218
Tobramycin	18	16 (88.9)	2 (11.1)	37	36 (97.3)	1 (2.7)	55	52 (94.5)	3 (5.5)	0.247
Amikacin	18	16 (88.9)	2 (11.1)	41	41 (100.0)	0 (0.0)	59	57 (96.6)	2 (3.4)	0.089
Ciprofloxacin	18	17 (94.4)	1 (5.6)	40	40 (100.0)	0 (0.0)	58	57 (98.3)	1 (1.7)	0.310
Levofloxacin	18	17 (94.4)	1 (5.6)	24	24 (100.0)	0 (0.0)	42	41 (97.6)	1 (2.4)	0.429
Imipenem	18	18 (100.0)	0 (0.0)	40	39 (97.5)	1 (2.5)	58	57 (98.3)	1 (1.7)	0.499
Aztreonam	18	13 (72.2)	5 (27.8)	41	19 (46.3)	22 (53.7)	59	32 (54.2)	27 (45.8)	0.120
Ceftazidime	17	17 (100.0)	0 (0.0)	41	41 (100.0)	0 (0.0)	58	58 (100.0)	0 (0.0)	1.000
TMP / SMX	18	1 (5.5)	17 (94.5)	40	2 (5.0)	38 (95.0)	58	3 (5.2)	55 (94.8)	0.930

The p-value is the comparison between the years 2000 to 2005 and 2006 to 2011.

TMP/SMX = trimethoprime/ sulfamethoxazole.

Table 3.

The susceptibility of Stenotrophomonas maltophilia to each antibiotic tested from bacterial keratitis cases

	2000 to 2005			2006 to 2011			2000 to 2011			p-value
	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	p-value
Gentamicin	7	1 (14.3)	6 (85.7)	21	13 (61.9)	8 (38.1)	28	14 (53.6)	14 (50.0)	0.079
Tobramycin	7	1 (14.3)	6 (85.7)	21	13 (61.9)	8 (38.1)	28	14 (50.0)	14 (50.0)	0.079
Amikacin	7	2 (28.6)	5 (71.4)	20	8 (40.0)	12 (60.0)	27	10 (37.0)	17 (73.0)	0.678
Ciprofloxacin	7	4 (57.1)	3 (42.9)	20	18 (90.0)	2 (10.0)	27	22 (81.5)	5 (18.5)	0.091
Levofloxacin	7	7 (100.0)	0 (0.0)	20	20 (100.0)	0 (0.0)	27	27 (100.0)	0 (0.0)	1.000
Cefotaxime	7	2 (28.6)	5 (71.4)	21	1 (4.8)	20 (95.2)	28	3 (10.7)	25 (89.3)	0.145
Ceftazidime	7	5 (71.4)	2 (28.6)	21	16 (76.2)	5 (23.8)	28	21 (75.0)	7 (25.0)	0.801
Cefepime	7	1 (14.3)	6 (85.7)	21	2 (9.5)	19 (90.5)	28	3 (10.7)	25 (89.3)	0.724
Imipenem	7	1 (14.3)	6 (85.7)	21	2 (9.5)	19 (90.5)	28	3 (10.7)	25 (89.3)	0.724
Aztreonam	7	1 (14.3)	6 (85.7)	21	2 (9.5)	19 (90.5)	28	3 (10.7)	25 (89.3)	0.724
TMP / SMX	7	7 (100.0)	0 (0.0)	21	21 (100.0)	0 (0.0)	28	28 (100.0)	0 (0.0)	1.000

The p-value is the comparison between the years 2000 to 2005 and 2006 to 2011.

TMP/SMX = trimethoprime/sulfamethoxazole.

Table 4.

The susceptibility of Serratia marcescens to each antibiotic tested from bacterial keratitis cases

	2000 to 2005			2006 to 2011			2000 to 2011			p-value
	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	p-value
Gentamicin	8	8 (100.0)	0 (0.0)	7	7 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000
Tobramycin	6	5 (83.3)	1 (16.7)	7	7 (100.0)	0 (0.0)	13	12 (92.3)	1 (7.7)	0.462
Amikacin	8	8 (100.0)	0 (0.0)	7	7 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000
Ciprofloxacin	8	8 (100.0)	0 (0.0)	7	6 (85.7)	1 (14.3)	15	14 (93.3)	1 (6.7)	0.467
Levofloxacin	8	8 (100.0)	0 (0.0)	2	2 (100.0)	0 (0.0)	10	10 (100.0)	0 (0.0)	1.000
Cefotaxime	8	8 (100.0)	0 (0.0)	7	7 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000
Ceftazidime	8	8 (100.0)	0 (0.0)	7	7 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000
Cefepime	8	8 (100.0)	0 (0.0)	7	7 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000
Imipenem	8	8 (100.0)	0 (0.0)	7	7 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000
TMP/SMX	8	8 (100.0)	0 (0.0)	7	7 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000

The p-value is the comparison between the years 2000 to 2005 and 2006 to 2011.

TMP/SMX = trimethoprime/ sulfamethoxazole.

Table 5.

The susceptibility of Coagulase-negative staphylococcus to each antibiotic tested from bacterial keratitis cases

	2000 to 2005			2006 to 2011			2000 to 2011			p-value
	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	p-value
Oxacillin	5	5 (100.0)	0 (0.0)	26	18 (69.2)	8 (30.8)	31	23 (74.2)	8 (25.8)	0.291
Penicillin	5	1 (20.0)	4 (80.0)	7	0 (0.0)	7 (100.0)	12	1 (8.3)	11 (91.7)	0.417
Penicillin	5	5 (100.0)	0 (0.0)	10	10 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000
Cephalothin	5	5 (100.0)	0 (0.0)	10	10 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	1.000
Erythromycin	5	5 (100.0)	0 (0.0)	26	21 (80.8)	5 (19.2)	31	26 (83.9)	5 (16.1)	0.560
Ciprofloxacin	5	5 (100.0)	0 (0.0)	26	22 (84.6)	4 (15.4)	31	27 (87.1)	4 (12.9)	0.832
Clindamycin	5	5 (100.0)	0 (0.0)	26	20 (76.9)	6 (23.1)	31	25 (80.6)	6 (19.4)	0.563
Teicoplanin	5	5 (100.0)	0 (0.0)	25	25 (100.0)	0 (0.0)	30	30 (100.0)	0 (0.0)	1.000
Vancomycin	5	5 (100.0)	0 (0.0)	26	26 (100.0)	0 (0.0)	31	31 (100.0)	0 (0.0)	1.000
Tetracyclin	5	4 (80.0)	1 (20.0)	26	20 (92.3)	6 (7.7)	31	24 (77.4)	7 (22.6)	0.880
TMP/SMX	5	5 (100.0)	0 (0.0)	26	24 (92.3)	2 (7.7)	31	29 (93.5)	2 (6.5)	0.521

The p-value is the comparison between the years 2000 to 2005 and 2006 to 2011.

TMP/SMX = trimethoprime/ sulfamethoxazole.

Table 6.

The susceptibility of gram-negative bacteria to each antibiotic tested from bacterial keratitis cases

	2000 to 2005			2006 to 2011			2000 to 2011			p-value
	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No. (%)	p-value
Gentamicin	41	30 (73.2)	11 (26.8)	96	78 (81.3)	18 (18.7)	137	108 (78.8)	29 (21.2)	0.238
Tobramycin	41	30 (73.2)	11 (26.8)	90	73 (81.1)	17 (18.9)	131	103 (78.6)	28 (21.4)	0.304
Amikacin	41	30 (73.2)	11 (26.8)	97	80 (82.5)	17 (17.5)	138	110 (79.7)	28 (20.3)	0.214
Ciprofloxacin	41	35 (85.3)	6 (14.7)	93	86 (92.5)	7 (7.5)	134	121 (90.3)	13 (9.7)	0.335
Levofloxacin	41	40 (97.6)	1 (0.4)	61	61 (100.0)	0 (0.0)	102	101 (99.0)	1 (1.0)	0.402
Piperacillin	41	33 (80.5)	8 (19.5)	95	58 (61.1)	37 (38.9)	136	91 (66.9)	45 (33.1)	0.972
Cefotaxime	41	14 (34.1)	27 (65.9)	80	29 (36.3)	51 (63.7)	121	43 (35.5)	78 (64.5)	0.904
Ceftazidime	40	33 (82.5)	7 (17.5)	96	85 (88.5)	11 (11.5)	136	118 (86.8)	18 (13.2)	0.503
Cefepime	41	32 (78.0)	9 (22.0)	99	74 (74.7)	25 (25.3)	140	106 (75.7)	34 (24.3)	0.843
Imipenem	41	30 (73.2)	11 (26.8)	97	59 (60.8)	38 (39.2)	138	89 (64.5)	49 (35.5)	0.234
Aztreonam	41	22 (53.7)	19 (46.3)	95	41 (43.2)	54 (56.8)	136	63 (49.3)	73 (50.7)	0.154
TMP / SMX	41	30 (73.2)	11 (26.8)	27	22 (81.5)	5 (18.5)	68	52 (76.4)	16 (23.6)	0.429

Only selected isolates and antibiotics were tested; The p-value is the comparison between the years 2000 to 2005 and 2006 to 2011.

TMP/SMX = trimethoprime/sulfamethoxazole.

Table 7.

The susceptibility of gram-positive bacteria to each antibiotic tested from bacterial keratitis cases

	2000 to 2005			2006 to 2011			2000 to 2011			p-value
	Total No.	Susceptible No. (%)	Resistant No. (%)	Total No.	Susceptible No. (%)	Resistant No.(%)	Total No.	Susceptible No.(%)	Resistant No.(%)	p-value
Oxacillin	11	10 (90.9)	1 (9.1)	29	21 (72.4)	8 (27.6)	40	31 (77.5)	9 (22.5)	0.399
Penicillin	16	4 (25.0)	12 (75.0)	19	7 (36.8)	12 (63.2)	35	11 (31.4)	24 (68.6)	0.493
Cefotaxime	11	11 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	26	26 (100.0)	0 (0.0)	1.000
Cephalothin	11	11 (100.0)	0 (0.0)	15	15 (100.0)	0 (0.0)	26	26 (100.0)	0 (0.0)	1.000
Ciprofloxacin	11	10 (90.9)	1 (9.1)	29	25 (86.2)	4 (13.8)	40	35 (87.5)	5 (12.5)	0.688
Erythromycin	16	12 (75.0)	4 (25.0)	39	31 (79.5)	8 (20.5)	55	43 (78.2)	12 (21.8)	0.995
Clindamycin	16	13 (81.3)	3 (18.7)	39	30 (76.9)	9 (23.1)	55	43 (78.2)	12 (21.8)	0.724
Tetracyclin	16	10 (62.5)	6 (37.5)	39	29 (62.5)	10 (74.4)	55	39 (70.9)	16 (29.1)	0.581
TMP/SMX^*	15	12 (80.0)	3 (20.0)	35	29 (82.9)	6 (17.1)	50	41 (82.0)	9 (18.0)	0.810
Teicoplanin	11	11 (100.0)	0 (0.0)	28	28 (100.0)	0 (0.0)	39	39 (100.0)	0 (0.0)	1.000
Vancomycin	16	16 (100.0)	16 (0.0)	39	39 (100.0)	0 (0.0)	55	55 (100.0)	0 (0.0)	1.000

Only selected isolates and antibiotics were tested; The p-value is the comparison between the years 2000 to 2005 and 2006 to 2011.

TMP/SMX = trimethoprime/sulfamethoxazole.

Table 8.

Total number of initial antibiotics in bacterial keratitis cases, Number of resistance strain and treatment failure

	Total No. (%)	Resistance case
	Total No. (%)	Resistance strain	Total No.	Treatment failure No.
Cefazolin/Tobramycin	125 (77.6)	S. maltophilia	5	1
		A. xylosoxidans	2	0
		P. aeruginosa	1	0
Levofloxacin	8 (5.0)
Gatifloxacin	12 (7.5)
Ofloxacin	5 (3.1)
Vancomycin/Ceftazidime	11 (6.8)
Total	161 (100.0)		8	1

S. maltophilia = stenotrophomonas maltophilia; A. xylosoxidans = alcaligenes xylosoxidans; P. aerusinosa = pseudomonas aerusinosa.

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