Emerging Enterococcus isolates in postoperative endophthalmitis by selection pressure of fluoroquinolones: an 11-year multicenter and experimental study. Issue 1 (1st January 2020)

• Record Type: Journal Article
• Authors: Kim, Jiyeun Kate; Nam, Ki Yup; Chung, In Young; Jeung, Woo Jin; Kwon, Yoon Hyung; Park, Jung Min; Han, Yong Seop; Lee, Ji Eun; Byon, Ik Soo; Park, Sung Hu; Kim, Hyun Wong; Park, Kang Yun; Yoon, Hee Sung; Park, Indal; Kim, Han Woo; Lee, Sang Joon
• Is Part Of: Emerging microbes & infections. Volume 9:Issue 1(2020)
• Page Start: 1892
• Page End: 1899
• Publication Date: 2020-01-01
• Subjects: Selection pressure -- Enterococcus -- fluoroquinolone -- antibiotic resistance -- endophthalmitis; Medical microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.9041
• DOI: 10.1080/22221751.2020.1810134
• Languages: English
• ISSNs: 2222-1751

Abstract

ABSTRACT: Postoperative endophthalmitis (PE) is the devastating complication that frequently results in vision loss. Recently, enterococcus have emerged as a major cause of PE in several countries and resulted in poor visual outcome. However, the reason remains elusive. We investigate whether selection pressure of fluoroquinolone exerts effects on microorganism profiles isolated from PE. Medical records of patients who were diagnosed with PE at eight resident training institutions between January 2004 and December 2015 were reviewed. The most common isolate was Enterococcus faecalis (28.0%), followed by Staphylococcus epidermidis (18.6%) and other coagulase negative Staphylococci (7.6%). However, the rates of E. faecalis isolated from conjunctival microbes were 6.2% (16/257) and their resistance to fluoroquinolones was higher than those of S. epidermidis . In vitro and in vivo co-culture models of E. faecalis and S. epidermidis were established for survival assays after administration of fourth-generation fluoroquinolone. In in vitro co-culture model, the survival assay of E. faecalis and S. epidermidis against the treatment of moxifloxacin showed that E. faecalis survived significantly better than S. epidermidis in the presence of moxifloxacin 1 µg/mL and more. In in vivo co-culture model, E. faecalis survived significantly better than S. epidermidis after topical treatment of moxifloxacin (5 mg/mL). E. faecalis has been the most common causative strain of PE in Korea. We suggest that the increase of E. faecalis in PE could be associated with the selection pressure of fourth-generation fluoroquinolone. Summary: Enterococcus spp. have emerged as a leading causative strain of postoperative endophthalmitis in 11-year clinical data. We suggest that the increase of Enterococcus spp. is associated with the selection pressure of fourth-generation fluoroquinolone.