title: Ciprofloxacin and levofloxacin resistance among methicillin-sensitive Staphylococcus aureus isolates from keratitis and conjunctivitis.
abstract: OBJECTIVE
  The majority of Staphylococcus aureus isolated from ocular infections are methicillin sensitive (MSSA). Fluoroquinolone resistance among methicillin- resistant Staphylococcus aureus is well known but not among MSSA. In this study we investigate the emergence of fluoroquinolone (ciprofloxacin, levofloxacin) resistance among methicillin-sensitive Staphylococcus aureus isolates from keratitis and conjunctivitis.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Minimal inhibitory concentration susceptibility profiles for 1230 S. aureus isolates from keratitis and conjunctivitis were analyzed. Historical and current rates of emerging fluoroquinolone resistance for methicillin-resistant (MRSA) and methicillin-sensitive isolates (MSSA) were evaluated. Sensitivity patterns for vancomycin and gentamicin were also documented.
  
  
  RESULTS
  Ciprofloxacin resistance among corneal and conjunctival S. aureus isolates during the first 6 years after its introduction (baseline) (1990-1995) was 8% and ranged from 3% to 11%. The rate for the most recent 6 years (current) (1996-2001) was 20.7%. Baseline ciprofloxacin resistance for MSSA isolates was 2% vs 55.8% for MRSA. The current resistance rate for MSSA is 5% vs 83.7% for MRSA. The general resistance rate from January 2000 to December 2001 for levofloxacin was 25.5% vs 33.2% for ciprofloxacin (P =.13). The levofloxacin-resistance rate for MSSA was 4.7% vs 11.9% for ciprofloxacin (P =.05). In MRSA isolates, a higher resistance rate was found for ciprofloxacin (95.7%) vs levofloxacin (82.1%) (P =.04). No resistance for vancomycin was documented for any of the S. aureus isolates. Gentamicin susceptibility for MSSA was 99% and MRSA was 86%.
  
  
  CONCLUSIONS
  Ciprofloxacin and levofloxacin resistance among methicillin-sensitive S. aureus corneal and conjunctival isolates is increasing. This is of concern because it narrows treatment choices for the management of these common ocular infections.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33136, USA. ealfonso@medmiami.edu
authors.forename: Fabiana B
authors.initials: FB
authors.lastname: Marangon
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
authors.forename: Marcus S
authors.initials: MS
authors.lastname: Muallem
authors.forename: Andre C
authors.initials: AC
authors.lastname: Romano
authors.forename: Eduardo C
authors.initials: EC
authors.lastname: Alfonso
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology; D003234:Conjunctivitis, Bacterial / Q000382:microbiology*; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D007634:Keratitis / Q000382:microbiology*; D064704:Levofloxacin; D008712:Methicillin / Q000494:pharmacology*; D008826:Microbial Sensitivity Tests; D015242:Ofloxacin / Q000494:pharmacology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D064704:Levofloxacin; D015242:Ofloxacin; D008712:Methicillin