title: In vitro fluoroquinolone resistance in staphylococcal endophthalmitis isolates.
abstract: OBJECTIVE
  To evaluate the in vitro susceptibility and cross-resistance of gatifloxacin and moxifloxacin vs older fluoroquinolones among coagulase-negative staphylococci recovered from patients with clinical endophthalmitis.
  
  
  METHODS
  A combination of E tests and disk diffusion methods was used to determine in vitro susceptibility and cross-resistance for 111 coagulase-negative staphylococci isolates recovered during a 15-year period (January 1, 1990, to December 31, 2004) against 5 fluoroquinolones.
  
  
  RESULTS
  In vitro susceptibilities (percentage sensitive) in descending order were as follows: gatifloxacin, 74.5%; moxifloxacin, 72.1%; levofloxacin, 69.3%; ciprofloxacin, 65.6%, and ofloxacin, 60.4%. More than 65% of the coagulase-negative staphylococci resistant to ciprofloxacin (n = 38) demonstrated in vitro cross-resistance to gatifloxacin (25 [65.8%] of 38) and moxifloxacin (27 [71.1%] of 38). During the initial 5 years (January 1, 1990, to December 31, 1994), 96.6% of the coagulase-negative staphylococci were sensitive to gatifloxacin and moxifloxacin, with minimal inhibitory concentration required to inhibit or kill 90% of the isolates of 0.19 microg/mL and 0.12 microg/mL, respectively. During the last 5-year period (January 1, 2000, to December 31, 2004), the percentage of sensitive coagulase-negative staphylococci declined to 65.4% for gatifloxacin and moxifloxacin (P=.02). Minimal inhibitory concentration required to inhibit or kill 90% of the isolates was 32 microg/mL or greater for both drugs.
  
  
  CONCLUSIONS
  Gatifloxacin and moxifloxacin demonstrated an in vitro efficacy of less than 80% for coagulase-negative staphylococci endophthalmitis in the present study. Ciprofloxacin resistance may serve as a surrogate for concurrent in vitro resistance for gatifloxacin and moxifloxacin. Resistance increased significantly during the last 5 years. Declining in vitro susceptibility to gatifloxacin and moxifloxacin may have important implications for the prevention and treatment of postoperative endophthalmitis.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Fla 33136, USA. dmiller@med.miami.edu
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Flynn
authors.forename: Ingrid U
authors.initials: IU
authors.lastname: Scott
authors.forename: Eduardo C
authors.initials: EC
authors.lastname: Alfonso
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D009877:Endophthalmitis / Q000382:microbiology*; D015817:Eye Infections / Q000382:microbiology; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D013203:Staphylococcal Infections / Q000382:microbiology; D013210:Staphylococcus / Q000187:drug effects* / Q000302:isolation & purification*; D014822:Vitreous Body / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones