title: Fourth-generation fluoroquinolone-resistant bacterial keratitis after refractive surgery.
abstract: We report the first 2 cases of bacterial keratitis resistant to fourth-generation fluoroquinolones after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). The first patient had Pseudomonas aeruginosa keratitis after PRK despite treatment with moxifloxacin. The second patient was on gatifloxacin post-LASIK when she had methicillin-resistant Staphylococcus aureus (MRSA) keratitis diagnosed. In both cases, culture susceptibilities showed isolates resistant to moxifloxacin and gatifloxacin, and treatment with topical aminoglycosides and surgical intervention was necessary to effect a cure. These cases show the potential limitations in the coverage of these antibiotics.
authors.affiliation: John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah 84132, USA.
authors.forename: Majid
authors.initials: M
authors.lastname: Moshirfar
authors.forename: Garen
authors.initials: G
authors.lastname: Mirzaian
authors.forename: Vahid
authors.initials: V
authors.lastname: Feiz
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kang
mesh_terms: D000328:Adult; D001372:Aza Compounds / Q000494:pharmacology / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use*; D000077734:Gatifloxacin; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D015948:Keratoplasty, Penetrating; D054018:Lasers, Excimer; D008826:Microbial Sensitivity Tests; D000077266:Moxifloxacin; D009216:Myopia / Q000601:surgery*; D018903:Photorefractive Keratectomy; D011183:Postoperative Complications; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology*; D011804:Quinolines / Q000494:pharmacology / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000077734:Gatifloxacin; D000077266:Moxifloxacin