title: Antibiotic susceptibility of conjunctival bacterial isolates from refractive surgery patients.
abstract: OBJECTIVE
  To determine the in vitro antibiotic susceptibility patterns of conjunctival bacterial flora isolated before surgery from patients undergoing refractive surgery.
  
  
  METHODS
  In vitro laboratory investigation.
  
  
  METHODS
  One hundred five eyes from 105 patients scheduled for refractive surgery at Balgensesang Ophthalmology Clinic between September 2005 and January 2006 were studied. Among 105 patients, 71 (67.6%) underwent LASIK using a femtosecond laser, 24 (22.9%) underwent LASIK using an automated microkeratome, 8 (7.6%) underwent LASEK, and 2 (1.9%) patients underwent phakic intraocular lens implantation.
  
  
  METHODS
  Preoperative conjunctival swab samples were inoculated directly in culture media at the bedside before topical anesthetic or antibiotic application. Blood agar, chocolate agar, thioglycolate broth, Sabouraud dextrose agar, and Ogawa media were used for bacterial, fungal, and mycobacterial cultures.
  
  
  METHODS
  Minimum inhibitory concentrations (MICs) of ofloxacin (OFX), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX), gemifloxacin (GEM), and other commonly used antibiotics were determined using an E test.
  
  
  RESULTS
  From 105 patients, 73 (85%) coagulase-negative staphylococci (CNS), 2 (2.3%) Staphylococcus aureus, 1 (1.2%) Streptococcus pneumoniae, and 5 (4.8%) gram-negative bacilli were isolated. No fungi or mycobacteria were isolated. The MIC that would inhibit the growth of 90% of the tested bacterial isolates (MIC(90)) of OFX, LEV, GAT, MOX, and GEM for methicillin-susceptible CNS (n = 46) were 0.5 microg/ml, 0.19 microg/ml, 0.094 microg/ml, 0.047 microg/ml, and 0.023 microg/ml, respectively. The MIC(90) values for methicillin-resistant CNS (n = 27) were 32 microg/ml, 4 microg/ml, 1 microg/ml, 0.5 microg/ml, and 0.25 microg/ml, respectively (P<0.001).
  
  
  CONCLUSIONS
  The most effective against conjunctival bacteria isolated from refractive surgery patients were GEM, MOX, and GAT; however, resistance to earlier-generation fluoroquinolones (OFX and LEV) is increasing among methicillin-resistant CNS. It may be a therapeutic option to use newer fluoroquinolones in patients undergoing refractive eye surgery to reduce such infections as methicillin-resistant CNS.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Lim
authors.initials: JL
authors.lastname: Chung
authors.forename: Kyoung Yul
authors.initials: KY
authors.lastname: Seo
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Yong
authors.forename: Francis S
authors.initials: FS
authors.lastname: Mah
authors.forename: Tae-im
authors.initials: TI
authors.lastname: Kim
authors.forename: Eung Kweon
authors.initials: EK
authors.lastname: Kim
authors.forename: Jin Kook
authors.initials: JK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001431:Bacteriological Techniques; D003228:Conjunctiva / Q000382:microbiology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D049008:Keratectomy, Subepithelial, Laser-Assisted; D020731:Keratomileusis, Laser In Situ; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D054140:Refractive Surgical Procedures; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents