title: Relationship of in vitro susceptibility to moxifloxacin and in vivo clinical outcome in bacterial keratitis.
abstract: BACKGROUND
  For bacterial infections, the susceptibility to antibiotics in vitro has been associated with clinical outcomes in vivo, although the importance of minimum inhibitory concentration (MIC) has been debated. In this study, we analyzed the association of MIC on clinical outcomes in bacterial corneal ulcers, while controlling for organism and severity of disease at presentation.
  
  
  METHODS
  Data were collected as part of a National Eye Institute-funded, randomized, controlled trial (the Steroids for Corneal Ulcers Trial [SCUT]). All cases enrolled in SCUT had a culture-positive bacterial corneal ulcer and received moxifloxacin. The MIC to moxifloxacin was measured by E test. Outcomes included best spectacle-corrected visual acuity, infiltrate/scar size, time to re-epithelialization, and corneal perforation.
  
  
  RESULTS
  Five hundred patients with corneal ulcers were enrolled in the trial, and 480 were included in this analysis. The most commonly isolated organisms were Streptococcus pneumoniae and Pseudomonas aeruginosa. A 2-fold increase in MIC was associated with an approximately 0.02 logMAR decrease in visual acuity at 3 weeks, approximately 1 letter of vision loss on a Snellen chart (0.019 logMAR; 95% confidence interval [CI], .0040-.033; P = .01). A 2-fold increase in MIC was associated with an approximately 0.04-mm larger infiltrate/scar size at 3 weeks (0.036 mm; 95% CI, .010-.061; P = .006). After controlling for organism, a higher MIC was associated with slower time to re-epithelialization (hazards ratio, 0.92; 95% CI, .86-.97; P = .005).
  
  
  CONCLUSIONS
  In bacterial keratitis, a higher MIC to the treating antibiotic is significantly associated with worse clinical outcomes, with approximately 1 line of vision loss per 32-fold increase in MIC.
  
  
  BACKGROUND
  NCT00324168.
authors.affiliation: Department of Ocular Microbiology, Aravind Eye Care System, Madurai, India.
authors.forename: Prajna
authors.initials: P
authors.lastname: Lalitha
authors.forename: Muthiah
authors.initials: M
authors.lastname: Srinivasan
authors.forename: P
authors.initials: P
authors.lastname: Manikandan
authors.forename: M Jayahar
authors.initials: MJ
authors.lastname: Bharathi
authors.forename: Revathi
authors.initials: R
authors.lastname: Rajaraman
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Ravindran
authors.forename: Vicky
authors.initials: V
authors.lastname: Cevallos
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Oldenburg
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ray
authors.forename: Christine M
authors.initials: CM
authors.lastname: Toutain-Kidd
authors.forename: David V
authors.initials: DV
authors.lastname: Glidden
authors.forename: Michael E
authors.initials: ME
authors.lastname: Zegans
authors.forename: Stephen D
authors.initials: SD
authors.lastname: McLeod
authors.forename: Nisha R
authors.initials: NR
authors.lastname: Acharya
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Lietman
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001372:Aza Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology*; D024841:Fluoroquinolones; D006801:Humans; D008826:Microbial Sensitivity Tests; D000077266:Moxifloxacin; D011804:Quinolines / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D000077266:Moxifloxacin