title: Effects of moxifloxacin exposure on the conjunctival flora and antibiotic resistance profile following repeated intravitreal injections.
abstract: OBJECTIVE
  To evaluate the effects of moxifloxacin exposure on the conjunctival flora and antibiotic resistance profile following repeated intravitreal injections.
  
  
  METHODS
  Seventy-two eyes of 36 patients [36 eyes in control group, 36 eyes in intravitreal injection (IVI) group] were enrolled in the study. All the eyes had at least one IVI and had diabetic macular edema (DME) or age-related macular degeneration (ARMD). Moxifloxacin was prescribed to all the patients four times a day for five days following injection. Conjunctival cultures were obtained from the lower fornix via standardized technique with every possible effort made to minimize contamination from the lids, lashes, or skin. Before the application of any ophthalmic medication, conjunctival cultures were obtained from both eyes using sterile cotton culture. An automated microbiology system was used to identify the growing bacteria and determine antibiotic sensitivity.
  
  
  RESULTS
  The bacterial cultures were isolated from 72 eyes of 36 patients, sixteen of whom patients (44.4%) were male and twenty (55.6%) were female. Average age was 68.4±9.0 (range 50-86). The average number of injections before taking cultures was 3.1+1.0. Forty-eight (66.7%) of 72 eyes had at least one significant organism. There was no bacterial growth in 8 (20.5%) of IVI eyes and in 16 (44.4%) of control eyes (P=0.03). Of the bacteria isolated from culture, 53.8% of coagulase negative staphylococci (CoNS) in IVI eyes and 47.2% CoNS in control eyes. This difference between IVI eyes and control eyes about bacteria isolated from culture was not statistically significant (P=0.2). Eleven of 25 bacteria (44.0%) isolated from IVI eyes and 11 (57.9%) of 19 bacteria isolated from control eyes were resistant to oxacillin. The difference in frequency of moxifloxacine resistance between two groups was not statistically significant (12.0% in IVI eyes and 21.1% in control eyes) (P=0.44). There were no cases of resistance to vancomycin, teicoplanin and linezolid.
  
  
  CONCLUSIONS
  There was no difference in species of bacteria isolated from cultures, or in the frequency of resistance to antibiotics between eyes that had recurrent IVI followed by moxifloxacin exposure compared with control eyes. However, the number of eyes that had bacterial growth was higher in IVI group than in the control group.
authors.affiliation: Department of Ophtalmology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ataş
authors.affiliation: Department of Ophtalmology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey.
authors.forename: Burhan
authors.initials: B
authors.lastname: Başkan
authors.affiliation: Department of Ophtalmology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Ozköse
authors.affiliation: Department of Microbiology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Mutlu Sarıgüzel
authors.affiliation: Department of Ophtalmology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Demircan
authors.affiliation: Department of Ophtalmology, Kayseri Education and Research Hospital, Kayseri 38010, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Pangal
keywords: endopthalmitis; intravitreal injection; moxifloxacin